My Articles

Oral Appliance Therapy for Sleep-Disordered Breathing

Joachim Ngiam, Kate Sutherland, Ramesh Balasubramaniam,
Marie Marklund, Fernanda Almeida, and Peter Cistulli

Excellent overview chapter in the textbook: “Contemporary Oral Medicine (2019) – from several of the world leaders in the field. One of the authors has given permission for use in this program

Ten Misconceptions That Dentists Have About Treating Obstructive Sleep Apnea

B. Gail Demko, DMD1
JDSM Vol 5 No3 2018

“This article addresses the 10 misconceptions that many dentists have come to believe in the field of dental sleep medicine, and it uses published data to explain that many of these concepts are not supported by science. Evidence-based dental sleep medicine knowledge and protocols are necessary in order to provide optimal patient care, and dentists must understand that dental sleep medicine is an evolving field with a growing body of information that will continue to challenge previously accepted concepts”.

“Health Outcomes of Continuous Positive Airway Pressure versus Oral Appliance Treatment for Obstructive Sleep Apnea”

Peter Cistulli et al
Am J Respir Crit Care Med. 2013 Apr 15;187(8):879-87

This is a landmark article comparing CPAP and oral appliances, back to back, and establishing oral appliances as a major treatment, for even the severe forms of obstructive sleep apnoea.

Management of Side Effects of Oral Appliance Therapy for Sleep-Disordered Breathing

Rose D. Sheats, DMD1; Thomas G. Schell, DMD2; Alan O. Blanton, DDS3; Patricia M. Braga, DDS4; B. Gail Demko, DMD5; Leslie C. Dort, DDS6; Donald Farquhar, DDS7; Sheri G. Katz, DDS8; Jean-Francois Masse, DMD9; Robert R. Rogers, DMD10; Steven C. Scherr, DDS11; David B. Schwartz, DDS12; Jamison Spencer, DMD, MS13

This article is a consensus from a group of experienced clinicians on assessing and managing the various side effects encountered with oral appliance therapy.

Update on oral appliance therapy

Marie Marklund, Marc J.A. Braem and Johan Verbraecken4,
Eur Respir Rev 2019; 28

This excellent review article summarises the most recent knowledge about oral appliance therapy treatment with an emphasis on the factors which predict and contribute to successful outcomes.

Clinical practice guidelines for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015

Kannan Ramar; Leslie C. Dort; Sheri G. Katz; Christopher J. Lettieri; Christopher G. Harrod;
Sherene M. Thomas; Ronald D. Chervin
Journal of Dental Sleep Medicine 71 Vol. 2, No. 3, 2015

This seminal article outlines protocols for the best practice in dental sleep medicine. This is a joint initiative of the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine and provides a comprehensive summary of the evidence that has resulted in mandibular advancement splints becoming a key therapy for obstructive sleep apnoea.

Oral appliance treatment for obstructive sleep apnoea: an update.

Clin Sleep Med. 2014 Feb 15; 10(2): 215–227.

An excellent comprehensive review of dental sleep medicine.

Efficacy of an adjustable oral appliance and comparison with Continuous Positive Airway Pressure for the treatment of obstructive sleep apnea syndrome.

Holley, AB et al
Chest. 2011 Dec;140(6):1511-6.

A large study of 497 participants comparing the efficacy of oral appliances versus CPAP in the treatment of obstructive sleep apnoea.

Prevalence of probable obstructive sleep apnea risk and severity in a population of dental patients.

Levendowski DJ, Morgan T, Montague J, Melzer V, Berka C, Westbrook PR.
Sleep Breath. 2008 Nov;12(4):303-9.

This article looks at the prevalence of patients with sleep disordered breathing in dental practice and discusses methods of screening, diagnosing and managing the many patients identified as having problems.

Effect of a titration polysomnogram on treatment success with a mandibular repositioning appliance.

Fernanda R. Almeida, Jonathan A. Parker, James S. Hodges, Alan A. Lowe, and Kathleen A. Ferguson
J Clin Sleep Med. 2009 Jun 15; 5(3): 198–204.

This is a landmark study that shows how to improve the results of an oral appliance during a sleep study.

The incidence and prevalence of temporomandibular disorders and posterior open bite in patients receiving mandibular advancement device therapy for obstructive sleep apnea.

Perez CV, de Leeuw R, Okeson JP, Carlson CR, Li HF, Bush HM, Falace DA.
Sleep Breath. 2013 Mar;17(1):323-32.

This article, from some of the leading researchers and clinicians in the field, discusses the development of temporomandibular symptoms and posterior open bite in patients treated with a mandibular advancement splint.

Objective measurement of compliance during oral appliance therapy for sleep-disordered breathing.

Dieltjens M, Braem MJ, Vroegop AV, Wouters K, Verbraecken JA, De Backer WA, Van de Heyning PH, Vanderveken OM. Chest. 2013 Nov;144(5):1495-502

This article outlines the use of sensors within oral appliances in order to measure compliance. The use of sensors now put oral appliances on a par with CPAP in being able to objectively measure usage and compliance. Objective measurement of usage, rather than just relying on self reports is important when regulatory bodies need evidence of compliance, as well as for increasing the validity of scientific studies.

Referral Patterns and Positive Airway Pressure Adherence upon Diagnosis of Obstructive Sleep Apnea

Jonathon O. Russell, MD1 , Jordan Gales1 , Charles Bae, MD1 , and Alan Kominsky, MD1 2015, Vol. 153(5) 881–887\
Otolaryngology– Head and Neck Surgery.

Large study indicating the poor compliance with CPAP use.

Determinants of Objective Compliance During Oral Appliance Therapy in Patients With Sleep-Disordered Breathing A Prospective Clinical Trial

Marijke Dieltjens, MBS, PhD; Annelies E. Verbruggen, MD; Marc J. Braem, DDS, PhD; Kristien Wouters, PhD; Johan A. Verbraecken, MD, PhD; Wilfried A. De Backer, MD, PhD; Evert Hamans, MD, PhD; Paul H. Van de Heyning, MD, PhD; Olivier M. Vanderveken, MD, PhD

JAMA Otolaryngology–Head & Neck Surgery October 2015 Volume 141, Number 10.

Study outlining the main factors that lead to non compliance with a MAS.

Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis

Macario Camacho, MD1 ; Victor Certal, MD2 ; Jose Abdullatif, MD3 ; Soroush Zaghi, MD4 ; Chad M. Ruoff, MD, RPSGT1 ; Robson Capasso, MD5 ; Clete A. Kushida, MD, PhD1

This article is a meta analysis of published studies looking at the effectiveness of Myotherapy in children and adults.

Oral Appliances for the Management of OSA – An Updated Review of the Literature

Hamoda, M Almeida, F Kohzuka Chest June 2017 .06.005

An excellent overview of all the latest evidence based understanding on all aspects of oral appliances for sleep apnoea and snoring. Includes comprehensive references.

Self-Reported Sleep Quality With Mandibular Advancement Device or Continuous Positive Airway Pressure: A Randomized Clinical Trial on Patients With Mild and Moderate Obstructive Sleep Apnea

Lars Martin Berg, DDS1; Torun Karina S. Ankjell, MD2; Tordis Agnete Trovik, DDS, MPH, PhD3; Anders Sjögren, DDS, PhD1; Oddveig G. Rikardsen, MD, PhD2; Ketil Moen, DDS, PhD4; Yi-Qian Sun, PhD5; Vegard Bugten, MD, PhD6

JDSM Vol. 7, No. 2 2020

This article compares CPAP with Oral appliances in a group of patients with mild to moderate OSA

Cardiovascular Benefits of Oral Appliance Therapy in Obstructive Sleep Apnea: A Systematic Review

Gilles Van Haesendonck, BSc1; Marijke Dieltjens, MBS1,2; Chloé Kastoer, MD3; Bharati Shivalkar, MD, PhD1,4; Christiaan Vrints, MD, PhD1,4; Caroline M. Van De Heyning, MD, PhD1,4; Marc J. Braem, DDS, PhD1,2; Olivier M. Vanderveken, MD, PhD1,3
JDSM Vol. 2, No. 1, 2015

A systematic review of the current evidence regarding the cardiovascular benefits of oral appliance (OA) therapy in obstructive sleep apnea (OSA) patients.

Combination Therapy for Obstructive Sleep Apnea in Order to Achieve Complete Disease Alleviation: from Taboo to New Standard of Care?

Olivier M. Vanderveken, MD, PhD1,2
JDSM Vol. 2, No. 1, 2015

The Dentist-Physician Partnership

Kelly A. Carden, MD, MBA
JDSM Vol. 2, No. 1, 2015

A systematic review of the current evidence regarding the cardiovascular benefits of oral appliance (OA) therapy in obstructive sleep apnea (OSA) patients.

Comparative Effectiveness of the Different Treatment Modalities for Snoring

Stefanie Terryn, MD1,2, Joris De Medts, MD1,2, and
Kathelijne Delsupehe, MD1
Otolaryngology– Head and Neck Surgery
1–8 2015

Objective. To evaluate what effects treatments of sleep disordered breathing have on snoring and sleepiness: snoring surgery including osteotomies, mandibular advancement device (MAD), and continuous positive airway pressure (CPAP).

Long Term Patient Centered Outcomes Following Treatment with Oral Appliance Therapy for Obstructive Sleep Apnea

Carolyn Cronin, DMD, MS1; Greg Essick, DDS, PhD2; Hunter Boone, BA3; Ceib Phillips, PhD, MPH1 JDSM V6 No 3 2019

Study Objectives: This study assessed the long-term general and condition-specific quality of life (QOL) and perceived occlusal and functional changes of individuals with obstructive sleep apnea (OSA) who had oral appliance therapy (OAT) delivery 2 years ago or longer.

The Evolution of Oral Appliance Therapy for Snoring and Sleep Apnea
Where Did We Come From, Where Are We, and Where Are We Going?

B. Gail Demko, DMD
Sleep Med Clin 13 (2018) 467–487

This article explains the innovations of the previous 200 years and how they laid the groundwork for OAT today. The expansion of this treatment over the past 40 years has been explosive and evidence based.

History of Dental Sleep Medicine

Robert R. Rogers, DMD, DABDSM1; John Remmers, MD2; Alan A. Lowe, DMD, PhD, ABDSM3; Peter A. Cistulli, MD, PhD4;
Jeff Prinsell, DMD, MD, DABDSM5; Donald Pantino, DDS, ABDSM6
JDSM Vol1 No1 2014

This article highlights the development of Dental Sleep Medicine over the past 25
years which has led to the American Academy of Sleep Medicine for the first time, publishing guidelines for the evaluation, management, and long-term care of obstructive sleep apnea in adults that cites OAT as an effective option for the management of sleep disordered breathing

The Link between Sleep Bruxism, Sleep Disordered Breathing
and Temporomandibular Disorders: An Evidence-based Review

Ramesh Balasubramaniam, BDSc, MS; Gary D. Klasser, DMD; Peter A. Cistulli, MD, PhD; Gilles J. Lavigne, DDS, PhD
JDSM Vol1 No1 2014

This review examines the relationship(s) between sleep bruxism, sleep disordered breathing, and TMD with the aim of defining whether these clinical disorders are concomitant, and the nature and direction of any causal relationships, with the ultimate goal of providing advice to clinicians about what to do when they identify this clinical cluster in a given patient.

Utilization of a Mandibular Advancement Device for Obstructive
Sleep Apnea in the Veteran Population

Aaron J. Feinstein, MD, MHS1,2; Michael Zaki, BA1,2; Soroush Zaghi, MD1,2; Tracey Tajima, DDS3; Marilene B. Wang, MD1,2
JDSM Vol 4 No2 2017

This study looked at factors that explain the adherence rate of custom-fit MADs within the military veteran population with OSA.

Mandibular Advancement Device as a Comparable Treatment to Nasal
Continuous Positive Airway Pressure for Positional Obstructive
Sleep Apnea

Yoshikazu Takaesu, PhD1; Satoru Tsuiki, PhD2,4,5; Mina Kobayashi, PhD2,4; Yoko Komada, PhD2,3,4; Hideaki Nakayama, PhD6; Yuichi Inoue, PhD

Journal of Clinical Sleep Medicine, Vol. 12, No. 8, 2016

Study Objectives: Positional obstructive sleep apnea (P-OSA) is a clinically common phenotype of OSA, which can be treated effectively with mandibular advancement devices (MADs). We hypothesized that the efficacy of an MAD is comparable to that of nasal continuous positive airway pressure (nCPAP) in P-OSA patients.

Maxillomandibular Advancement for Treatment
of Obstructive Sleep Apnea
A Meta-analysis

Soroush Zaghi, MD; Jon-Erik C. Holty, MD, MS; Victor Certal, MD; Jose Abdullatif, MD; Christian Guilleminault, DM, MD, DBiol;
Nelson B. Powell, MD, DDS; RobertW. Riley, MD, MS, DDS; Macario Camacho, MD
JAMA Otolaryngology–Head & Neck Surgery Published online November 25, 2015

Maxillomandibular advancement (MMA) is an invasive yet effective surgical option for obstructive sleep apnea (OSA) that achieves enlargement of the upper airway by physically expanding the facial skeletal framework.
The objective of this study is to identify criteria associated with surgical outcomes of MMA using aggregated
individual patient data from multiple studies

Influence of Nasal Resistance on Oral Appliance Treatment Outcome in Obstructive Sleep Apnea

Biao Zeng, MD, PhD1,2; Andrew T. Ng, MBBS2; Jin Qian, MBiomedEng2; Peter Petocz, PhD3; M. Ali Darendeliler, PhD4; Peter A. Cistulli, MBBS, PhD1,2,5
SLEEP, Vol. 31, No. 4, 2008

This study looked at the hypothesis that nasal resistance differs between MAS responders and nonresponders and therefore may influence treatment outcome.

Non-CPAP therapies in obstructive sleep

W.J. Randerath*, J. Verbraecken*, S. Andreas, G. Bettega, A. Boudewyns, et al

This report summarises the efficacy of alternative treatment options in OSAS.
An interdisciplinary European Respiratory Society task force evaluated the scientific literature
according to the standards of evidence-based medicine.

Orofacial Pain and Sleep

Barry J. Sessle, Kazunori Adachi, Dongyuan Yao, Yoshitaka Suzuki, and Gilles J. Lavigne
Contemporary Oral Medicine 2018

This textbook chapter provides an overview of orofacial pain and its underlying mechanisms, as well as sleep and the mechanisms that underlie sleep. It particularly focuses on the clinical features and the processes involved in the interactions between pain and sleep.

Sleep Bruxism

Ramesh Balasubramaniam, Daniel Paesani, Kiyoshi Koyano,
Yoshihiro Tsukiyama, Maria Clotilde Carra, and Gilles Lavigne
Contemporary Oral Medicine, 2018

Excellent review chapter on all evidence based aspects on the diagnosis and management of bruxism from the leading experts and researchers in the world

Prevalence of probable obstructive sleep apnea risk and severity in a population of dental patients

Daniel J. Levendowski & Todd Morgan & Jon Montague & Victoria Melzer & Chris Berka & Philip R. Westbrook
Sleep Breath (2008) 12:303–309

The aim of this study is to assess the prevalence of probable obstructive sleep apnea/ sleep disordered breathing and symptoms associated with this condition in a population of dental patients using a validated questionnaire and software that could be administered in a dental office.

Comparison of Positional Therapy to CPAP in Patients with Positional Obstructive Sleep Apnea

Irene Permut, M.D.1; Montserrat Diaz-Abad, M.D.2; Wissam Chatila, M.D., FAASM1; Joseph Crocetti, D.O., FAASM3; John P. Gaughan, Ph.D.1; Gilbert E. D’Alonzo, D.O.1; Samuel L. Krachman, D.O., FAASM1
Journal of Clinical Sleep Medicine, Vol.6, No. 3, 2010

The conclusion of this study is that positional therapy is equivalent to CPAP at normalizing the AHI in patients with positional OSA, with similar effects on sleep quality and nocturnal oxygenation.

Upper-airway collapsibility and loop gain predict the response to oral appliance therapy in obstructive sleep apnea patients

Bradley A. Edwards1,2,3*, Ph.D., Christopher Andara2 , BSc, Shane Landry2, Ph.D., Scott A.
American Journal of Respiratory and Critical Care Medicine · May 2016

The objectives of this study were to determine 1) how oral appliances alters AHI and four phenotypic traits (upper-airway anatomy/collapsibility and muscle function, loop gain, arousal threshold) and 2) baseline predictors of which patients gain the greatest benefit from therapy.

A randomized prospective long-term study of two oral
appliances for sleep apnoea treatment

J. Sleep Res. (2009) 18, 321–328

This study compared the long-term effect of two different appliances in the treatment of OSA. A total of 103 patients with OSA were randomized and treated with an IST Herbst or Thornton Anterior Positioner (TAP ) appliance.

Temporomandibular disorder Pain and Dental Treatment of OSA

Dr Robert Merrill
Dent Clin n America 56(2012) 415-431

This article discusses the different types of TMD/orofacial pain problems that may occur during treatment of OSA with a mandibular advancement splint.

Trial Appliances: Are We There Yet?

Marie Marklund, Marc J.A. Braem and Johan Verbraecken4,
Eur Respir Rev 2019; 28

This excellent review article summarises the most recent knowledge about oral appliance therapy treatment with an emphasis on the factors which predict and contribute to successful outcomes.