If you remember from past blogs, Obstructive Sleep Apnea (OSA) occurs when the tongue falls to the back of the throat while asleep, causing an ‘obstruction’ of the passage of air.
There is an appliance called a Tongue Retention Device (TRD) which holds the tongue forward during sleep and prevents it from falling back and obstructing the airway.
As can be seen in the accompanying photo, the tongue is held in a plastic ‘bulb’ via suction. This ‘bulb’ retains the tongue which increases the three dimensional airspace at the back of the throat.
The suction of the tongue prevents it from collapsing backwards into the airway against the pharyngeal wall. This ‘collapse’ is due to the effects of gravity and the decreased muscle tone of the tongue that occurs while one is asleep.
Indications for a TRD … For Patient’s with:
1. Mild OSA.
2. Habitual snoring.
3. Large tongues and tongues that become too relaxed during sleep and fall back.
4. Large tonsils.
5. Large uvula.
6. Hypothyroidism: If one lacks thyroid hormone, then one tends to have a larger tongue as well as an increase in fat deposits in the tissues of the upper airway.
7. Edentulous patients: The TRD does not attach to the teeth so if one has no teeth the TRD may be a suitable alternative.
8. Active Temporomandibular Joint (TMJs) symptoms: If one has pain or dysfunction of the TMJs then the TRD may work as the TRD does not move the jaw forward, only the tongue.
Side Effects of the TRD
The two main side effects are an increase in salivation and difficulty swallowing. These tend to be short lived and resolve quite quickly.
Tongue Retaining Devices vs. Mandibular Advancing Devices
Mandibular advancing devices (MADs) are more effective than TRDs. MADs are anchored more securely in the mouth by holding/gripping onto the teeth, whereas the TRDs only retain through a suction action on the tongue; therefore, MADs can be used for mild to moderate levels of OSA, compared to the TRDs which can only manage mild OSA.
I hope that you’ve enjoyed reading about sleep apnea for the past while, however at this point we shall take a break from this subject matter.
If you have any questions regarding sleep apnea, snoring, cpap therapy, mandibular advancing devices or oral appliances, please do not hesitate to contact our office…in the meantime, sleep well!
Dr. Robert Axlerad, Brampton Dentist