Why dentists must embrace oral appliance therapy to combat obstructive sleep apnea

Dentistry has a vital but too-often underrated function in the long-term management, diagnosis, and treatment of sleep-disordered breathing. To treat patients properly, we must escape silos that go back too far and forge a truly collaborative partnership between medicine and dentistry grounded in education, respect, and evidence-based practice. Filling this gap would not only benefit patient outcomes but also the efficiency and reach of sleep medicine itself.

Why sleep apnea care should involve dentists

One of the most common myths for health-care providers is that obstructive sleep apnea (OSA) is strictly a medical, and not a dental, disease. Doctors tend to be unaware of the fact that specially trained dentists in dental sleep medicine offer an invaluable aspect of the diagnosis and treatment of sleep-disordered breathing, especially through oral appliance therapy (OAT). It is fallacious to believe that OSA should be treated only by pulmonologists or ENTs, and it creates an incomplete and less effective system of care.

Other myths include that OAT is ineffective. There’s a broad belief that CPAP is the only treatment for the underlying problem, and OAT merely masks symptoms. Actually, modern oral appliances work by stabilizing and opening the airway, often fixing the structural components of airway blockage—not just its symptoms.

The dentist’s role in early OSA detection

Dentists are specially positioned to identify early warning signs of sleep-disordered breathing during routine visits. As patients visit their dentist more often than their physician, this presents an important opportunity for early identification.

Signs of OSA include:

• Bruxism (grinding/clenching), which is often accompanied by microarousals due to sleep-
  disordered breathing
• Mouth breathing at night is common among patients with OSA.
• Scalloped tongue, enlarged or elongated uvula, and red/inflamed soft palate, which typically present as snoring
• High Mallampati scores (III or IV) indicate a narrowed airway.
• Disorders of the TMJ, such as restricted opening and tenderness, frequently coexist with sleep-disordered breathing due to parafunctional habits and airway-
  related jaw posturing.
• Patient-reported symptoms: excessive daytime sleepiness, poor quality of sleep, morning headache, and witnessed breathing pauses

By observing these oral and facial signs, general dentists can become key players in the early detection of sleep apnea. Through the addition of airway assessments and sleep health questionnaires to checkups, dentists can transform routine visits into life-saving appointments.

Limitations of CPAP therapy

CPAP was the initial first-line treatment for OSA, but compliance-based issues and new research questioning long-term superiority have shifted the landscape. Patients using CPAP report:

• Mask discomfort and intolerance
• Dry mouth and nasal congestion
• Sleep disruption
• Psychological and emotional triggers
• Travel and lifestyle inconvenience

Real-world compliance with CPAP is around 50%,¹ with “full compliance” defined as ≥4 hours per night use on ≥70% of nights.² CPAP requires a face or nasal mask, headgear, tubing, and electricity, which in turn may also lead to skin irritation or pressure sores, along with inducing disrupted sleep due to leakage from the mask or due to the sound of the machine.

Oral appliance therapy: A comfortable, effective alternative

OAT provides an efficient, effective, and comfortable option that is well-suited for CPAP-intolerant patients or those seeking less intrusive therapy. As personalized treatment becomes more standard, OAT is becoming better known not only as an alternative but as a first-line treatment in appropriate situations.

Oral appliances have several benefits over CPAP:

• Improved comfort and tolerability
• Quiet and unobtrusive
• Ease of use and portability
• Higher adherence rates (often up to 80%)³
• Fewer side effects
• Greater psychological acceptance

Mandibular advancement devices (MADs), which are one of the common forms of OAT, protrude the jaw to maintain an open airway during sleep. Patients can use the device all night, optimizing its clinical effectiveness and therapy duration.

Beyond traditional OAT: The structural approach to treating OSA

OAT has also become more sophisticated, with the most advanced devices currently available being more customizable, comfortable, and digitally accurate. The Vivos CARE oral medical devices are the only devices that are FDA-cleared for the treatment of mild, moderate, and severe OSA in adults and pediatric patients 16 years and older.⁴ Unlike traditional appliances that simply treat symptoms, these devices can stimulate airway remodeling and craniofacial growth, and hence, offer structural, long-term solutions.

These appliances are intended for an interdisciplinary setting. They function more as orthopedic or orthodontic appliances, causing permanent alteration instead of lifelong dependency. An interdisciplinary treatment team—led by the dentist and supported by chiropractors, physical therapists, craniosacral therapists, breathing specialists, and myofunctional and reflex integration therapists—offers a holistic, integrated treatment that improves not just sleep quality but also the overall quality of life.

High levels of comfort in patients and high-compliance oral appliances are a first-line treatment, even in advanced stages.

A new era for dentistry: Leading in integrated health care

To address the health-care needs of today, dentistry needs to change from a tooth-centered and reactive model to a whole-body and proactive approach. This transformation can position dentistry at the forefront of integrated health care and enhance outcomes in a variety of systemic conditions.

Dentists must be trained to identify how periodontal disease, bruxism, airway obstruction, and malocclusion are connected to systemic conditions such as cardiovascular disease, diabetes, and sleep apnea. However, fragmented communication among medical and dental providers often results in the failure to exploit opportunities for prevention.

To bridge this gap, dental professionals should implement systems of collaborative care—including shared electronic health records (EHRs), referral protocols, and interprofessional case conference—that can expand knowledge, contribute to their profession, and enhance patient outcomes by collaborating with other health-care professionals to build multidisciplinary care teams and integrating medical screening questions, risk assessment, and systemic health indicators into routine dental exams.

Patient education is also essential. Every visit to the dentist should establish the connections among oral health, airway health, inflammation, and chronic disease. Images, videos, and simple explanations can show patients the relevance of oral health in avoiding chronic disease.

The path forward: Positioning dentistry as a frontline health discipline

Closing the gap between oral and general health means dentistry must become a frontline health profession—a field that cures, diagnoses, prevents, and comanages chronic disease alongside the rest of the medical community. This model will take dental professions to the next level, improve patient outcomes, reduce long-term health-care costs, and help build an integrated future for overall well-being. 

Editor's note: This article appeared in the January 2026 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

References

1. Kim J, Tran K, Seal K, et al. Interventions for the treatment of obstructive sleep apnea in adults: a health technology assessment. Canadian Agency for Drugs and Technologies in Health; March 2017.
2. Chaplin H, Ward K. How many hours per night is enough? A systematic integrative review to identify optimal hours of CPAP therapy use for sleep apnoea. Health Sci Rev. 2022;5(4):100061. doi:10.1016/j.hsr.2022.100061
3. Skalna M, Novak V, Buzga M, et al. Oral appliance effectiveness and patient satisfaction with obstructive sleep apnea treatment in adults. Med Sci Monit. 2019;25:516-524. doi:10.12659/MSM.911242
4. Huntsman RK. FDA awards first-ever 510(k) clearance to treat severe OSA with unique oral medical devices. Dental Economics. December 4, 2023. https://www.dentaleconomics.com/sponsored/article/14302232/fda-awards-first-ever-510k-clearance-to-treat-severe-osa-with-unique-oral-medical-devices