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Oral Appliances for Sleep Apnea


#1

[Which Oral Device is best for me?][1]

Hello all,
Here is a lovely piece put together by our friends at the American Thoracic Society which speaks directly to the patient. Bottom line your physical makeup is going to determine what type of appliance you may be a candidate for, just like it is also a factor in what CPAP mask is best for you. The key is getting to a properly trained dentist who is well versed in a number of appliances and their pros and cons as to select the one that is right for you.
Sweet Dreams,
Daryl Coleman
Great Lakes Orthodontics, Ltd.
Tonawanda, NY
[1]: http://www.thoracic.org/patients/patient-resources/resources/oral-appliances-sleep-apnea.pdf?gclid=Cj0KEQiAsNyxBRDBuKrMhsbt3vwBEiQAdRgPsgSsUuG-I3wTqQkD-HRw1i3PlIe2s9vTOBjyYLyZ-VgaAsF-8P8HAQ


#2

I am a dentist working in dental sleep medicine. Please be aware that all dental sleep apnea appliances are not equally effective. Your sleep dentist should be able to provide you with written efficacy studies to show you exactly how effective each appliance that he is proposing to treat your case has been in treating OSA. Personally, if he can not show you these studies, I would not be comfortable getting the appliance. a.b.luisi,d.m.d.


#3

Good point, Dr. Luisi. I would feel more sure of wearing something that has been researched.


#4

This doesn’t have to do with choosing an oral appliance, but some very recent research titled “The Effects of an Oral Appliance in Obstructive Sleep Apnea Patients with Prehypertension” published in the Journal of Dental Sleep Medicine.

http://www.jdsm.org/ViewArticle.aspx?pid=29984


#5

Here is an article depicting the various dental appliances:


#6

Thank you so much for sharing this awesome display of oral appliances. Certainly a great resource for us patients as we want to learn more about our choices!


#7

Indeed not all oral appliances are the same. Some function best in the realm of snoring devices but have been migrated into apnea. Some of these would be best prescribed when the patient is on the lower end of the spectrum or mild apnea and will be absolutely ineffective for treating someone on the more moderate end or for hybrid therapy. These devices may not hold a patient in the therapeutic position and over I would also advise against any fixed position device unless the patient’s therapeutic position has been determined beyond a shadow of a doubt. The well constructed custom adjustable appliances are some of the most tested and verifiable available. Again it must be said that good models and an accurate protrusive bite (captured with some measuring device like a George Gauge) makes finding that therapeutic position a lot less mysterious. So the owness falls upon the prescribing clinician to know what will work given the patients dental geography, their skill/comfort with impression taking and bite registration, and knowledge of what appliances are available. This is one instance where a patient has to do some due dilligence. Is my clinician qualified/certified in treating snoring and sleep apnea. It is ok to ask WHY a clinician thinks this is the appliance is for me. It is ok to express your concerns and observations once you have received and worn the appliance. Be in tune to you. I often will tell people to journal their experience. make good notes regarding bedtimes, if you dreamt at all, and especially the first day you have felt refreshed. I also say make note of any quirks during this time as well, did you experience any pain…was it difficult to recapture your bite in the morning, etc… Most of all it is good to walk into the office with knowledge but remember NOT every appliance is for everyone. This is not a time to pick an applaicne based on an esthetic or a perceived value. Have an open mind…you can always suggest an appliance but be ready if the structure of your mouth or arrangement of your teeth does not permit this appliance to be ideal for you. The last thing that any clinician wants to do is prescribe something that is going to be ineffective …they want positive experiences as much as you do!
Partner with your Dr…and get the most out of your experience!
Sweet Dreams
Daryl


#8

Great advice Daryl, well said.
So many patients report how confusing the various oral appliances are, just like hundreds of masks to choose from, so many different oral appliances. Thanks for reminding us that we have to do our due diligence and thanks for providing some of the questions we should be asking.


#9

I am a dentist working in dental sleep medicine. The situation with choosing oral appliances can be confusing and difficult even for very well-trained and well-meaning dentists. Most oral sleep appliance manufacturers will state that their device has been, “FDA cleared” to treat sleep apnea. This sounds impressive, but it really is not. In order to be FDA cleared, an oral appliance does NOT need to be submitted with any test data proving efficacy. All the manufacturer needs to do is to convince the FDA that the design is “substantially similar” to appliances that have been previously cleared by the FDA. If so, the FDA clears this appliance, too. It is shocking, but true that many appliances have NEVER been subjected to objective, third party, peer reviewed efficacy testing. That is why I will use only appliances that have been shown effective by legitimate efficacy testing. I feel that patients should insist on this for themselves, too. a.b.luisi,d.m.d.


#10

Dr Luisi is very correct in that many producers of appliances are out to sell their appliance, whatever it may be. Essentially we are all attempting to move the Mandible forward without compromising the joint. Much like choosing a vehicle, they all drive…but which one has the options that will benefit the patient optimally. My company has been involved for over 25 years in this segment and believe me we have seen it all, the good, the bad, and the ugly. This is why my colleagues and I, encourage every Dr to have a general knowledge of what is available from all of the companies for these same reasons. I do not recommend that these companies market directly to patients as their conditiion has not been determined by anyone medically or dentally trained so what are you treating? Most patiients THINK that snoring is the problem because that is what has been determined by their bed partners/ room mates / etc… Once the population is educated to know that this may be a symptom associated with Apnea then they are much less convinced as to the efficacy of the cookie cutter appliance. There are those who exhibit snoring in conjunction with the lowest AHI numbers who may indeed find some benefit with one of these appliances but we do not know what we do not know. For your own peace of mind!!! Please find out first WHAT you have! This can only be done by making an appointment with a trained medical/dental professional. I would even encourage patients to seek out a board certified professional med/dent as these individuals have been exposed to a variety of appliances and are aware of the benefits and can tell you whether or not you are a candidate to receive such an appliance. DO THIS WORK FIRST!!! Do not skip to the next step…if you want a good place to start look here AADSM patient resource page these dentists are accutely aware of the symptoms of Apnea some even provide screening vis a vis a unit that can be taken home to record actual sleep for the purposes of screening, referral to a board certified sleep physician, verification and diagnosis. IT IS CRUCIAL for you as a patient to be active in this role in partering with your det/med team…this is YOUR health bottom line and you must feel in the end that you have chosen a treatment method that you can perform and are comfortable with. Know your Apnea Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI), ask exactly that question. Ask what KIND of apnea you have Central (central nervous system), Obstructuive (OSA caused by tissues in contact causing a blockage), or Mixed (combination of both). Write these things down…in fact request a copy of your sleep study and go through it…ask questions. This is your journey do not merely be a passenger. The patient actively advocates is the patient that gets the results. If you want a second opinion…get a second opinion. Participating in a forum such as this is ANOTHER excellent choice let’s learn from one another! but we have got to get the word out!!! Since my diagnosis this is what I do on all levels concerning my health. In the end…they may say that you are a challenging patient, and they would be correct, but i am the one who has to live with the decision so you better believe I am a challenging patient and some of the other adjectives too LOL
Sweet Dreams,
Daryl Coleman
Great Lakes Orthodontics


#11

Doctor, learning a lot of great information from you, thanks so much for sharing with us patients!


#12

Daryl, you are right on. We patients must take more responsibility in understanding our medical conditions and learning our best treatment options. We can never ask too many questions!


#13

Since we are on the topic, I thought some readers may find this article useful regarding some tips for cleaning the oral appliances. Very important to keep the bacteria at bay!


#14

It is important to remember that various oral appliances are made of different combinations of materials. Therefore, cleaning regimens do vary from appliance to appliance and using the wrong one could potentially ruin your expensive appliance. I think that the best thing to do is to read the daily care section in the user manual that was supplied with your device. If none was provided, ask your sleep dentist, or perhaps, best of all, call the manufacturer’s customer service department for advice.a.b.luisi.d.m.d.


#15

Great information! Thank you!


#16

questionable credibility within a government agency? Can’t imagine…


#17

Hi, I’m new here and wanted an opinion on either or not to use the sonic cleaning containers with the Dental Brit ?


#18

I can’t get to the article.=(


#19

@Miki - Here is the conclusion section of the study:

CONCLUSION

The result of the present study suggests that oral appliance can reduce blood pressure and can bring a radical change in blood pressure, apnea-hypopnea index, snoring index, and sleep apnea quality of life within a short period (3 months) and has the ability to sustain this trend in the long run (1 year).


#20

Thank you for the information.