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Will Oral Appliance Therapy work for me?


#1

Here is a list of common questions asked by sleep apnea patients who are considering OAT (oral appliance therapy)

I hope a sleep dentist will jump in and answer questions! OAT users, chime in as well!

Thanks in advance

Is there a list of things that might automatically rule out OAT as a treatment option for my sleep apnea?

I wear dentures, take em out at night, can I still use OAT?

I wear dentures and only take them out to clean, so I sleep with them, can I still use OAT?

I am a mouth breather, can I still use OAT?

I have TMJ can I still use OAT, if so will it make TMJ worse?

I have mixed apnea (obstructive and central) can I still use OAT?

I am elderly and have many bridges and crowns can I still use OAT?

I have gum disease and my teeth are not stable can I still use OAT?

Will OAT stain my teeth?

Will OAT shift or move my teeth?

How often will I have to replace an oral appliance?

Is there any pain or discomfort to using OAT?

Should I expect an office visit charge by a sleep dentist for an evaluation? It has been recommended to talk to more than one sleep dentist for evaluation but not sure I can afford it.

What is required to find out if OAT is covered by my health insurance, don’t tell me to call my ins provider, they say they will approve or deny a claim, in other words, they won’t commit one way or another

My insurance company told me OAT is not covered because it is considered “experimental” What does that mean?

If I have apnea, a pre-existing condition, is OAT automatically covered if I choose not to use CPAP, which is covered?


#2

I am a dentist working in dental sleep medicine. This is a truly daunting list of questions, but I think that I am up to it. You be the judge. 1. There is indeed a list of things that will automatically rule out OAT. But I would have to take a whole separate post for this one. 2. At this time, oral appliances can not be made for people who are edentulous(have no teeth). 3.Some oral appliances can be made for people with full upper dentures worn at night opposing natural lower teeth. No oral appliances can be made for people with full upper and lower dentures worn at night unless they are secured by dental implants. 4. There are many oral appliances than can be used by most, but not all, mouth breathers. 5. Some people with certain TMJ symptoms can use OAT, some can not. It is a tough call that needs to be made by a highly skilled sleep dentist — and sometimes we are still wrong. 6. Use with mixed apnea is tricky and hard to judge. Can be beneficial in some cases— total answer too complex for this post. 7. Elderly people with good bone support and many crowns and bridges in good repair can use OAT. 8. OAT with active gum disease is contraindicated. OAT with treated, controlled gum disease is O.K. if there is adequate bone support. 9. OAT will generally not stain the teeth. However, I have seen a few isolated cases of staining. 10. OAT can and does cause MINOR tooth movement. Can usually be minimized with good oral appliance and good management. 11. High quality appliances that are well maintained will typically last 3-5 years for a patient who is not a severe nocturnal tooth grinder.12. There is often minor initial discomfort with OAT, but it can usually be managed and goes away with time. 13. Some dentists charge an initial consultation fee. Some do not. Shop around. 14,15, 16 Insurance coverage for OAT has always been spotty and tricky, but is improving. My advice to patients is that if having to pay for OAT themselves would be devastating financially, I wouldn’t take the chance of depending on insurance coverage. a.b.luisi d.m.d…


#3

Dr. Luisi;
Can’t thank you enough for your time in answering the questions!

While these specific questions are fairly common, they represent inquiries received in just the past few weeks. This tells me there is great interest in oral appliance therapy and patients want to learn more.

I know your educational post will be helpful to many.
YOU ROCK!


#4

Sharing this article

Sleep Disorder Therapy Taking New Direction, Driven By Medical Reimbursement Rates

For more than 30 years, the CPAP machine has been the Gold Standard
for treating obstructive sleep apnea (OSA). However, the reimbursement
rate for durable medical equipment (DME), such as CPAP, has declined
throughout the years making it difficult to find local suppliers.
The Centers for Medicare and Medicaid Services (CMS) has altered
their billing practices to the extent that many care providers have
consolidated. Patients and medical professionals who treat OSA are
forced to use Internet suppliers as their only option. These factors
combined have greatly reduced the compliance of CPAP use as well as the
reimbursement rates. As of January 1, 2016, CMS reduced reimbursement
rates for CPAP by 25%, which will directly affect the quality of care
for OSA patients.

On the flip side, oral appliance therapy (OAT) was not a focus for CMS
and, therefore, has been an underfunded therapy for patients. For
Medicare patients, access to OAT may be difficult. Due to the lack of
reimbursement, dentists have struggled to provide OAT for patients.
However, for some states in the U.S., CMS has increased its
reimbursement rate for OAT as of January 2016. The CMS slowly
understands that OAT has higher compliance rate for patients, and it
provides a better rate of return on sleep therapy dollars.

Read more https://www.aapmd.org/aapmd-blog/sleep-disorder-therapy-taking-new-direction-driven-medical-reimbursement-rates?utm_source=March+7th+Inspire&utm_campaign=inspire&utm_medium=email


#5

I have had a mouth appliance for a few years, and it does not work for me. First of all, I have a hard time falling asleep with it in my mouth. I can life it out with my tongue even though it’s been adjusted about a dozen times. I take it out in my sleep a lot. Also, I have a chronic cough and often wake up coughing, and at that point I have to take it out. So the coughing and the taking it out in my sleep are probably the things that prevent it from working. Any suggestions?


#6

Patty, I am a dentist working in dental sleep medicine. There is no question that the chronic cough would make an oral appliance impossible to use. It would seem to me that you need to get medical attention to pin-point the cause of the cough. Some types of physicians might be a pulmonologist, an ENT doctor, your family physician, or an allergist if you have allergies. If you can get the cough under control, and that would not be a certainty, you could, perhaps, investigate getting an appliance with better comfort. There are a number of different appliance designs and an experienced dental sleep medicine dentist should be able to tell which one would be optimal for you. a.b.luisi,d.m.d.


#7

I’m new here and not at all sure of the protocols but have you managed to get your chronic cough under control? Mine was simply a change in my blood pressure medication.