Forum · dental appliances

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[-] InventiveBlueLocust8446 +0 points · over 2 years ago

Do they work

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[-] TheresaS +0 points · over 2 years ago

Thanks for posting your question, @InventiveBlueLocust8446. Perhaps someone having used a dental appliance would be kind enough to share their own experience?

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[-] SusanR +0 points · over 2 years ago

Hi @InventiveBlueLocust8446,

Oral appliances are increasingly recognized to play a role in managing sleep apnea. There will soon be a new "practice parameter" published by the American Academy of Sleep Medicine that I will share with you when out. This guide reviewed all of the available evidence. The guide noted there is still a need for more research but based on the existing data made a number of recommendations.

Here are some key points about oral appliances: Oral appliances are generally not as effective as CPAP in lowering the AHI compared to CPAP when each device is used for the same duration. However, some people tolerate oral appliances better than CPAP and wear them longer, so that the overall improvement in sleep apnea (AHI) averaged over the entire night and across nights can be similar to to CPAP when worn for a shorter time. Some studies show that oral appliances can reduce blood pressure and improve sleep apnea symptoms, sleep quality and quality of life, too. However, oral appliances are not without side effects--some people may have problems with their jaw or teeth with this treatment. Oral appliances can only be fit in people with a minimal number of teeth and who dont have problems opening their mouth.

The best oral appliances are those that are customized by a dentist and "titrated" to provide the right amount of jaw opening needed for the individual patient. Generally, oral appliances are recommended when patients do not tolerate CPAP. They are also often used to treat snoring that is not accompanied by sleep apnea. If you are interested in an oral appliance, talk to your sleep doctor and review what is best for you.

More research on oral appliances is needed so better decisions can be made on when to use them and who is likely to get the most benefits.

thanks for this question and let me know if you need more information.

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[-] RichinKansas +0 points · over 2 years ago

Hi All, Im on my second appliance. The first, an EMA worked good for me. I had some dental work done shortly after receiving it, and that led me to my second appliance, the TAP-3 Elite. Just started wearing this for one week now. Unfortunately, I do not know if this will work out for me or not. I am still waking up VERY tired in the morning, and I do not know why. I believe the TAP-3 is doing its job, and there may be something else causing my tiredness in the mornings. I have an app on my phone that I turn on prior to going to sleep and it monitors my snoring levels. So far, and it shows very little snoring, so I do not believe there are any obstructions and the TAP is doing its job.

My Bio: 5'1; 119lbs;health: good shape (could be better with more exercise! :) ); age: 52; diagnosed CPAP intolerant

I am a new forum member here and my goal is to talk with others and share ideas and stories. Feel free to contact me here with any questions.

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[-] AmusingYellowMink9421 +0 points · almost 2 years ago

What software are you using to monitor your sleep? I was going to try the Snorelab software, but would be interested in knowing what you are using.

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[-] SusanR +0 points · over 2 years ago

Hi @RichinKansas-- Did your dentist have you undergo a second sleep study to confirm that the TAP-3 is titrated appropriately to reduce your apneas?

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[-] RichinKansas +0 points · over 2 years ago

Hi @SusanR, No second sleep study yet at this time. The other morning I did not realize that I had adjust the TAP all the way to its limit, so yes, I will for sure be going back to the dentist soon.

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[-] CarlG +0 points · about 2 years ago

I have tried every treatment under the sun, and only use a manibular advancement appliance for about 2 years now. While not perfect, I would say it is 50% effective. I did have a second sleep test after fitting the appliance and it was as effective as cpap for me, but everyone is different. My biggest side effect is my bottom jaw is permanently moving forward. I am seriously considering surgery at the end of this summer if i dont find a better solution soon.

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[-] MooseGubba +0 points · about 2 years ago

Carl G, I have been using a dental appliance for probably 10 years now. My first provider was a maxillofacial surgeon who knew the device well and knew that the lower jaw would move forward but thought that was the price to pay. And my jaw did move. Now my second provider who specializes in only sleep apnea dental devices is very concerned about lower jaw movement. I have a mold called a morning positioner that I can use to move the jaw back in to position. I hardly use it because I find it easier to just rest my lower jaw on my hand while working on the computer in the morning. However, that is easy to forget. There are all kinds of exercises that you can do to correct this. Your dentist should be able to advise you.

In all this time I have never had a second sleep study to titrate my appliances. I tried to do one a couple of years ago but the setup was so uncomfortable that I could not sleep enough to get it done. Now at the five year point on my second device (Medicare only pays for one every 5 years) I will need to get a sleep study. I am hoping they will accept a home study because I cannot stand those labs, especially the last one.

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[-] Chuck +0 points · almost 2 years ago

for those folks here that have used a dental appliance, what is the issue(s) with the jaw moving forward ?? Approx how far forward is the advancement? Can you or someone else see the movement or is it that you feel your teeth mis-align. I am supposed to be fit for a dental appliance. I can not tolerate CPAP.

My large tongue base is my OSA issue. I am 62, 180 lbs and have a 16 neck. No health issues except slightly high BP. I am undergoing a series of 6 treatments on the base of my tongue. High frequency ablation of my tongue base is done outpatient in my ENT's office, under local anesthesia. It supposed to reduce the tongue base 10-15% and stiffen the tongue base tissue, which relaxes and collapses during sleep. Causes my nasty snoring at night also.

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[-] MooseGubba +0 points · almost 2 years ago

Chuck, I believe the issue with the jaw moving forward (and staying forward if you don't do the corrections) is that it screws up your bite. As I said, my first provider either did not care or did not know that the advancement could be corrected. In my case, getting the sleep apnea under control was the primary motive for getting a dental device and the heck with the jaw. The jaw advancement can be seen in the mirror in my case, it is a little like Marlon Brando in The Godfather but not as extreme. The advancement is not much, a few millimeters at time. And it has to be done gradually not all at once. Once the device is removed from the mouth most of the Marlon Brando appearance is gone, i.e. the jaw does not stick out much. I can feel the stiffness in the morning and if I do my excercises that goes away pretty quickly.

It would be interesting to find out how often and how many hours per night CPAP is commonly used. I use my dental device all night, every night. I don't think every CPAP user can say that. It would be interesting to hear some comments on that issue, I have not read the other forums so there may well be that discussion going.

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[-] UnderstandingBronzeGoose1541 +0 points · almost 2 years ago

Oral appliance therapy is best done with a dentist trained in the field. The American Board of Dental Sleep Medicine (www.ABDSM.org) oversees a rigorous examination and submission of completed cases (with sleep studies before and after) and has a list of qualified dentists in the US and Canada. While the list is quite limited at the moment, more than 100 dentist have already signed up to take the next exam. Important data to know about oral appliance therapy is that they do not always work. Unlike CPAP which can open the entire collapsible airway (4" in women and 5" in men), oral appliance are site specific. Since your physician does not know where your blockage is, there is no way to predict if oral appliance therapy will be successful; this can be a very expensive trial and error adventure. Medical insurance will often cover the cost of an oral appliance if you have been diagnosed by a physician with sleep apnea. There are many rules that are unique to each insurance company. An example is that Medicare requires that you have a sleep study that is no more than 1 year old at the time of oral appliance therapy. Seems as if dentist have to follow the rules laid down for CPAP companies. Oral appliances are more effective in patients with mild to moderate sleep apnea, who are of normal weight and who needed CPAP pressure lower than13.
Side effects are related to the fact that the oral appliances in use belong to a class of orthodontic devices developed over 100 year ago to permanently move forward small lower jaws in children. Where the children had to wear the device 24 hours / day for 5 years, patients with sleep apnea only have to use the appliance during sleep. While some patients can have permanent jaw movement (I guess this is good if you have a small lower jaw), many dentist have developed various ways that can help you maintain normal jaw position. Switching between CPAP and oral appliance use could be one way of limiting side-effects.

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