Forum · Problems your having with dental appliances

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[-] DrTonySoileau +0 points · 9 months ago

NiceSilverBison1316 I would suggest wait and let your dentists make the adjustments after you discuss your jaw soreness. Dental appliances work by bringing the jaw forward and holding it in a position where your tongue does not fall back into your throat. And the key to success is to get the muscles of the head and neck to allow the appliance to take you to that position. Its not that for out usually. Most of my patients are brought forward to about there you would bite though a sandwich. The appliance is not causing the sore and cramped muscles. The sleep apnea is. But in order to treat the sleep apnea you need the muscles to relax. I would do the following.

  1. Consult with your dentist about appliance design and advancement. Possibly consider a different appliance. Not all CPAP mask work for each patient. Not all dental appliances work for each patient.

  2. Have a new sleep study after 3-4 months of wearing the appliance to see if it have your AHI number where you want them. If not continue advancement and get a another study.

  3. Consider therapy for your muscles. Massage, chiropractor, physical therapy, etc. Sleep apnea causes several additional health problems. Heart issues, blood pressure issues, diabetes, weight gain, etc. All these additional issues are treated. Muscles spasms and TMJ dysfunction are also a very common problem with sleep apnea. But the medical community does not treat TMJ so it is often ignored in sleep apnea patients.

Hope this helps. Feel free to reach out to me if I can answer any more of your questions.

Dr Tony

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[-] NiceSilverBison1316 +0 points · 7 months ago

Dr. Tony,

I have been wearing my TAP 3 Elite dental appliance for a few months now. It seems to be working well, but I experience dry mouth a lot. I have tried using biotene oral rinse and mouth spray, but after a couple of hours my throat is dry again. I am also using a humidifier to moisten the air in my bedroom, but haven't noticed any improvement. Do you know what could be causing the dry mouth and do you have any suggestions? Thanks for your help.

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[-] DrTonySoileau +0 points · 7 months ago

Dry mouth is caused by breathing in and out through your mouth instead of breathing in through your nose and out your mouth. Or many medications cause a reduction in saliva. Your dentist will have his favorite saliva substitute to offer you and there are many on the market. But this is simply covering up the problem and not solving it. You may want to check all your meds to see if any cause dry mouth. Its also high pollen season. So if your taking antihistamines that will be adding to the problem. Besides getting a saliva substitute from your dentist or over the counter and checking your meds you could also contact your ENT. There may be some otions he can offer you so you can breath in through your nose. This will also help a lot!

Dr Tony

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[-] SleepDent +0 points · 6 months ago

I am a dentist working in dental sleep medicine. Dry mouth associated with an oral appliance is most often caused by mouth breathing. If you take medications, they could also be contributing to the condition and you need to be aware of that. Airway Management now offers an intraoral mouth shield for use with the TAP appliances. This soft, comfortable shield sits just inside the mouth and literally seals it off. It stops the mouth breathing and the dry mouth. The shield was originally designed for the MyTap appliance, but can be retrofitted to the TAP3 Elite with a metal post designed for the TAP-PAP CS device. Better, dedicated mouth seals are currently being engineered by the company and will be available soon. a.b.luisi,d.m.d.

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[-] SleepDent +0 points · 6 months ago

I am a dentist working in dental sleep medicine. If you have generally liked the features of the TAP, but feel that the tongue is somewhat cramped and restricted, be aware that there is a new version called the DreamTap that has a modified design which increases tongue room dramatically. Maybe you could work something out with your dentist to trade up to that. a.b.luisi,d.m.d.

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[-] PhilosophicalIvoryRaccoon2708 +0 points · 8 months ago

Hello Dr. Tony,

I have a few questions maybe you can assist me with. I have had a very difficult time finding a qualified dentist in my area trained in sleep medicine. I am from Arkansas. I have had a couple of appliances made over the years and I was wondering if you had an answer for this. How can an appliance have better results in an end to end position rather than 3,4,5 or even 6mm advancement out? It would seem that further advancement would always mean further area behind the tongue? How can you have a worse AHI with further advancement than you did without an appliance in at all?? I have had an in home sleep study and I had a higher score with advancement than end to end. Also, have you seen over time an appliance works better than when you first start using it. Lets say you get an appliance and you don't change the position on it for 3 months, have you seen in your practice people getting better results after months of treatment rather than at the initial start of it? If so, why is that? Thank you Dr. for your time.

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[-] DrTonySoileau +0 points · 8 months ago

You have asked several great questions. So please be patients as the answers will be separate to read.

What part of Arkansas do you live? I can see if I know of a great sleep dentist close by.

How can an appliance have better results in an end to end position rather than 3,4,5 or even 6mm advancement out? It would seem that further advancement would always mean further area behind the tongue? The more is better rule does not always apply. The appliance simply brings the lower jaw forward until the base of the tongue is no longer blocking the throat at all. Fo some patients this is an edge to edge and for some the jaw must be brought out quite a bit more. Don't get hung up on the numbers as everyone is different. Once the tongue is out of the throat bringing the appliance further forward is not accomplishing anything and may start to cause the muscles around the throat to stretch too far and change the shape of the opening of the throat.

How can you have a worse AHI with further advancement than you did without an appliance in at all?? I have had an in home sleep study and I had a higher score with advancement than end to end. Two thoughts here. First you could be stretching the muscles too far and narrowing the opening of the throat. Usually you begin to have teeth and muscle soreness before you get this far out. But I have had some cases referred to me without pain that were not getting better. Lower jaw was wayyyyyyyy out there each time. I brought the jaw back according to where her muscles were not overly stretched and the AHI dropped. Or the higher AHI could have nothing to do with jaw position and could be a lowering of AI but a significant raising of HI. You always have to look at these number separately and not focus just on single AHI. Every spring I have patients that were doing fine all winter, No snoring. Sleeping great. AHI below 5. Then I get a call and they are snoring again. We do a new sleep study. Their total APNEA INDEX went from 4 to 1. Its actually better. But their HYPOPNEA INDEX went from 10 to 40. SO their AHI is worse but their APNEA count is better. Their appliance still has their tongue forward enough. But their nose is clogged. Springtime allergies. So I suggest you look at the AI and HI index, and the total A and H count. Then also look at the snoring count. Also positional. You may have slept on your back more for one test. The total time on your back is also a factor. So yeah I see this quite a lot. But its not always worse. And its not always the throat. You have to take all factors into consideration and often multiple doctors to get everything back on track.

Lets say you get an appliance and you don't change the position on it for 3 months, have you seen in your practice people getting better results after months of treatment rather than at the initial start of it? If so, why is that? See this a a lot as well. Has to do with the inflammation and clenching of the teeth caused by sleep apnea. Well actually the cortisol release caused by sleep apnea. Once the apnea is under control the inflammation in the body decreases. We take photos of all our patients throats when we start treatment. Always red and angry looking. About 3 months later the tissue has shrunk and looks normal. But this just opens the throat a little. Some. But not much. The bigger issue is the muscles are relaxing as the apnea gets better. So the tongue can advance further. This is why we have an in house massage therapist that works on every patient. We get results in 2-4 weeks as opposed to 3 months.

So sorry for long answer. But you asked some great questions that deserved to be answered.

Dr Tony

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[-] ReservedWhiteKangaroo6396 +0 points · 8 months ago

Hey everyone!

I'm new here and was just diagnosed with moderate sleep apnea so I'm trying out a new dental appliance (mouthguard). Just tried it for 3 nights so far and it's been hard getting used to it.

First, the guard would cause me pain when I'm using it and laying right on it. I sleep on my stomach. Sleeping on my back seems impossible. I finally figured it out and tried to lay my head, just my head, on something so there's no pressure on the side of my face where the guard is. So that's gotten a bit better.

Since the first night, I've been "drooling" with it in but I've been reading that's normal and should go away at some time but how do I deal with it while it's happening?

I'm concerned the tip of my tongue is going to touch the gap in the front of the appliance while I'm asleep so I won't be able to breathe through my mouth and I might wake up from that. I'm not sure the name of the appliance but it's the kind where's there's metal pieces on the sides so the bottom jaw will move forward. I guess you could call them hinges. See below for a picture of what it looks like. It's not mine! lol

Now my biggest issue that started last night. Whenever I relax my face, my top and bottom teeth on the left with the device in clenches together and it hurts! That appliance I got is hard as a rock and pretty big, I'm sure you know that. So I don't know how people can put their teeth together at the sides without their teeth hurting as you bite onto the appliance. I wish they had made the appliance into something soft and not something so big. Does it have to be so hard and big? I have another mouth guard to stop grinding my teeth at night and while it's as hard, it's not as big. It just looks like a little plate and it's just for the upper teeth and I never had trouble with that but it won't bring my jaw forward, of course, so I can't use that instead.

So glad we have a dentist on this board and I hope I get some helpful answers soon! I'd hate to think about getting a CPAP. It doesn't sound more pleasant at all than this dental appliance.

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[-] DrTonySoileau +0 points · 8 months ago

Well I guess your referring to me so I will offer what advice I have.

First this is a Herbst style appliance. It is not my first choice for appliances. Didn't say it didn't work. just not my first choice for some of the reasons you listed. The Micro2 and the Narval are my two favorites. www.micro2sleepdevice.com/ www.resmed.com/us/en/consumer/products/dental/narval.htm

The advancement arm can be uncomfortable in some positions. Which is why I don't like this appliance. Its bulky like you say. And the screws tend to come loose.

You may make excess saliva but you should not drool on your pillow. The arms can sometimes rub against your paratoid glands on your cheeks. These glands make a lot of saliva and if your stimulating them you will make too much. But your lips should be closed when your in REM sleep. You may be opened too wide. Your dentist can grind down the thickness of the appliance to close your lips together but its often easier to make a new appliance.

Your tongue should fit into your palate at night. If the appliance is too bulky you may not have enough room for your tongue. The Narval is the thinnest appliance on the market and the Micro@ does not cover the tongue side of your teeth. This gives extra room for the tongue to move forward.

If you clench and grind your teeth, which it sounds like you do since you have a bite splint, this may not be the best appliance for you. This is not to say it can't be adjust so it fits perfectly. It has to be hard to support the metal arms and somewhat bulky. But not to the point where it hurts to wear it. That defeats the purpose. Have your dentist reduce its bulk and back up the arms so your not so forward. Wear it a few days and see if the pain goes away.

Sorry I don't have simple solutions. And yes this appliance can work for you. Sounds like it just needs some adjusting.

Dr Tony

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[-] ReservedWhiteKangaroo6396 +0 points · 8 months ago

Hi Dr Tony,

Yes, I'm sorry, I was hoping you'd answer so I'm glad you did.

Unfortunately, they never asked me what kind of appliance I wanted because I know nothing about those kind of things. That's just what they gave me. That's good that they can possibly adjust the appliance because I hate to go through all the trouble to get another kind. I'm supposed to go back in a month for a follow up after I get used to this appliance. They did give me some "keys" or something so I can do something with the screws but I'm afraid to do it myself because I might mess up and make it worse or the appliance might fall apart if I do something wrong! I have no idea how to adjust the appliance myself. I don't have pain while it's not in my mouth but if I'm laying in bed with it i then it does get sore on the side and you're right, I am a teeth grinder. That's why I have another mouth guard I've had for years from my regular dentist to stop the grinding. I just haven't been using it because the jaw pain stopped so I figured grinding wasn't a problem anymore. So I guess I started grinding again but didn't know it. I wish I could just use the mouth guard again that I used just for the grinding because that's smaller and causes me no discomfort but I know it doesn't help with the sleep apnea. :(

Thanks!

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[-] DrTonySoileau +0 points · 8 months ago

There are 5-6 appliances on the market that are uniquely different and probably a 100 designs to choose from. Sometimes insurance and particularly Medicare dictates which appliances dentists offer. I certainly don't offer my patient a 100 choices. I usually show them 3-4 different types based on the size of their mouth, condition of their teeth, if they sleep with their mouth open, how much they clench and grind, etc.

We adjust our patients appliances for them. Yes it means several appointments but it allows me to talk directly to our patients so I can monitor how they are sleeping. And how much advancement in the appliance so I can also manage their TMJ and muscle issues. I strongly suggest you go see your dentist and let his office adjust it for you. At least the first couple of times.

Don't get discouraged. Some of my patients take a little more effort to get to a great night sleep too! TMJ is almost always caused by sleep apnea. Not 100% of the time. But the vast majority. Once your sleep apnea is under control your TMJ problems should also start to get better.

Fell free to ask me any other questions you may have. And keep us posted on how your doing. Your not the only one out there in this same situation. So your questions and comments also help a lot of other patients.

Dr Tony

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[-] SleepDent +0 points · 6 months ago

Also, remember that there are 100 different appliances with 100 different levels of effectiveness. Be sure to ask your sleep dentist if he can provide you written efficacy studies for each type he is recommending, so that you don't spend your money on an ineffective "dud". The Herbst-style appliance is not one of my favorites either but it does test out relatively well in terms of effectiveness if you can get used to it. a.b.luisi,d.m.d.

[+] [deleted] +1 point · 8 months ago
[+] [deleted] +0 points · 8 months ago
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[-] AdventurousPinkDolphin1486 -1 point · 8 months ago

Hello Dr. Tony,

I have been using the Somnodent device for over a year. It originally helped my OSA but never stopped my snoring. I have adjusted it a few times when I started to feel fatigued during the day, but have not had another home study done. I am currently not feeling rested at all and considering a cpap, which I dread. Was the device supposed to stop snoring and since it didn't, does that mean it isn't working? I had a dentist in Baton Rouge and am now living in Colorado. Can you recommend someone in the Dever area?

Thanks, Tracy

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[-] DrTonySoileau +0 points · 8 months ago

Your snoring may be due to inflammation of your soft palate as well as the base of your tongue falling into your throat. If you have chronic sinus issues that can affect the soft palate. The appliance wont fix that. I tell all my patients that I will get their tonque out of their throat and if that solves all their problems then great. If they still have some snoring issues then they see my medical director who is an ENT and sleep specialist. In the spring time almost all my patients get an evaluation form both of us because of seasonal allergies. Start with a home sleep study to see if the apnea is under control and also look closely at the hypopnea score.

In Denver Dr Gary Radz is a fantastic cosmetic and sleep dentist. I know him very well and he will take great care of you. His website is http://www.downtowndenverdentist.com/ This may be his cosmetic site and not his sleep apnea treatment site. But they are the same contact number so no worries.

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[-] ReservedWhiteKangaroo6396 +0 points · 8 months ago

Well I've been trying this mouthguard for nearly a week now. I know it should take at least a couple of weeks to get used to it but it's still hard. When I lay there to try and sleep, nothing feels uncomfortable or hurts for a while until after about an hour and a half or so. How come it takes that long for my teeth on the front left side to get sore and not right away? Does this mean anything? I'm also still having a hard time falling asleep with it in. Any suggestions to falling asleep while you have it in and any ideas why it takes a while before it finally hurts? When I take it out, no problem. The soreness goes away after a few minutes.

Also, I already have an appointment for a follow up about a month from now but at what point should I call them before giving up to tell them about this problem?

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[-] DrTonySoileau +0 points · 8 months ago

Call them now. The inside of the appliance needs to be opened up a little bit and probably on the deep inside part where the edges of your teeth fit. Teeth can take some pressure before they start to hurt. Every time you bite down you are compressing the teeth into the bone and pushing them out. Its the normal part of chewing. The ligaments give and stretch. But if you keep them stretched long enough they say OUCH! If you have a pain response, even a very small one, that causes the release of the stress hormone cortisol. This hormone also wakes you up in the morning. So the pain in your teeth plus the anxiety of the appliance not fitting is causing a stress event that is releasing cortisol and thats why you can't sleep. Not much to do but bring it in and let them grind it out a little bit. This is common with the type of appliance you have. Its made of the same acrylic they make dentures with. Think about how many times dentures need to be adjusted when you first get them. The material shrinks as it hardens. So the lab tech has to allow for that shrinkage or the appliance is too tight in spots. This is not easy to do. So expect to adjust the inside a few times until it fits perfect. Easy to adjust. Just give your dentist a call and show him which teeth hurt.

Dr Tony

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[-] AdventurousPinkDolphin1486 +0 points · 8 months ago

Thank you so much!! I'm going to call and make an appointment tomorrow!

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[-] ReservedWhiteKangaroo6396 +0 points · 8 months ago

Ok, so I got the device adjusted on Friday and since then, no pain or discomfort or soreness at all. So that's good. Now I'm having some difficulty falling asleep in less than 2 hours with it in but I guess that's because I just need to get used to having it in my mouth even though there's no soreness or pain or anything. The thing is I'm still waking up after about an hour or so! Since I'm still trying to get used to the device, I'm just hoping I'm waking up because of the device and just trying to get used to it. I really hope it isn't because the device isn't helping. Although before I got the device and when I was waking up because of the apnea, I would wake up after about 2-5 hours but now with the device, I wake up after an hour or an hour and a half. Things like this are so distracting and can easily keep you awake! This is why I didn't want to do the CPAP yet. I don't like the idea of having air blowing in my mouth or my face all night long or having the mask on me that long. It wasn't easy sleeping through the sleep study with the nasal thing in my nose and all those monitors. I can't even sleep with my fan on in my room so if I got hot, I just don't cover up or I put on cooler pajamas.

So without having a sleep study because I'm sure my sleep dentist will want me to take more time to get used to the device, how can I know if I'm waking up because of the device or because the device isn't helping the sleep apnea? I'm guessing it's the device because when I breathe in with the device, I do feel air really coming down through behind my tongue and going down the airway so I think the device may be working but I don't know for sure. Do many people often wake up with the device in their mouths for a while before getting used to it? I think it's also anxiety because of the device so I'm thinking about anti-anxiety medications. Good idea? Also while I'm thinking about medicine, before I got the device, I'd wake up but once I took a sleeping pill (I only take it as needed if I can't sleep or if I can't get back to sleep so I'll take it in the middle of the night if I do take it) because I couldn't get back to sleep, I'd sleep like a baby! So it's like the sleeping pill is helping the sleep apnea but I know it doesn't do that. Is it possible I woke up while on the pill but just can't remember once I get out of bed in the morning?

How successful would you say devices like this have been for people with mild sleep apnea and compared to CPAP even for people with just mild to moderate sleep apnea? Is there a reason to think the device wouldn't work for mild sleep apnea? Does my sleeping on my stomach make a difference?

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[-] BrightLimeRam2756 +0 points · 7 months ago

Hi, I have been using a mouth guard for a while now. It has been titrated to 1 MM under the max. It isn't too uncomfortable when it's in, but it really is in the mornings. A majority of the time the little things they gave me to "reset my bite" don't even "fit" because the bite is so bad. Not only that, but my bite in general is quite bad now. I had braces, so this is NOT what I want after spending so much money for straight teeth. Furthermore, my TMJ has gotten a lot worse since using the mouth guard. Do you have any suggestions or tips for me? Thanks in advance.

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[-] AmiableCrimsonMouse5096 +0 points · 7 months ago

Hi, I wore a Somnodent appliance. but stopped after gum surgery and that was 5 years ago. I am 68 and retired so not as tired in the daytime. I also had braces and they brought my bottom jaw too far in to correct bite. I just used to massage over the TMJ joint by rubbing in circles. then a very hot shower and I felt fine for the day. I could never wear device all night. It seemed to trap my tongue and purpose is to not let tongue fall back. Went to doctor today for new sleep study. I just found my device and it feels pretty good. I am going to try it tonight and maybe don't need a new one.

What type of device do you have?

It seems that each dentist specializes in one type. I felt like there was too much material in my mouth.

Wish more people discussed oral appliances. Have you found many?

Ms Sharon

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[-] DrTonySoileau +0 points · 7 months ago

Hey Ms Sharon, not sure if you were asking me about what devices we offer. I work with the Micro2, Somnodent, Moses, Respire, and Narval. I have placed probably another 10-15 types that a patient had originally and wanted another just like it. The TAPIII is an example. But the first ones listed are the main ones I offer. Each one has pros and cons over the other. So we chose an appliance based on each individual patients needs. And if one type of appliance is not working for whatever reason I make them a different one at no cost and the first one becomes a spare.

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[-] DrTonySoileau +0 points · 7 months ago

Can I ask the name of the appliance? Some appliance are OK all the way up to max and some get weak structurally if you get too close.

The morning pain should not be there. There should never be pain associated with a dental appliance if everything is being monitored and adjusted correctly. You may be further out than actually needed. Have you had a sleep study with the appliance in this position? If you have and your apnea is under control try backing the appliance up. Actually I would back the appliance up anyway to help your muscles and teeth adapt to this position and then move forward again if necessary. May I ask if you adjusted the appliance forward or did your dentist do it for you? It would help if I knew how much and at what intervals it was brought forward.

The bite change may be the teeth being moved or it may actually be your jaw is re-positioned forward. This could be the correct place your jaw is supposed to be and the teeth were aligned with braces to where it was before your apnea was treated. If it is thats OK. That can be worked out.

I would also suggest seeing a massage therapist that treats TMJ. Ask for TMJ treatment specifically. You muscles are probably full of trigger points and lactic acid and other by products from clenching and grinding. I would also make sure the appliance is bringing the jaw out in the right direction! If the bite was set a little off at close setting it may not matter but at max your jaw may be 5-6 mm off to one side. Thats a lot. And can cause the problems your having.

You have a situation where you need to consider your apnea issues, muscle issue, and teeth issues separately and they may all need a little bit different help but then come together at the end.

I know I am not giving you specif advice. I wish I could. Its the best I can do with what you have told me. Feel free to ask me any further questions.

Dr Tony

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[-] BrightLimeRam2756 +0 points · 7 months ago

I was using the Narval CC with 22mm rods for a jaw advancement of 82% maximum protrusion. I was told if I was in pain to either change rods or stop using the bands. I wasn't really in pain then, so I changed the rods to 21.5mm for a jaw advancement of 86% maximum protrusion. I know that wasn't the smartest thing to do, but my bite and TMJ was already acting up and I noticed I wasn't feeling as refreshed in the morning, so I figured I didn't have much to lose. I had a sleep study at the beginning of this year. The tech was (or was supposed to be) informed to titrate if I had 9 apneas, hypopneas, RERAs, etc within the first hour. That didn't happen. in either case, my AHI went from 28 (with no treatment) to 18 with the oral appliance. In order for a treatment to be "successful", my AHI should've decreased by 50%, though the real goal is to be below 5. I was looking into getting the UPPP procedure, because I feel my airway is small and my uvula is longer than "normal". I attached pictures for reference - laying on my back (top picture) and laying on my side (bottom picture). My uvula is a lot longer than it appears here, it has just "fallen back", which I know you know from your experience in the field.

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[-] DrTonySoileau +0 points · 7 months ago

So it sounds like the Narval is bringing the base of your tongue out of your throat. 28 down to 18. The question now becomes is the base of your tongue all the way out of your throat and your nose is the obstruction or do you need to bring the Narval a little more forward. Maybe it is your uvula but your airway is not that constricted. Not normal but not the most constricted I have seen this week alone. Because you TMJ dysfunction is acting up I would back the Narval up 1mm and try an over the counter nasal spray like FLonanse. This may not solve your problem. But if you find you sleep a little better then that tell you your nose is the issue and an ENT consult is next step. A UPPP is an option but let that be the last option. Try simple first.

Dr Tony

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[-] Newatthis +0 points · 7 months ago

Hi,

I have been recently diagnosed with moderate to severe OSA, and just received my MAD (Moses). Last night was my first experience with it, and I have noticed an improvement in my energy level (and this is before any adjustments have been made). My husband has mentioned that my snoring is greatly reduced, and barely audible now, and I am no longer gasping for air. The device is not terribly uncomfortable once it is in place, and my morning jaw soreness this morning was minimal. I think I am on my way to a successful treatment! However, I have a couple of concerns.

First, I find the device extremely difficult to remove. It snaps very tightly onto my lower jaw, and I have to wrestle with it to get it off. Is there some small amount of "give" that develops in the plastic material over time, or is my morning routine destined to be a daily battle with my oral device? Second, and somewhat related, I have a crown on one of my lower molars. I am terrified that it is going to pop loose during one of my attempts to extricate myself from my appliance. It hasn't happened yet, but, as the placement of the crown was not a particularly pleasant experience the first time (local anesthesia didn't work on my raw tooth nerve), I would like to avoid this scenario.

Finally, what is the long-term success/complication rate for these appliances? My goal in using this is to avoid a tonsillectomy/hyoid bone surgery, as the recovery from a tonsillectomy is not something I care to endure in my 40s.

Thanks.

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[-] DiscreetCrimsonFerret0630 +0 points · 7 months ago

Hi my name is James and I have sleep apnea and I just got my new sleep pap machine does it supost to make me tired still in the morning???

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[-] Newatthis +0 points · 7 months ago

Hey, I think you meant to "reply" to Dr. Tony, but you replied to my post instead. You will probably have a better chance of getting an answer if you delete and re-post in reply to Dr. Tony's first post.

Good Luck.

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[-] DrTonySoileau +0 points · 7 months ago

First question about the tightness and some give over time. Yes it will loosen up over the next couple of weeks. Not much. But should be enough to take it off easily. I this is not the case in two weeks of getting the Moses you should ask your dentist to shave out the inside a little. I like to see all my patients within 1 week of delivering any sleep appliance just for this reason.

The crown is a concern so I would have your dentist shave out the underside over the crown regardless of the fit. Its just one tooth and should not affect the retention at night. But this is just in case and to insure nothing happens. If a crown is well made and enough tooth under it to support it then it should not come out with the appliance.

Long term the appliance should continue to work as long as it fits properly and your tongue does not change its elasticity or "sag". All muscles tend to sag as we age. If this happens over time and base of your tongue begins to fall into your throat again you may need to advance the appliance. Or if its at it maximum range you may need a new one with the bite set further forward. Also keep in mind the appliance does not fix sinus or turbinate issues. The appliance may be doing its job keeping the base of your tongue out of your throat and you develop some sinus congestion/infection, allergies, turbinate swelling, etc. This may cause you to snore or develop some apnea issues. Its not the appliance that stopped working. Its your nose that need some attention. We see that a lot right now in my office because its the beginning of pollen season.

Dr Tony

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[-] Newatthis +0 points · 7 months ago

Thanks for your reply! After a few of days, the appliance is a lot easier to remove in the morning, and I am no longer worried about the crown. Unfortunately, I have a new problem. The first couple of days were fine in the morning, with no soreness after the first 10 minutes or so of jaw stiffness. However, on day 4 I noticed the left side of my jaw had some minor persistent soreness, and yesterday I felt actual pain when I tried to close my mouth, but only in the left mandibular joint. The right side was completely normal after about 10 minutes or so. Last night I skipped wearing the appliance because I am concerned that 1. Pain that wasn't there at first is now present, 2. It's only on one side, and 3. It appears that the pain is a bit worse each morning. This morning, the left side is still a bit sore but slightly better.

I would really hate to give up using the device because it really seems to be giving me much better sleep than I have without it, but I am concerned that something is wrong. My oral surgeon says this is normal, but I expected the trajectory to go the other direction- pain at first, slowly improving. I should also point out that this is the "getting used to the appliance" phase, so no actual adjustments have been made to it.

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[-] DrTonySoileau +0 points · 7 months ago

Well, I see what your oral surgeon is saying and some of my patients have some soreness too. But it should be limited and only for the first couple of days. The fact that it is occurring only on one side may mean the muscles connecting to your jaw joint on that side are tighter and have not loosened up like the other side. That is probably the case. It could also mean that the bite is set off to one side and the appliance is pulling your jaw in a direction it is not willing to go. If thats the case a new appliance may need to be made. But its early in your treatment to consider that. I just want you to know its a possibility.

Dr Tony

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[-] AmiableCrimsonMouse5096 +1 point · 7 months ago

Dr Tony I had no luck with Cpap. Finally, I was fitted at Tufts Dental in Boston with a Somnolent. From previous orthodonture, my lower jaw is too far back. I have a small mouth cavity and find the Somnolent bulky. I found that my tongue felt trapped in the small space. Plus, they added a piece to come down from top. Can't remember why. It squeezed my molars until they were sore. In general, it did make me feel more rested but I could only wear it a very few hours a night. TMJ joint could be massaged and with hot shower, I felt ok. I am about to get new device and just began to think that I should research others. I saw a very tiny device called the Something2. Do you have any favorite oral appliances?

Tufts had you use a massage tool and do trigger points on arms and back as therapy.

I am 68 and have to get this right.

I have had about 5 sleep studies in my life and even a latent study. Since retired, and not exhausted from work, I am not so tired during the day.

I would love advice from you

I now live in Maine. mssharon68$$

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[-] DrTonySoileau +0 points · 7 months ago

Yeah having orthodontic extraction creates a lot of problems. God meant for you to have all your teeth and to take teeth out just to make it easier to straighten them often has long term consequences of TMJ issues and retracted jaw causing or at least contributing to sleep apnea. I see this a lot.

The Somnodent is a good appliance but it is bulky and when I see extracted teeth and everything pulled back I usually don't suggest it. If the patient can wear it great. But often thats not the case. Without seeing your case I would suggest a MIcro2 or a Narval. The Narval is the thinnest on the market. But if you get any dental work done it may not fit very well and can't be retrofitted to the new dental work. So I would suggest getting all dental work done first if you want this appliance. The Micro2 does not cover the tongue side of your teeth so it leaves a lot of room for your tongue. And it can be relined if you get dental work done. It is slightly thicker than the Narval but I lot less than the Somnodent.

Did this answer your question? If not please reply back.

Dr Tony Soileau

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[-] gpmVancouver +0 points · 7 months ago

I've been using the Narval for 2 years - love it. Changed my life. I use it 100% of time, for 100% of night. However the lower jaw part keeps slipping off. I think I've worn it out - it does not grip my teeth as tightly as it use to. I've been using PolyGrip denture cream to hold it in place at night. Not great, but does the job. Is there a way to permanently improve the tightness of fit of the lower jaw component?

I currently have the rib settings at 24mm - pretty tight. I have a relatively smaller mouth/jaw (actually use women's model, not male version). Could it be that I have the connectors too tight and I should back off to a wider setting? In general, the tighter the fit the better I sleep (the more oxygen) and don't care if jaw is a little tight the next day. I may have tightened it too far?

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[-] DrTonySoileau +0 points · 7 months ago

I would try backing it up .5 mm. If that works thats you best way to make it fit better.

There is a process where you hear the Narval with a micro torch on the model it was made to and compress the Narval tighter to the the teeth. I have tried this many times and have not been successful. It does not hold the new shape for long and then returns to the original shape is was made to.

The Narval is a great appliance and is the appliance I currently wear. But the one con to the appliance is either the fit is prefect or its not.

Dr Tony

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[-] AmicableCoralLocust5605 +0 points · 7 months ago

Hi all.

I had an overall apnea index of 11 (measurement of all sleep interruptions). I was told by the sleep clinic in Baton Rouge that they like to treat anyone with an index "greater than 5."

I bought an APAP and after two months of data collection via the machine, my index had dropped only to a 10. Not enough to please them (or me) and I was having to take a stimulant - NuVigil - to stay awake at work.

They sent me to Dr. Vance (dentist in my area who specializes in fitting people for apnea mouthpieces). I believe he fit me with the latest TAP device at the time. It's been less than a year now. With the TAP, I noticed immediately that I was dreaming deeply at night. Something I had not done in a very long time but I hadn't noticed really. Since I think we only dream when we are in deep sleep, I took the dreaming as a good sign that I was now getting into REM/deep sleep.

Over a short period of time, I began to need my stimulant less often. Can't remember the last time I've taken it.

Did a follow up sleep study at home, with the mouthpiece, and my index dropped from a 11 or 10 to a ONE. I am thrilled with the results. I never sleep without my TAP device. Not even when I'm taking a short nap on a rainy weekend day. 😊

I do have a small bit of jaw soreness in the morning. I address that by rubbing my jaw in the shower or chewing a piece of gum.

Some days I notice some jaw displacement since my bite is slightly off. Dr. Vance gave me a mold of my original bite though and if I wear it in the morning - about as long as it takes me to brew a cup of tea (or less time) - the mold quickly resets my bite and I'm good to go.

If you don't improve with a CPAP or APAP, I would highly advise seeing a dentist who is board certified to fit you for an apnea related mouthpiece. It has been life changing for me!

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[-] Dmamsquared +0 points · 7 months ago

Dr. Tony: I was not compliant with bipap therapy. I wasn't identified as a mouth breather right away. Ultimately, that revelation "ramped" my choices to full face masks. That didn't go over so swell, so I decided to investigate options. I went with a somnodent appliance. The subsequent sleep study revealed an improvement from moderate to mild apnea. What I want to know is this: if I were to wear my appliance as well as nasal pillows (bipap) could it address the mouth-breathing issues? I've had a health setback recently in that I was diagnosed with A Fib. Thanks

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[-] DrTonySoileau +0 points · 7 months ago

It certainly could help if you were to wear nasal pillows at same time. You also have the option of having a turbinate reduction or some how "clearing" your nose so the air can travel through it. A lot of my patients, myself included!, have problems with the air simply not being able to pass through the nose. Its not always a sinus/mucous issue. Inflamed turbinates is very common especially with those suffering with sleep apnea. The turbinates are the folds of cartilage in your nose. Over time the skin covering them can become inflamed and begin to reduce the amount of space the air has to travel through the nose. So you then begin to take in air through your mouth. The type of turbinate reduction I had done was with a cold laser. In office. Took less than 15 minutes. Full insurance coverage. You may not have an issue like this but it is something you may want to have your ENT take a look at.

Dr Tony

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[-] FaithfulAzureScorpion6355 +0 points · 6 months ago

I wear a bite splint at night, so I was fitted with a nasal/ oral cpap mask. My apnea was diagnosed as mild. Should I have been told about an oral device instead? I did snore quite a bit. I'm having a hard time adjusting to cpap pressure, but I've worn a bite splint for years.

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[-] DrTonySoileau +0 points · 6 months ago

My opinion is that a patient should always hear about different options no matter what the level of apnea is! Yes they should have given you the option of an oral appliance.

Dr Tony

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