BGailDemko140

Arthur,

Have you bothered to check the ingredients?

The address for ProDent.com is a UPS store in Carlsbad, CA.

Just wondering.

B. Gail Demko, DMD

The Vodka soak helped you or the appliance?

Alcohol is bad for all acrylics used in oral appliances and will lead to premature cracking and breakage.

Stay with cleaners recommended for orthodontic retainers and be aware there are special cleaners if the appliance contains any metal parts; these are normally sold with a sign saying "Safe for Partial dentures".

Some companies recommend use of an antiseptic hand soap and a soft tooth brush because there is less chemical reaction with appliance components. This does leave a soapy taste that will go away if you then soak the appliance in clean water.

B. Gail Demko, DMD

Sleep Dental Consultant to MyApnea.Org

Assoc. Editor of the Journal of Dental Sleep Medicine

Expert Advisor to the FDA on Oral appliance Therapy

Past President of the Academy of Dental Sleep Medicine

American Board of Dental Sleep Medicine

As a sleep dentist, I know they will not pay for another or a different oral appliance in less than 5 years and one day after paying for the initial appliance.

As to PAP; If the machine is not yet paid for and your physician decides to put you on a different machine, it would be up to the company supplying the machine to switch you to the new machine, but is not mandatory. If the CPAP is fully paid for, there will be no more funds from Medicare until 5 years and 1 day has passed.

B. Gail Demko, DMD

Assoc. Editor of the Journal of Dental Sleep Medicine

Expert Advisor to the FDA on Oral appliance Therapy

Past President of the Academy of Dental Sleep Medicine

American Board of Dental Sleep Medicne

The Narval device often opens the back teeth more than other devices and is hard to adjust to allow even biting forces on all the teeth. It is designed to put all forces on the back teeth. Most people with active TMJ pain are put on a device that concentrates biting forces on the front teeth like the TAP, SomnoDent with discluder, or Snore Hook, etc. Moving forces forward away from the joint often decreases the pressure muscles can create.

Do not use the Narval unless the pain is completely gone.

If your dentist wants to speak with me, she can get me through the Academy.

B. Gail Demko, DMD

Assoc. Editor of the Journal of Dental Sleep Medicine

Expert Adviser to the FDA on Oral appliance Therapy

Past President of the Academy of Dental Sleep Medicine

American Board of Dental Sleep Medicine

CMS has very stringent rules for oral appliances. At present there are 22 appliances that are contracted with the Price coding analysis segment of the government (PDAC). 14 of these appliances are various forms of Herbst appliances, but are all made by different laboratories often designed to get a piece of the Medicare pie. Some are cast metal and very thin, some have bulky proprietary hardware. Those that are not Herbst or TAP devices are the Medley Gold, OASYS with lingual lifters or nasal dilators and the SnoreHook Splint (similar to a TAP).

Be aware that Medicare has recently gone through a system wide update and will only pay to treat your sleep apnea once every 5 years. This includes CPAP OR an oral appliance. If you have received a CPAP machine , covered by Medicare, and find yourself unable to tolerate it, Medicare will not pay for an oral appliance until 5 years has passed. The reverse is also true. This means you have to think about costs involved. An oral appliance is custom made and has to be bought outright. CPAP is based on monthly rental and, therefore, may be more affordable out-of-pocket.

Discuss the options of therapy with your sleep physician and the costs involved. While mild-moderate sleep apnea can be treated with an oral appliance as a first line option, severe sleep apnea (the only life threatening level of sleep apnea) is best treated with CPAP. Oral appliances can control sleep apnea in only 30% of patients with severe OSA.

B. Gail Demko, DMD Assoc. Editor Journal of Dental Sleep Medicine Expert Adviosr to the FDA

The Mallampati throat form is a quick way to classify the size of the tongue base (since you have to stick out your tongue to make a determination). The Friedman score looks at the size of the body of the tongue (what sits inside the teeth when your tongue is in a relaxed position). I use the Mallampati to determine if I have to use an appliance with a very thin profile inside the teeth: EMA, Narval, MicrO2 and well made Herbst devices. Bulk outside the teeth does not crowd the tongue. A dentist has no use for the Friedman throat form and this was developed by Michael Friedman, MD (Chicago) to determine how likely soft tissue throat surgery might work; irrelevant for dentists.

A Mallampati 4 throat form means that ,when you stick out your tongue, all that can be seen is the roof of your mouth; this indicates that you have a lot of tissue (ginormous comes to mind) sitting in your airway 24/7 which must be moved to allow you to breathe at night. IT tells me I need both a thin contour of appliance, but I also I need to open between the teeth to give the tongue some place to go to get it out of the airway. I have one lecture slide of a patient with a Class 4 tongue size and I had his teeth almost 3/4" apart ( I normally keep that to 5 mm). He put in the device and his tongue naturally moved forward to fill the opening between the teeth and the patient was very happy with this solution.

B. Gail Demko.DMD Associate Editor Journal of Dental Sleep Medicine

Resmed has bought the rights to the Narval appliance ( developed in France) and this is a very nice appliance as long as your teeth are appropriately shaped. It is CAD-CAM printed, very thin and has minimal bulk near the tongue. The rods are replaced twice a year and one study showed it was more effective in those with more severe sleep apnea if elastics were used to hold the mouth more closed. EMA is also thin and , if trimmed back, is virtually undetectable.

The MicO2 also has minimal bulk inside the teeth and should be considered an option but it allows easy opening too. There is minimal published literature on this appliance.

With 150 FDA cleared appliances, there is something for everyone.

B. Gail Demko, DMD Associate Editor Journal of Dental Sleep Medicine

The EMA recently obtained FDA clearance for new straps that are durable and do not require frequent replacement. I have had patients in EMA's for many years and the shell has stood up well. One problem with both TAP and EMA is that more than 10 laboratories fabricate them, each with a slightly different way of doing them. It took me a long time to find the 5 different laboratories I use to make oral appliances for me. B. Gail Demko, DMD

Oral appliances to treat sleep apnea put significant forces on your teeth and their major side-effect is tooth movement. If you have had braces after the age of 21 (it seems as you are still in braces) there is a 100 % chance of unwanted tooth movement with an oral appliance. This could lead to the back teeth not touching and significant problems. As a dentist who has treated sleep apnea for almost 30 years, I think you should not consider oral appliance therapy. As associate editor of the Journal of Dental Sleep Medicine, I know of no good literature that shows treating your sleep apnea will treat your TMD. I also know of no good literature that shows orthodontics is the appropriate treatment either. NIH suggests symptomatic treatment with NSAIDs, a soft diet and moist heat. That being said, there is anecdotal information that orthodontics and oral appliances can be helpful in a small highly selected group of patients. Treatment of your sleep apnea is recommended because there are good studies that show tired patients have a very low pain tolerance / threshold. There are many treatments for sleep apnea. You need to discuss your options with a Board certified sleep specialist and look at all your options. Oral appliance therapy will cause you more problems than you can imagine. B. Gail Demko,DMD

The TAP 2 stopped production a few years back. The TAP 1 allows you to 'unhook ' the pieces without removing the appliance so you can take a pill. It was also less bulky than some of the newer TAP appliances. One problem with oral appliances is that more than one laboratory makes them and quality control varies from one lab to another and one technician to another. There are no license requirements to be a dental laboratory technician, something I find inexplicable, since even your hairdresser has to have training and pass a licensing exam. Some 15 years ago, I had a TAP appliance fabricated for a patient by a laboratory in Texas that was totally incorrect. When I called to ask the laboratory to remake the appliance, They told me that it had been made by a person new to the laboratory who used to be a roofer. I then went to using a laboratory in Michigan.