BGailDemko140

Your sleep dentist can have the laboratory make new segments that move the jaw further forward. One of the drawbacks to the MicrO2 is the initial setting that allows only 3 mm of jaw alteration. Since the MicrO2 is fabricated by a computer, then new segments can be made.

Use of an oral appliance can make very slight changes in how your teeth hit together. Before appliance treatment, it is probable that your teeth came together simultaneously, worn in by years of eating in the same way. The oral appliance can shift things slightly and , when you eat, specific teeth can hit first slightly before the rest of the teeth. This causes the noise you hear; often described as the sound of a mortar and pestle. It take less than 40 microns of movement to cause a noticeable difference.

Having the dentist adjust the teeth is fine if the alteration is minimal, but the American Academy of Dental Sleep Medicine in Lisle, Illinois does not recommend altering the teeth unless you are willing to stop using your oral appliance. As long as you wear an oral appliances, the teeth continue to shift. This has been proven in people who wear appliances as long as 15 years.

The wise way to handle this is to eat slowly and focus on your chewing.

Looking at published articles on oral appliances, shows that only 50% of patients who get them are successful with them. There are many reasons for having sleep apnea and anatomy (large tongue, long soft palate, obesity) is not the only cause. They work best in younger (under 56), thinner patients with mild-moderate sleep apnea. While some obese older patients find complete relief with an oral appliance they are less common than are failures and those of us who treat sleep apnea rely on the patient wearing a less effective (than CPAP) oral appliance for longer than they wear their CPAP.

As Dr. Soileau said, moving the jaw forward can often improve outcomes, but some people get worse if they move too far. Another concern is that the most effective appliances do not let you open you mouth easily. If you received an appliance that does not use elastics, hooks, wires, etc, to limit mouth opening, you may need to have the dentist re-engineer the appliance to limit opening during sleep.

The most effective oral appliance is one that moves the bottom jaw forward; but there are also custom fitted tongue retaining device that is comfortable for patients who wear dentures. The custom tongue retaining device was invented before the jaw movement device ; based on a treatment for patients who had too much chloroform 140 years ago and stopped breathing. The devices that are prefabricated tongue retainers are not very comfortable. A custom fitted one is best. It fits on the tongue not on the bony ridge that supports your denture. Only one laboratory technician in the US makes the custom tongue retainer and he works on his own in Racine Wisconsin and also provides these devices for Space Maintainers Laboratory. Check with Space Maintainers for a provider near you.

Moving the jaw too far is a common problem since most dentists do not understand that more in not always better. Thin, young people with mild-moderate sleep apnea may need to move their jaw only 2-5 mm. Larger patients or those with severe sleep apnea have to move their jaw more. Because a person’s response varies so much from other’s, follow-up testing is always required. All studies have shown that using multiple overnight sleep tests to ‘zero in’ on the best jaw position for each person improves outcomes. Remember, the best position for you may be backwards from where you are.

Side-effects increase the further forward you go (long-term tooth movement) so finding that perfect balance is important.

Also, achieving an AHI < 5 is statistically an end point used in studies. All the research shows that if you are no longer sleepy and your symptoms are gone, an AHI < 10 is fine. Oxygen levels mean more than the number of breathing events.

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

Any dentist who treats patients with oral appliances, even grinding, should know the science behind what is being done. All oral appliances, even those you can buy in the drugstore, can change how your teeth meet. This is mostly related to minute swelling in the joint area called edema. When using a Silent Night, or any device that moves the jaw forward as well as keeps the teeth from touching, can make this bit of edema worse. For most, the symptoms resolve quickly each morning. The expectation of permanent changes increasing with longer use of the oral appliance. Returning to positive airway pressure is the common result.

Grinding and clenching are a different sleep disorder and is not often corrected with correction of your apnea. It is correlated to everything from acid reflux and alcohol consumption to medication use. While they may not cause it, these triggers often occur simultaneously. Bite guards do not stop grinding, only give you a way to spread out the forces on your teeth or a material to grind through instead of breaking your teeth. Adjusting your bite, by reshaping the teeth is not supported by science but can be helpful if the teeth are only slightly out of alignment. If the teeth are seriously out of alignment and use of the APAP is not helping to reset your back teeth, I recommend you discuss this with an orthodontist.

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

The roots of the upper front teeth end just below the edge of the nasal bone. Pressure on this area from the edge of a nasal mask can cause tooth pain and can actually move teeth in some patients. B. Gail Demko, DMD Assoc Editor of the Journal of Dental Sleep Medicine

Airway surgery, including tonsils or adenoids, has not been found terrible successful in adults. Adenoids are almost always vestigial (not really there) and tonsils tend not to be floppy as they are in children and do not block the airway. Since a dentist cannot see the adenoids (They are tucked way up behind the soft palate), an evaluation by an ENT is the next step. Remember that snoring is controlled with an oral appliance 80% of the time, but sleep apnea only 50% of the time. As Dr. Luisi said, follow-up testing by a sleep physician is required for every oral appliance. Keeping the mouth closed at night is the ideal, but research has shown that this makes a big difference only in severe sleep apnea. The majority of patients only open a small amount each night and that is related to the level of sleep (it is natural to have your mouth open wider during dream sleep). Chronic nasal congestion and a steep jaw angle make correction of sleep apnea with an oral appliance more difficult. B. Gail Demko, DMD Assoc. Editor: Journal of Dental Sleep Medicine

I presume you have seen a good Ear Nose and Throat (ENT) doctor to evaluate your nose properly. As a dentist, I can see the front area of enlarged turbinates, but there are a host of things that can be involved in poor nasal breathing. Proper work-up is required, and see an ENT referred by your sleep physician. I worked with 8 different sleep centers in Boston and each had a preferred ENT. These ENT's worked with sleep apnea day in and day out and knew what was a problem for CPAP or oral appliances.

One must not forget that almost 50% of patients who get an oral appliances, and for whom they are successful, discontinue use within 2 years. Many patients with chronic diseases are NOT perfectly adherent with therapy. This includes high blood pressure medication