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Ask your dentist about Perio Protect trays to use during the day. This may be your answer.
Dr Tony
Dr Luisi is correct. There is not a lot you can do to "tighten" a narval. And I am not a fan of chin straps as they can hold your jaw in the wrong position. I have made a lot of Narvals over the last few years. The question I would ask is do you go back into the appliance after you yawn or open wide at night?
Sounds like the appliance is set too far forward to begin with. A new bite needs to be taken and the appliance remade. You can try over counter anti inflammatory like Alleeve or Tylenol right before bed but that will not fix the problem and only offer mild relief. You could try massage or chiropractic therapy to loosen up the muscles which probably needs to be done regardless. But I would still want the initial position brought back if you ere my patient. Wish I had a better solution.
What does your dentist suggest? Is he monitoring your appliance settings and how well your sleeping? Dr Tony
The key is to get the muscles, tongue (which is a muscle), and nose all working together. Once that is achieved you will breath normally and sleep great. This is if the only thing affecting your sleeping s lack of air. It kinda sounds like the appliance was not set far enough forward to begin with. This could be because your muscles would not let your jaw come forward to their relaxed length. When you brought the appliance back it relaxed the muscles but the sleep issues came back. When you brought it forward the sleep issues went away but the muscles started fighting the appliance. Eventually the muscles will let go. There is a comfortable spot for the appliance that also fixes the sleep issues. But you will have to slowly advance the appliance up to it or you will pass it up.
Yeah it does happen. Having the top and bottom parts connected is one down side to the Narval. Not saying its a bad appliance. I make a lot of them. Very thin and light. Cant break them. Good fit. But you are connected. Two ways of looking at fixing this problem your having. Change the appliance set up or change your breathing set up.
Lets start with breathing because that's your best option. You should be breathing through your nose and not your mouth when you breath IN. The nose cleans, warms, and humidifies the air. Breathing through your mouth skips this very important step. To get the most oxygen to transfer from the air and into your blood through your lung tissue the air must be warm, humid, and clean! Breathing in through you mouth works, but its OK air and not the GREAT air. I would have an ENT take a look at your nose to see how much air actually goes through. I am not talking about mucus, snot, and sinuses. I am talking about the size of air space through your nose. If the space is constricted and can be widened with antihistamines, steroids, or simple surgery then this is your best option. Even if the appliance fits great its still good to have your nose checked. If you breath through your nose you will not keep your mouth open or at least not as much.
To change the appliance set up you don't have many options with the Narval once its made. You can try putting longer bars to allow your jaw to stay in it longer. That is pretty much your only option with the Narval. The second best option would be to get into a different appliance. In my office if the an appliance is not working you give it back to me and I make you a different type. I don't charge patient or insurance twice. Please keep in mind that is my office policy and may not be your dentist's policy.
Hope this helps at least get you moving in the right direction. Please respond back if I can help some more.
When you ask for "appropriate" do you mean appliances in general or something specific like cost, size, fit, etc?
There are a lot of appliances on the market and every doctor has his favorite. I always first recommend getting whichever appliance works best in your doctors hands.
Let me know a little more about what your looking for or I can just list several appliances and their pros and cons.
Here to help.
Yeah I hear you! I wear the Narval too. And yes I have seen this problem with several patients. The problem your having most likely is that your grinding side to side at night and when you get way out to the side opposite the the bar thats popping off your clenching down enough to bend and flex the bar to the point there it pops off. So this is a muscle problem more than an appliance problem. The lab bill for the Narval is quite high so your dentist is probably not excited to make you a different appliance. But if your torquing your muscles this much you would have problems with other appliances too. You best option is to get the muscles under control. Have you done any kind of massage therapy, chiropractic, physical therapy for TMJ or upper back problems?
Would like to tell you a solution so the Naval would stay together even with extreme grinding but there just isn't one.
Tony
The hard part Dr Luisi is listening to what your body is telling you, not letting others tell you it something else, and letting go of paradigms. Then after you accomplish that finding the right therapies to put the body back like it was intended to be.
