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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
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.
What your describing sounds a lot like candidiasis which is a yeast growing on your tongue. We have both good and bad bacteria in our mouth. The good bacteria control the levels of yeast. But if the good bacteria are reduced by dry mouth, antibiotics, and certain medications. It can be treated with antifungal medication easily. The important thing to do is figure out why its there in the first place so once treated it does not come back. I don't use CPAPs to treat sleep apnea. I treat with dental appliances. But I do see a lot of CPAP patients that come to me with this condition. Most are taking a lot of medication. So it could be from their meds or the CPAP is drying out their mouth, or both.
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.
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
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.
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.
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.
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.
Just saw this post. Sorry for delay. Which part of LA? I know of a few dentists there. Kind of a big location
