SleepDent

I am a dentist working in dental sleep medicine. No, this level of discomfort is not normal. In most cases, the dental impressions used to fabricate these devices are very accurate, but, from time to time, there can be a little bit of distortion. This, or some discrepancies in the production process could cause this level of discomfort. Do not wear the appliance any more until you go back to the dentist for an adjustment. Most appliances can be adjusted for fit and they should either be entirely comfortable or maybe a slight sense of tightness that goes away in about five minutes, but nothing like the pain that you are getting. Any competent sleep dentist should be able to handle this, no problem. If the appliance is one of the few that can not be adjusted, then it would have to be remade from new impressions. Arthur B. Luisi, Jr., D.M.D., The Naples Center For Dental Sleep Medicine.

I am a dentist working in dental sleep medicine. From a medical insurance perspective in the U.S.A., they usually will only pay for a sleep study if it is initiated AFTER an initial consultation with a physician certified in sleep medicine and the results are reported and interpreted by a physician certified in sleep medicine. As a practical matter, most family physicians have little or no knowledge about sleep disorders anyway, so it is sort of a moot point because most don't even want to get into it. If your family practitioner does, that would be unusual. Arthur B. Luisi, Jr., D.M.D.

Result couldn't be better. Congratulations! Actually, the standard protocol for oral appliance therapy includes a follow-up sleep test with oral appliance in place to assure that it is working properly. This occurs after all adjustments to protrusion have been made, and , subjectively, the patient feels that he is doing well. A home sleep test will suffice for this purpose and the HST is usually done for cost and time efficiency reasons. Nevertheless, a full lab test is still the prefered route to take and that is done in a few cases where the insurance will pay for it. It is not O.K. to go without the post test and an ethical sleep dentist will make the patient agree to do it up front as a pre-condition to starting treatment. There can be a placebo effect and, sometimes, a patient may think that he is doing well when, in fact, he is not. Arthur B. Luisi, Jr., D.M.D. The Naples Center for Dental Sleep Medicine.

I am a dentist working in dental sleep medicine. Your question is simple enough. Unfortunately it can not be answered long distance. The selection of an oral sleep apnea appliance is a highly individualized process. An appliance that will work well for one person would be a total failure in another. The only way to be assured of the right choice is to have a consultation with a dentist highly experienced in dental sleep medicine who can evaluate your personal situation and help you to make a wise choice. Arthur B. Luisi, Jr., D.M.D., The Naples Center for Dental Sleep Medicine.

I am a dentist working in dental sleep medicine. My sense of the general feeling in the medical profession is that, when it comes to blood pressure, they would rather err on the low side IF YOU FEEL O.K.. If and when the blood pressure is getting so low that you are feeling tired most of the time or getting dizzy when changing position or standing up, it may be time to re-think it. Certainly, one of the beneficial side effects of CPAP is that it can lower B.P.. Apparently, the lower B.P. is making you symptomatic, so an adjustment of medication is a reasonable conversation to have with your health care providers. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. CPAP machines are classified as durable medical equipment. Oral sleep apnea appliances are also classified as durable medical equipment. I have observed on this forum that patients are extremely careful to research their PAP machines for safety, effectiveness, features, durability, and cost. The same level of care and seriousness should be applied in the search for oral sleep apnea appliances. In my opinion, the availability of anti-snore(NOT RATED TO TREAT OSA) appliances readily on line does send out the wrong message to the public and tends to trivialize the whole mode of treatment. Unfortunately, poorly fitted and poorly made oral appliances can do serious damage to your teeth, oral tissues, bone structure, throw off your bite, and ruin your jaw joints. My advice to the public is-- don't use them. The ones at the drug stores are for snoring only, again, not legal to treat obstructive sleep apnea. There are over one hundred oral sleep apnea appliances on the market, some good, some bad, and some fair. No one is good, or even usable for all patients. It takes a highly sophisticated and experienced sleep dentist to select just the right appliance for you and to fit it just right in your mouth. So your one job is to find a top-notch sleep dentist. If you do, hopefully, good things will follow. Arthur B. Luisi, Jr., D.M.D., The Naples Center for Dental Sleep Medicine.

I am a dentist working in dental sleep medicine. Based on what you have related, it appears that you may have strained your jaw by over-protruding it. I think that the early symptoms that you had around the 5 month mark should have acted as a red flag and that you should probably have gone to a less aggressive level of protrusion at that point very quickly. Of course this is 20/20 hindsight. This is one reason why I do not particularly like the appliances that adjust via straps. Most often the adjustments are too coarse(too much protrusion at one time). I prefer appliances that can be adjusted very gradually in increments of about a tenth of a mm at a time. Gentler and more easily controlled. It is impossible to tell long distance, but it sounds from the clicking that you may have developed a TMJ condition called anterior disc derangement. The best bet might be to find a dentist who specializes in TMJ problems and let him do a complete diagnostic work-up to determine the health of your TMJs. At that time, he may be able to tell whether or not your condition is structural or muscular and what treatment would be necessary. Personally, I would not attempt to use the appliance again until this is done. And it could well be the case that you may be advised not to attempt to use it again. It depends. Arthur B. Luisi, Jr., D.M.D.. The Naples Center for Dental Sleep Medicine. Practice partner, dental sleep medicine, The NCH Healthcare System. Practice partner, dental sleep medicine. The Millennium Physician Group.

I am a dentist working in dental sleep medicine. If a patient has normally solid teeth and gets a high quality, properly professionally fitted oral sleep apnea appliance, loosening of the teeth should not be a concern. If a person has active periodontal(gum) disease or has lost a significant amount of bone support due to past periodontal disease, then it could be a concern. You would need a professional consultation with an experienced sleep dentist to find out. Oral sleep apnea appliances are a very good alternative for people with mild sleep apnea, as they tend to be quite effective, with better comfort and portability. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. Well, obviously, breathing through either your nose or your mouth will keep you alive. However, in terms of best health, breathing through your nose is definitely preferable. Your nasal passages are designed to filter and improve the air that you breathe. The nasal hairs trap and filter bacteria and other impurities in the air. Your nasal turbinates and linings humidify and heat the air for better absorption by the lungs. Nitric oxide, secreted by the nasal sinuses, acts as a natural disinfectant for your respiratory system and facilitates the absorption of oxygen by the alveoli in the lungs. So, we encourage nasal breathing, if at all possible. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. Oral sleep apnea appliances have been around twenty or more years now. Given that length of time, they have been extensively tested and we now have a large body of test data about their efficacy. Actually, they have been found to be quite effective in treating both mild and moderate sleep apnea and are considered a first line treatment for both, as well as CPAP. I believe that many of the same oral appliances found in the USA are also available in Canada. A MyTap appliance can be had in the USA for about $650(US) and is quite effective. However, it is not very strong or long-lasting. It does make a great starter appliance for someone trying to see it the concept works for them. Please understand though, that these work only for obstructive sleep apnea and not for central sleep apnea. Arthur B. Luisi, Jr., D.m.d.