SleepDent

This post underlines one of the main problems of these inexpensive OTC devices. Mandibular advancement devices, by definition, place a certain amount of orthodontic force on the teeth. A precisely made custom appliance well-fitted by an experienced sleep dentist will manage these forces in a way that will not move your teeth and will keep them comfortable. The OTC devices are often not that precisely manufactured and the one-size-fits all can be uncomfortable and move your teeth in harmful ways. They often also depend on the patient to fit the device and a lay person usually doesn't have the experience to do this well, again often with harmful results. In my view, this is one of those instances where the government does not provide sufficient oversight and regulation of these devices to protect the public from harm. Arthur B. Luisi, Jr.,D.M.D.

Well, I would say probably yes on both counts. The degree of nasal patency(how open your nasal passages are) does have an effect on how well your oral appliance will work. And if your nasal passages were pretty closed up before, it would have made it harder for the CPAP air to get into your nose and made the CPAP less comfortable. Your MAD may or may not work well enough and be comfortable enough with the enlarged turbinates. Only time will tell. Patients tell me, in general, that their turbinate reductions were not too tough a procedure as these things go, so I guess that you and your doctor could re-visit doing it if need be. Arthur B. Luisi, Jr., D.M.D.

Well, maybe what I said about the DreamTaps being heat adjustable was a bit misleading. I would not worry about the lining in the DreamTap being different from or inferior to that of the Tap3 because they are identical. Both are offered with the same choice of a TL or Thermacryl lining, The TL being the basic, common one. The real difference is that the hard outer layer of the DreamTap is made of a different plastic than the Tap3 and the DreamTap plastic is more heat resistant. You can place the DreamTap in boiling water briefly to soften the TL lining up just a bit so it inserts more easily and accurately and it works well. If you put the Tap3 into boiling water it would distort and be ruined. So I really see no down side for the DreamTAp. The lining is NOTHING like the boil and bite heat fit lining of OTC cheapie appliances and I would not worry about it. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. If you go to the Zquiet web site, you will see that they only claim to deal with snoring, not obstructive sleep apnea. This is not appropriate treatment for patients with obstructive sleep apnea. There are custom appliances that can be quite effective for many cases of obstructive sleep apnea, but they must be placed by special dentists trained in dental sleep medicine and are quite a bit more expensive. Arthur B. Luisi, Jr., D.M.D.

You said that you thought it was working. The first thing that I would ask is whether or not the efficacy of the device was ever objectively confirmed by either a home sleep test or an in-lab sleep test with the oral appliance in place. It is mandatory that the efficacy be confirmed this way because there is a placebo effect wherein patients can think the OA is working well when it actually is not. Assuming that it was tested, you would then have to ask yourself what changed during the last week. Typically, there has been a change in nasal patency, i.e., a head cold, a sinus attack, allergic rhinitis, or similar. This can put a drag on the OA and make it less effective. If so, a trip to an ENT doctor may be in order to clear it up. One drawback of the Somnodent, is that it does not hold the mouth closed as some other appliances, like the Tap3, do. When the mouth falls open, the mandibular protrusion created by the Somnodent can not overcome the apneas caused by mouth opening in all instances. I would theorize that when you slept on your stomach, your mouth may have been forced wide open for an extended period of time, thus allowing apneas. You may also have over-adjusted the appliance forward past your optimal "sweet spot", thus allowing more apneas. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. Fundamentally, I agree with your over-all assessment of surgical options. However, I would make one exception. Some minor ENT procedures to improve nasal patency have greatly improved the performance of oral sleep apnea appliances. Most notably, the turbinate reduction. This is relatively painless, not debilitating, and not too expensive and really does significantly improve nasal patency. In some select cases, a septoplasty, although more serious surgery, can also make a significant difference. A.B. Luisi, D.M.D.

I am a dentist working in dental sleep medicine. I think that tip off as to what may be happening is that the pain started in the morning AFTER you removed the appliance. The following could be happening: Oral appliances work by moving the mandible(lower jaw) forward. This forward movement moves the condyle(ball) of the mandible out of the socket over night. There are delicate tissues(the retrodiskal tissues) behind the condyle that get engorged with fluid over night. This tends to move your bite temporarily forward in the morning. When you take the appliance out in the morning and vigorously attempt to close into your normal bite right away, the condyle presses on the engorged tissues and causes pain. The answer here is to be GENTLE after your remove the appliance in the morning. Just accept that your bite may be off for about thirty minutes and don't try to fight it. Then SLOWLY and GENTLY try to close into your normal bite in stages. This will probably solve the problem. Actually, I give my patients an A.M. aligner to help them deal with the problem. I tell them to just ignore the bite problem for 30 minutes and then GENTLY and SLOWLY use the aligner to resolve it. A.B.Luisi, D.M.D.

I am a dentist working in dental sleep medicine. I agree that the Tap appliances are excellent. In my opinion, the best ones out there. In my twelve years of experience, the vast majority of appliances that I have placed have been Taps. However, the biggest drawback has been that they are extremely difficult to fit. You have to have supreme patience, experience, and real talent to do it. At this point, I know how to fit them reliably well, but it took time. Many dentists just don't want to bother, therefore, the Taps have been a bit less popular than they deserve to be. The new DreamTap is a real break through in that it is the first model that is HEAT ADJUSTABLE. I find that it is much easier to fit than the previous models. I think that when the dentists catch on to this, they will start to use them more. A.B. Luisi,D.M.D.

I am a dentist working in dental sleep medicine. If a person opens their mouth wide enough and hard enough ANY oral appliance in which the upper and lower trays are attached together will come loose and come off. Generally, the lower tray will come off first because the teeth are smaller and hold less tightly. The question really is whether or not that will happen when you sleep and you can't tell until you try it. I agree with your dentist that because the upper and lower Narval trays are attached together, the likelihood of your swallowing it or choking on it is virtually nil. A.B. Luisi, D.M.D.

I am a dentist working in dental sleep medicine. There is not a linear relationship between the degree of mandibular protrusion and the efficacy of an oral appliance. There is, indeed, a "sweet spot" which is different for each patient. You may have over-shot it. You need to consult your sleep dentist to discuss whether or not you should re-titrate the appliance, i.e, go back to a more conservative position and slowly work it out again. A.B.Luisi, D.M.D.