SleepDent

I am a dentist working in dental sleep medicine. You have posted the same question in a separate thread. I have answered it there. A.B.Luisi, D.M.D.

I am a dentist working in dental sleep medicine. Both the EMA and Silent Nite appliances are considered light duty appliances suitable only for relatively mild OSA cases and snoring. They are also of light duty construction with struts susceptible to stretching and breakage. Basically, not sturdy at all. The other side of the coin, is that they also feel very light and thin in the mouth, which for a small minority of users is critical for success. Personally, though, if my patients needed a very light, thin appliance, I would go with the Micro2, which is light, thin, AND strong. The TAP appliances are MUCH sturdier than the EMA and Silent Nite. All the difference in the world. They also have much more precise adjustability and much better levels of efficacy. I would also agree that the new DreamTap is usefully improved from the TAP3. However, they do keep the mouth pretty shut which is one of the reasons that they work better than the EMA and Silent Nite. If you need the mouth the be relatively open for yawning, talking, etc., I would go with the Micro2. However, be aware that it is significantly more expensive than the EMA and Silent Nite(but worth it, in my view). A.B. Luisi, D.M.D.

I am a dentist working in dental sleep medicine. The vast majority of oral appliances are designed to allow both nasal breathers and mouth breathers to use them successfully. In my 12 plus years of experience, I have found no reason to believe that mouth breathing decreases the efficacy of an oral appliance. The only negative of mouth breathing that I find is that it can result in dry mouth, which, in a few cases, can be unbearable. However, if the patient mouth breathes BECAUSE there is limited or no nasal patency, that is material to the efficacy of oral appliances. One way to find out is to use Breathe Right strips for a few days to see if that improves the efficacy of the appliance. As a practical matter, I always refer a mouth breather with limited nasal patency to an ENT for evaluation before placing an oral appliance. A.B. Luisi, D.M.D.

The first question that comes to mind for me is whether or not you have a history of sleep clenching/bruxing and TMD(temporomandibular joint dysfunction). This is one of the conditions that I routinely screen for during the initial consultation with potential oral appliance patients. If so, those conditions need to be addressed PRIOR to oral appliance placement. Arthur B. Luisi, Jr., D.M.D.

Actually, let me take another shot at asking them for an update and I will get back to you. Sleepdent

Hi! I am a dentist working in dental sleep medicine. Were you efficacy tested by HST or polysomnogram for each appliance you wore and, if not, which appliances were tested? Of the appliances that you mentioned, the TAP 3 is the most universally effective. This is because the TAP 3 holds the mouth closed, which has been shown to best control OAS. The fact that it does hold the mouth closed also makes it significantly less comfortable for many people. Being able to open and close the mouth at will with the appliance in place is a comfort plus for many people. The key here is to find out if this comfort feature will reduce the effectiveness of the appliance for the patient. In some cases it will, in some cases it won't. If you have had good results with the Somnomed MAS, this shows that you can get away with an appliance that lets your mouth fall open. I have used the Oasis in the past and, in the main, patients have found it to be pretty bulky and uncomfortable. Actually, I no longer use it in my practice for that reason. The Narval is thin and comfortable, but the adjustment struts can be problematic. If you have done well with the Somnomed MAS, I think that the Micro2 could possibly be a better choice for you. It is made with new CAD/CAM technology which makes it strong, thin, light, and very comfortable. It also has a simplified tray system which eliminates the need for adjustment tools. Arthur B. Luisi, D.M.D.

Hello, I am a dentist working in dental sleep medicine. First of all, which oral appliance did you try? The Tap 3 line(TAP3, DreamTap) has been acknowledged within the dental sleep medicine as significantly more effective for severe OSA than other alternatives. If you haven't tried a TAP, you haven't given it your best shot. Secondly, there would definitely be hope for you with a combination device called the Tap-Pap CS. It incorporates a Tap OSA appliance into a nasal pillow mask and has a patented intraoral mouth shield that eliminates leakage through the mouth from mouth breathing. It is highly effective(better than CPAP or an oral appliance alone) and studies of people who have been CPAP intolerant, but for whom the OAs were ineffective, that 70 percent of those patients COULD successfully manage with the Tap-Pap CS. Those odds are pretty good, don't you think? Arthur B. Luisi, Jr.,D.M.D.

I am a dentist working in dental sleep medicine. I would not recommend any of the cheapie OTC or online available devices because the fit and level of efficacy is not sufficiently close to custom devices. However, there is a relatively inexpensive device called a MyTap that can be provided by sleep dentists in-office. It typically costs between $450-$600, depending on the office and is highly effective. It is also only made out of strong plastic and will only last about 1-1.5 years without breaking, but that is good enough for a tester. You can go to the Airway Management website "www.tapintosleep.com" to locate a provider in your area. Arthur B. Luisi, Jr.,D.M.D.

One appliance that is really excellent for extreme side to side grinders is the DreamTap. The two trays are joined centrally by a hook that can slide easily side to side on a long metal track. The device is sturdy, stands up to extreme grinding and takes the pressure off the TMJs. I think that many dentists do not factor in extreme side to side grinding when making appliance selections. Extreme side to side grinding is not totally obvious, but there are certain patterns of tooth wear that can be discerned to make the diagnosis if you are alert to it. And you should be. Arthur B. Luisi, Jr., D.M.D.

Hi! I am a dentist working in dental sleep medicine. Wiredgeorge is right. You have provided inadequate information. Is your device a prescription oral device? Did a sleep dentist or your regular general dentist place it? What is the brand of the device? Generally, the percentages you cited are percentages of your maximum protrusive range, i.e. how far you can stick out your lower jaw at maximum, but I don't know that. There are other criteria to be considered besides how you feel. What is the feed-back from your bed partner? Are you still snoring and how loud? Are you still doing apneas? What is your observed demeanor when you sleep? Relaxed and calm? Active and tortured? These things have to be considered. Also, the protrusion should be increased at a SLOW steady pace usually. You seem to be going way too fast. Approach your sweet spot slowly and deliberately. Oftentimes, people being successful will actually feel more tired initially, but that is feeling more RELAXED because your body is not in a death struggle to breathe. The bottom line is that you need more guidance and maybe some intermediate home sleep testing with the appliance in place. Contact your sleep dentist STAT(right away) to get your problems and questions dealt with. Arthur B. Luisi, Jr., D.M.D.