SleepDent

Perhaps I should present a little more information for your evaluation. I am fairly new to this forum, but was a heavy contributor for four years on the past forum www.apneasupport.org. This forum seems to be more liberal than that one about revealing information so you can find my bio at www.naplescenterdentalsleepmedicine.com. I think they will allow this now. a.b.luisi,d.md.

Hi! Actually you are talking about a bite plane or night guard designed to combat nocturnal clenching and grinding. These are not designed the treat obstructive sleep apnea. An actual sleep apnea appliance works by holding your lower jaw a little protruded(forward of your top teeth) and this pulls your tongue away from your airway. The worst thing about it is that studies have shown that maxillary bite splints or planes can actually push your lower jaw BACKWARD, making the sleep apnea worse. I would not encourage you to use a bite plane to treat sleep apnea. Won't work. a.b.luisi,d.m.d.

One major problem with the oral appliances is the extreme lack of really competent, really experienced sleep dentists. These oral appliances are VERY difficult to deliver well and proper appliance selection is critical because there are a lot of bad ones on the market. What is happening is that a lot of regular general dentists are taking a few courses and adding dental sleep medicine to their practices as a new profit source. They are not doing a particularly good job, there are many failures that could have been averted, the patients are not well served and the reputation of oral appliances suffers. I have ten years of experience and do dental sleep medicine on an almost full time basis. At this point, my long term success rate with mild-moderate OSA patients is 85% and I am even doing fairly well with severe patients. There is a steep learning curve and you have to do a lot of cases to get there. I do have some sympathy for the other dentists because they probably don't have much sleep appliance volume and they are trying to make a living. The take away here is to try to find a really experienced full-time sleep dentist and a lot of the so-called "Trial and Error'' goes away. a.b.luisi,d.m.d.

Hi IntuitiveSapphireZebra3375, I am a dentist working in dental sleep medicine. As to the plastic taste, the appliance is brand new and sometimes a little bit of the acrylic monomer will leach out until the plastic ages a bit. That could account for the plastic taste. It will probably go away over time. There is also a new universal cleaning agent called Prodentclean that might help. See": www.Prodentclean.com. I know that you are looking for patient feed-back, but I can tell you that I personally know hundreds of patient who have done well long term on oral sleep apnea appliances. Isn't it a amazing just how much more comfortable it is than CPAP. It is a real pity that the sleep physicians as a group are relatively unsupportive of oral appliances. They could be helping a large number of patients who could really benefit. a.b.luisi,d.m.d.

O.K., The Herbst appliance. The Herbst appliance is one of the more effective oral sleep appliances, but unfortunately, it is on the bulky side, in my opinion. The metal hinge hardware is somewhat heavy and the trays are pretty stout. Understand, the average person could cope, but a significant number of people could not. Maybe your dentist could at least thin the trays out for you. There are other choices that are a lot slimmer. Two advanced fourth generation appliances are the Narval and the Micro2. These are manufactured with computer aided milling and are light and strong. I think that the efficacy tests that I saw for the Narval were mediocre, but the ones for the Micro2 were pretty good, if not the best. The Silent Nite and the E.M.A. are pretty slim, too, but they are fragile and break comparatively easily in my view. Also, the Silent Nite and the E.M.A. are considered light duty, mostly for snoring and some low-end(very mild) obstructive sleep apnea. Their published efficacy tests are not particularly impressive, in my opinion. I think the Micro2 is a good choice for people who are very bulk averse. You might want to get your dentist's feeling about it. It is a relatively new product and he may not know about it. There is hope for you, though. a.b.luisi,d.m.d.

Hi ReservedWhiteKangaroo6396. I am a dentist working in dental sleep medicine. It would be helpful if you could tell me which oral appliance you are using. There are major differences in bulkiness between the various brands and if I knew the brand I would have a feel for how bulky it is. Bulkiness is also a very personal preference. Some people do very well with even the very bulky ones and others can't stand ones that are relatively slender. I could suggest two things. Depending on the appliance, it might be possible for your sleep dentist to trim it down somewhat so it doesn't feel so big in your mouth. Also, if you tell him about your problems, he may be able to help you select another type that is built smaller. You really don't know how sensitive a patient is going to be to bulk until after the appliance is placed unless a patient specifically mentions bulk as a concern. Patients have certainly complained to me from time to time that the appliance feels too big in their mouth and often you can replace it with a model that is much trimmer. That usually works. Personally, I don't place the really bulky types, even if they work well, because size and comfort is always a factor. a.b.luisi,d.m.d.

Actually, a visit to an ENT doctor might be in order in addition to the visit to your dentist. Poor nasal patency(poor breathing through the nose) can put a severe drag on an oral appliance and even cause it to fail. Since the ringing in the ears predated the oral appliance, that would also be a valid area of inquiry for an ENT. Since you are early on with the oral appliance, it is probably not adjusted to your sweet spot yet, so it wouldn't necessarily be working very well. You should certainly tell your dentist about your nasal problems and get his input on it. TMJ problems, in and of themselves, can cause ringing of the ears, and the oral appliance could conceivably have made it worse. The oral appliance could be causing two effects, one of which would make the ringing less severe and one that could make it worse. The condyle(ball joint) of your mandible sits very close to your inner ear. If your inner ear is already inflamed, pressure from the condyle on the inner ear as you brux could conceivably make the ringing worse. Often times your muscles do fight the oral appliance initially and bruxing can temporarily increase until the obstructive sleep apnea is under better control, at which time, the bruxing generally subsides. On the other hand, the mandibular protrusion caused by the appliance actually tends to pull the condyle further away from the inner ear, thus lessening the negative effects. It could go either way depending on what prevails. You have a lot to get sorted out here. a.b.luisi,d.m.d.

In my over ten years of fitting oral sleep apnea appliances, a continuing concern has been how to keep them clean and sterile. There are over 100 brands of oral appliances and each one is made out of different combinations of materials. If you make a mistake and clean them the wrong way, they can be totally destroyed in short order and your expensive investment goes up in smoke. I have seen it happen many times. And many times, patients find the cleaning regimen specified by the manufacture to be inadequate and the appliance ends up smelly and unsightly. For the first time, there is a new universal cleaning agent for all oral sleep apnea appliances called Prodentclean. The manufacturer states that it is safe for all appliances, kills bacteria, removes biofilm, is non-toxic, environmentally friendly, and leaves the appliance clean and fresh-smelling with no aftertaste. See: www.prodentclean.com. This product is long over-due. a.b.luisi,d.m.d.

Also, remember that there are 100 different appliances with 100 different levels of effectiveness. Be sure to ask your sleep dentist if he can provide you written efficacy studies for each type he is recommending, so that you don't spend your money on an ineffective "dud". The Herbst-style appliance is not one of my favorites either but it does test out relatively well in terms of effectiveness if you can get used to it. a.b.luisi,d.m.d.

I am a dentist working in dental sleep medicine. As was mentioned previously, good nasal patency(being open) is critical to the success of an oral sleep apnea appliance. If you suspect that that the air exchange through your nose is not good, an easy test is to get some Afrin nasal spray and some Breathe Right nasal stips to see if that improves things temporarily. Often times things do improve enough so that you have a clue that it is time to see the ENT doctor. Of course, this is not a definitive test and you should never do anything mentioned in this forum without the express prior approval of your health care professionals. a.b.luisi.d.m.d.