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.
Hi Gutts. I have tried the Zquiet device. I find it quite effective. I only have moderate SA. My only complaint is that it has moved my slightly crooked bottom teeth and I have had some gum receeding especially on the tooth that moved the most. I still use it. I take breaks. I'm still looking for something that won't put so much pressure on my teeth.
I didn't try the zQuiet, but I did try a similar device: the Zyppah (for snoring. At the time I was still in denial that I probably have sleep apnea.) My plan was to try the (relatively) inexpensive device and if successful, visit my dentist and invest in a professionally fitted, custom device. The Zyppah was marginally effective in reducing my snoring but it became increasingly uncomfortable to wear. I had read advice that said it would take some time to get used to and was prepared to tough it out but it was getting more and more uncomfortable instead of less and less. When I noticed two of my front teeth were loose, I threw the thing away and GOOD RIDDANCE!
It wasn't all bad. The experience did help me emerge from denial that I (most likely) have sleep apnea. My New Year's resolution is to get a sleep study and begin PAP therapy. Everyone else must have the same resolution. The sleep clinic couldn't get me in with one of their docs until March but at least I got it booked. I'm looking forward to sleeping better in the spring.
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.
I must post a comment on side-effects with oral appliances (OAs). As Dr. Luisi stated, these devices put significant force on the teeth because they all began life as orthodontic appliances in the 1970’s (based on a device actually invented in 1909). That being said, all OAs, regardless of who makes them, have the possibility of moving teeth and actually moving the entire lower jaw. What we do know is that people with advanced gum disease and resulting bone loss will rapidly see tooth movement (and even lose teeth). Those who undergo orthodontic therapy after the age of 21 have a 99% change of developing tooth movement with the use of an OA. It occurs least in those with a healthy dentition and never had orthodontic therapy.
Long term studies, looking at patients who have used an OA for more than 10 years, find that the side-effects of OAs increase with the time used. Those using an OA for 10 years had much more tooth movement than those using it for 2 years. Patients who used the OA all night long had more tooth movement than those who used it for 4 hours/ night.
Dr. Luisi is correct that a qualified dentist (www.aadsm.org/dentistqualified.aspx) can help choose an OA that can limit forces on individually weakened teeth or spread the forces out over all the teeth. This should help limit tooth movement and unwanted side-effects. A qualified dentist can also monitor changes in your jaw alignment and warn you that there might be problems since the majority of people do not feel any problem until it is very advanced.
My favorite treatment regimen in those who use CPAP for 4 hours each night is for them to use CPAP for the time they can and then switch to their OA for the rest of the night. This get a patient treated all night long and limits the side-effects of either treatment.
To mitigate the tooth movement effects of oral appliances, I feel that it is very important to use a resetting appliance in the morning after using an oral appliance all night. My resetting appliance of choice happens to be the A.M. Aligner supplied by Airway Management. Basically, it is a pink wafer that is heated and used to record what your bite and tooth alignment is pre-appliance. It is inserted about 30 minutes after the OA is removed and used for 5 to 10 minutes. The A.M. Aligner returns your bite and your tooth positions back to where it was the night before. It has been my experience that, if patients use it every day properly, they seldom have significant tooth movement or bite change, assuming that their bone support of the teeth and their periodontal condition was acceptable to start with. Of course there are no 100% guarantees about it though. Arthur B. Luisi, Jr., D.M.D.
Since this post is about OTC appliances, I want to talk about a very important aspect of it. Obstructive sleep apnea is a VERY big deal. It has ended people's jobs, it has ended people's marriages, it has ended people's lives. I think that sleep dentists have been too polite about the issue of which appliances really work for far too long. If a patient is offered an appliance with a success rate of 25% vs. one with a success rate of 84%, the repercussions could be devastating for him. This has to stop. The current oral sleep apnea appliance landscape is like the Wild West. You have minimally regulated OTC "anti-snoring" appliances of all kinds on the internet. It is a poorly kept secret that significant numbers of people with suspected or diagnosed OSA are self-treating with these appliances because of the low cost, "Wink. Wink". This simply should not be allowed to happen in my opinion. The F.D.A. "clearance" procedure for actual OSA appliances is so weak that it is basically a farce. In my view, EVERY manufacturer of oral sleep apnea appliances should be required by law to submit independent, third party, peer-reviewed efficacy data to the F.D.A. as a pre-conditon to entering the market. There should be stringent minimal standards for appliance efficacy. If you can't meet them, you can't sell the appliance. Period. Now, the manufacturers will say that the testing is too expensive. NOT OUR PROBLEM. Patients would be better served by having a more limited selection of safe, high quality, effective appliances to choose from anyway. Arthur B. Luisi, Jr., D.M.D.
To date there is no scientific study that shows use of a morning repositioner helps to minimize tooth and jaw movement. There is a study being funded at the University of British Columbia to see if use of a morning aligner decreases morning side-effects. They are also looking at whether patients actually use the repositioner. Orthodontists argue that use of an morning realigner puts increased forces on the teeth and may actually do damage. We just don't know. That is why a scientific study is required. Like Dr. Luisi, I always give patients a morning realigner and encourage its use. Some people use if every morning, others never use it. I like to believe that use of a morning realigner makes a difference, but 'belief' has no place in medicine.
Very interesting point. I have been answering questions on these forums for many years and do try to only make assertions that are scientifically supportable. In this case, I thought that the efficacy was self-evident, but apparently not. I would say that common sense tells you that if you have an aligner with holes in the matrix for each tooth and the teeth continue to fit into the same holes, the teeth couldn't have moved very far. At least I would think so, but maybe not? I definitely agree that compliance is a problem with the aligners. This would be anecdotal from my practice, but the patients that are very compliant with the aligners don't seem to get into much trouble and some of the non-compliant people in my practice are the ones have gotten the tooth movement and bite change. But over-all, bite change and tooth movement haven't been a big problem. Ultimately, it gets down to the patients' priorities. If a patient is CPAP intolerant and gets good results with an oral appliance, is the risk of some tooth movement and some bite change a fair trade off for a good night's sleep, waking up refreshed in the morning, having good daytime energy, and taking heart attack, stroke, AFIB, etc. off the table a worthy trade-off. I think that many patients have and would say yes, providing that it is an informed choice. Arthur B. Luisi, Jr., D.M.D.
