Oral Appliance Therapy – Overview

Unlike most offices that use a single appliance, the dentists in the Pittsburgh Dental Sleep Medicine use several different oral appliances, choosing the one that is best for you. The choice of oral appliance is made after a thorough medical history, oral examination and years of past experience.

appliance1Oral appliances have been in use for over 30 years to effectively treat snoring and obstructive sleep apnea. Currently, over 100 different appliance designs are available to specially trained dentists for this use. Many scientific studies have been published that demonstrate the effectiveness of these appliances when utilized by trained and experienced sleep-disorders dentists.

The oral appliance is placed in the mouth much like an orthodontic retainer or an athletic mouth guard. It is utilized during sleep to prevent the collapse of the tongue and soft tissues in the back of the throat so that the breathing passages stay open during sleep. The appliance promotes adequate air intake thereby helping to allow normal sleep for those who suffer from snoring and/or obstructive sleep apnea. Oral appliances can be used alone or in combination with CPAP, or after surgery. Determination of proper therapy is best made by joint consultation between your sleep-disorders dentist and your physician.

All appliances utilized by Pittsburgh Dental Sleep Medicine dentists are FDA cleared.

Types of oral appliances

Of the many appliances available today, each falls under one of two categories based on mode of action. The first and largest category is that of the “mandibular repositioning device”. By far the majority of all appliances in use today fall into this category. These devices serve by gently repositioning the lower jaw forward during sleep. The second category is that of the “tongue retaining device”. These appliances are seldomly used but can be effective occasionally. The tongue retaining devices function by engaging the tongue directly and holding it in a forward during sleep.

Below are shown some of the appliances utilized by Pittsburgh Dental Sleep Medicine:

Medley Gold

Medley Gold

Narval

Narval

Thornton Adjustable Positioner (TAP)

Thornton Adjustable Positioner (TAP)

SUAD

SUAD

What to Expect During Treatment

The first step in being treated for snoring or obstructive sleep apnea is to obtain an evaluation by a physician who will provide a formal diagnosis based on a medical sleep study. After that, an evaluation by a sleep-disorders dentist will determine whether you are a good candidate for oral appliance therapy and which oral appliance will be most effective for you.

Your first dental appointment will involve a discussion of your sleep apnea condition, review of your medical status and a detailed focus on the advantages, limitations and risks of oral appliance therapy. Different appliance types will be discussed and one x-ray will be taken of your teeth and jaw joint. A thorough examination of your teeth, jaw joint and bite will be performed. Impressions will be taken of your teeth for fabrication of the appliance and a photograph will be taken of your bite.

Your second appointment will involve custom fitting the oral appliance and learning how to use and care for it.

After that, you will return in approximately 4 weeks for a follow-up visit to monitor the effects of the appliance and to make any necessary adjustments to ensure comfort and effectiveness.

Ultimately, when the snoring and daytime sleepiness have been improved, you will be referred back to your physician for a follow-up sleep study to ensure the effectiveness of the appliance. You will be evaluated again in 6 months and then annually to ensure adequate long-term success and to monitor any possible side effects.

Choosing a Dentist

Snoring and obstructive sleep apnea can be serious medical problems. Improperly treated obstructive sleep apnea can increase the risk for heart attack, stroke, diabetes, daytime sleepiness and other serious illnesses. Choosing a sleep-disorders dentist who is qualified to work with your physician is essential to your health or the health of a loved one.

The dentist you choose to treat your problem with sleep-disordered breathing must be properly educated and have adequate experience. Legally, any dentist can treat snoring and/or sleep apnea with an oral appliance, however, that does not mean that every dentist has the necessary experience and training to provide proper therapy. Because no special qualifications are required, it is your responsibility to choose your dentist wisely.

A qualified sleep disorders dentist should have:

  • appropriate knowledge of sleep medicine
  • adequate training in oral appliance therapy
  • experience with many different appliance types
  • solid relationships with local sleep labs and sleep physicians
  • current knowledge of emerging trends
  • ability to derive maximum insurance benefits for you
  • a team approach with other professionals
  • a proven follow-up system to ensure healthy long-term results
  • in-depth knowledge of oral appliance research

 

Patient Instructions

Your Pittsburgh Dental Sleep Medicine dentist will carefully follow and guide your progress throughout your treatment. You will be seeing in the office several times to ensure acceptance, comfort and effectiveness of the therapy. Instructions will be given on the proper adjustment of the appliance and any areas of concern will be addressed. The objective will be to resolve your snoring and daytime sleepiness through gently and gradually repositioning your lower jaw.

Care of your oral appliance

Your oral appliance is easy to care for. Each morning, simply brush it with a toothbrush and toothpaste. Rinse it well and allow it to sit in its case all day with the top open. Be sure it is up, out of the way, where no curious dogs can chew on it! Avoid extremes of temperature.

Examine your appliance frequently and call your sleep-disorders dentist if you observe any broken or bent areas.

Daily Jaw Exercises

Very often patients find that they are unable to close their teeth completely in the morning immediately after removing the appliance. This is normal and is due to a temporary jaw joint change and some transient microscopic tooth movement. This will generally resolve on its own in 15 to 30 minutes as the joint and teeth drift back into their normal positions. After 30 minutes (not sooner) jaw exercises are helpful to reestablish joint position and good tooth contact. This can be accomplished by several minutes of clenching on a morning aligner that will be fabricated for you at the time the appliance is delivered.

Side Effects

Most of the side effects encountered during appliance use are minor and temporary and do not preclude use. They include tenderness to teeth, muscles and jaw joint.  Loose dental work may become dislodged. Dry mouth and increased salivation is also noticed frequently but is generally not a major issue. As mentioned above, teeth may not meet properly for 15 to 30 minutes after first removing the appliance after a nights use. Occasionally bite changes can become permanent but are generally minimal.  Your sleep disorders-dentist will work with you to manage these occurrences and minimize any problems.

When to Call the Office

Please feel free to call the office any time you have a concern that you feel needs personal attention. You can also contact us by email at info@pittsburghdentalsleepmedicine.com. We check emails often and will try to respond within 24 business hours. In this way we can quickly and easily answer any questions or suggest you schedule an appointment to make an office visit. We are here to help you!

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