Oral Appliances

Have you ever seen a CPAP in action? Just visit www.youtube.com and search under "CPAP" or "Sleep Apnea" and you will observe firsthand what a nuisance this type of treatment can be. Although effective, the idea of wearing a bulky appliance and active pump can almost be as big of a distraction as the snoring itself.

Oral appliance therapy is arguably the best treatment option available for patients when taking into account both treatment efficacy and patient compliance.

The American Academy of Sleep Medicine (AASM) recognizes oral appliances as a first line treatment for mild to moderate sleep apnea.

"Although not as efficacious as continuous positive airway pressure (CPAP), oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to CPAP, or who do not respond to CPAP, are not appropriate candidates for CPAP, or who fail treatment attempts with CPAP or treatment with behavioral measures such as weight loss or sleep-position change"

Advantages of Oral Appliance Therapy

The advantages of oral appliance therapy are clear. The patient is offered a non-invasive, reversible, solution that requires minimal effort to comply with. In addition to the obvious benefits of eliminating snoring, reducing apnea and improving the quality of sleep, there are other great benefits of OAT.

High Compliance - 3 year compliance with oral appliances has been documented by various studies at nearly 70%. CPAP compliance after just one year is said to be 35%

Favorable compared to CPAP - In a study published in Chest (Clark, 1996) it was noted that patients preferred oral appliances over CPAP twenty to one.

Highly Effective - As discussed already, appliance efficacy can be as high as 90%.

Portable - CPAP is a cumbersome device, especially for people traveling. Oral Appliances are simple and easy to pack away in your toiletry kit.

Easy to Use - There are no buttons to push or equipment to learn how to set up/take down.

I do not want to wear a CPAP, how can Dr. Agatep help me?

Dr. Agatep is trained to treat patients with mild to moderate cases of Sleep Apnea and Snoring. Her strategy is to use Oral Appliance Therapy in order to re-position the mandible, advancing the tongue from falling back and creating blockage. Currently there are a number of FDA approved appliances to choose from, and after careful analysis, Dr. Agatep can make a recommendation which option would be best.

 

Fig 1: Example of Full Breath Oral Appliance

 

I am interested in Oral Appliance Therapy, what is the next step?

Step 1: Schedule a visit to the office for a brief consult with Dr. Agatep. At the office you will undergo a series of diagnostic screening tests in order to establish candidacy for a sleep study.

Step 2: If you are a candidate, Dr. Agatep will refer you to a qualified sleep center where you will be observed for a sleep study. The sleep center will then forward the results of your test to Dr. Agatep.

Step 3: Return to the office to go over the results with Dr. Agatep. If you are interested in progressing with the treatment, Dr. Agatep will then draw out a treatment plan in order to facilitate the construction of your oral appliance. This treatment plan will include "training" your bite for optimum position in order to open up your airway. Once this position has been measured, a mold will be taken and sent to the lab for fabrication.

Step 4: Within 14 working days, the final appliance will be delivered and fitted. Results should be immediate, but may require follow up visits for final adjustments. This will be a work in progress, but efficacy has been shown to to be upwards of 90% for compliant patients.

Step 5: Enjoy a restful sleep! You will be periodically monitored by Dr. Agatep to make sure treatment is progressing as planned.

Will this be covered by my insurance?

Many medical insurances (not dental) will cover this in lieu of CPAP treatment. Each case is different, but we can help you deal with details.

Are there any side effects?

No treatment is perfect, oral appliances included. Most of the problems associated with oral appliance therapy are either minor/temporary or can be alleviated by qualifying the patient properly and selecting the right appliance.

Excess Salivation at Night (drooling) - This is a very common side effect of OAT. The good news is that most of the time it is temporary and should not continue for more than a few weeks as you adjust to your new appliance.

General Discomfort - Usually due to the appliance fitting improperly. Small adjustments to the acrylic in the office can usually fix this problem.

Tooth Damage - Usually happens when the patient is a bruxer (grinder) and the appliance used does not allow enough lateral mobility.

TMJ Problems - The single largest concern of dentists is creating a TMJ problem with an appliance. It is important to evaluate TMJ conditions prior to creating an appliance so any pre-existing conditions are recognized. Dr. Agatep is SPECIALLY TRAINED to treat TMJ using advanced Neuromuscular techniques. This advanced training combined with appliance therapy can help reduce future TMJ problems. For more information on TMJ visit our Neuromuscular section.

Occusal Changes - Usually caused by excessive advancement of the mandible. Although most patients will note a small occlusal change in the morning, this should not last more than 30 minutes. Chewing or clenching the molars together works to return the bite to normal for most people.