Replies to This Discussion

Permalink Reply by Dr. Richard Charmoy DMD on February 18, 2009 at 9:09pm

Juanita said:

I have moderate sleep apnea & have successfully used a CPAP machine with a nasal mask for around 5 years. I will not try to sleep without it. Although I am a compliant patient, it would be nice to be able to switch to a dental appliance. Years ago I had asked my doctor about dental appliances and he recommended the CPAP over dental appliances although he was willing to refer me to someone to a dental appliance specialist.

He had some concerns about TMJ at my then young age of 30 something (age & length of use was a factor to him). When I asked about using it part time such as on vacation etc. he was not keen on the idea. His opinion was either one or the other.

My questions are:
1) Have dental appliances improved over the past 5 years?
2) If I am currently a successful compliant CPAP user, is it better to keep using the CPAP & not try the dental appliance (I'm not concerned about the expense if there is a good possibility of improving quality of life).
3) Do you agree that I shouldn't try to switch back & forth between these 2 types of sleep apnea solutions? The only reason 2 swtich back & forth would be to help prevent TMJ.
4) Is TMJ or other dental issues a valid concern when using dental appliances?

Thanks for you help,

Juanita

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Permalink Reply by Dr. Richard Charmoy DMD on February 18, 2009 at 9:15pm

If you have no problem with CPAP it is still the best for sleep apnea. A
It that being said the appliances have improved and continue to improve. Many people do use dental appliances when there CPAP maybe in appropiate to use. Hopefully this answers your questions.

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Permalink Reply by Dr. Richard Charmoy DMD on February 18, 2009 at 9:17pm

Eric Hyman said:

Dr. Richard Charmoy DMD said:

I am all in favor of mandibular advancement appliance provided the dentist is aware of what he is doing. We are constantly getting flyers about making these appliances to help our patients.. I have studied this extensively with some of the top sleep dentist in the country. If the proper appliance is made and considerations for TMJ situation you should have
no problems. All of the appliances I make I take this into consideration therefore avoiding TMJ problems. If they do occur most resolve themselves within a week or two. I am in Central Jersey it takes me 45 minutes from NYC, my practice is in Somerville. I use both lab testing at our local Sleep for life Center apart of Somerset Medical Center and also ambulatory sleep studies. Obviously if a patient has cardiac or other medical conditions I would prefer a sleep lab test.Since sleep apene is a life threatening condition there are not many dental situation to prevent the fabrication of these appliances. I have made them on patients who have no teeth and patients who have periodontal conditions. I define success two ways one by patients epsworth and berlin tests, family and the patients reporting back to me. Secondly I like a lab or ambulatory test to quantify my numbers and compare to original sleep study, RDI/ AHI etc.Insurance is a trety situation they look at a dentist making a medical device, however I have a computer program that will generate a 30 page report including pictures and sleep studies, and all oral cavity related situations that can be a cause of sleep apnea. Over 15 years of making these appliances with really the majority within the last 5 years not one patient on follow up tell me they are not using the appliance. I get quotes of you have changed my life and my families. My spouse now sleeps with me, I am rested, I am now excersizing everyday and am rested. If you wish to contact me further my e-mail is rcharmoy@drcharmoydmd.com.
I am here to help you and your patients in anyway.
Dr. Charmoy

I am about to start CPAP this week (baseline AHI =40, min 02 =84%). I had a consultation yesterday with a dentist who is recommending a Somnomed, which I will receive on March 12. I have TMJ and bruxism (am currently using an NTI) and the dentist assured me we will proceed slowly with Somnomed use and adjustments, but I still have concerns that it may aggravate the TMJ. Still is there much risk of worsening the TMJ even with gradual acclimatization or would the Somnomed be likely to improve the TMJ by reducing grinding. I am, however, interested in the potential for eliminating the CPAP at least during travel if not on a daily basis -- how realistic is this with severe obstructive apnea and normal weight (5'6", 138 lb)?

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Permalink Reply by Dr. Richard Charmoy DMD on February 18, 2009 at 9:20pm

The somnomed appliance with anterior ramp should elevate and help any problems you may have.

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Permalink Reply by Dr. Richard Charmoy DMD on February 18, 2009 at 9:22pm

Eric Hyman said:

Dr. Richard Charmoy DMD said:

I am all in favor of mandibular advancement appliance provided the dentist is aware of what he is doing. We are constantly getting flyers about making these appliances to help our patients.. I have studied this extensively with some of the top sleep dentist in the country. If the proper appliance is made and considerations for TMJ situation you should have
no problems. All of the appliances I make I take this into consideration therefore avoiding TMJ problems. If they do occur most resolve themselves within a week or two. I am in Central Jersey it takes me 45 minutes from NYC, my practice is in Somerville. I use both lab testing at our local Sleep for life Center apart of Somerset Medical Center and also ambulatory sleep studies. Obviously if a patient has cardiac or other medical conditions I would prefer a sleep lab test.Since sleep apene is a life threatening condition there are not many dental situation to prevent the fabrication of these appliances. I have made them on patients who have no teeth and patients who have periodontal conditions. I define success two ways one by patients epsworth and berlin tests, family and the patients reporting back to me. Secondly I like a lab or ambulatory test to quantify my numbers and compare to original sleep study, RDI/ AHI etc.Insurance is a trety situation they look at a dentist making a medical device, however I have a computer program that will generate a 30 page report including pictures and sleep studies, and all oral cavity related situations that can be a cause of sleep apnea. Over 15 years of making these appliances with really the majority within the last 5 years not one patient on follow up tell me they are not using the appliance. I get quotes of you have changed my life and my families. My spouse now sleeps with me, I am rested, I am now excersizing everyday and am rested. If you wish to contact me further my e-mail is rcharmoy@drcharmoydmd.com.
I am here to help you and your patients in anyway.
Dr. Charmoy

I am about to start CPAP this week (baseline AHI =40, min 02 =84%). I had a consultation yesterday with a dentist who is recommending a Somnomed, which I will receive on March 12. I have TMJ and bruxism (am currently using an NTI) and the dentist assured me we will proceed slowly with Somnomed use and adjustments, but I still have concerns that it may aggravate the TMJ. Still is there much risk of worsening the TMJ even with gradual acclimatization or would the Somnomed be likely to improve the TMJ by reducing grinding. I am, however, interested in the potential for eliminating the CPAP at least during travel if not on a daily basis -- how realistic is this with severe obstructive apnea and normal weight (5'6", 138 lb)?

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Permalink Reply by Dr. Richard Charmoy DMD on February 18, 2009 at 9:30pm

I have had success with patients that have sleep studies showing severe sleep apnea. However CPAP is the best tool for sleep apnea . The dental appliances help and I am in favor of them for people who can't use CPAP at least it will help, relief or success is measured many ways but it all depends on what your level of success is along with your doctors measurements of AHI and RDI.

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Permalink Reply by Dr. Richard Charmoy DMD on February 18, 2009 at 9:32pm

Gary Caselman said:

I have been searching for an alternative to the CPAP machine which I hate by the way. I end up fighting that all night. I live in the midwest and have searched for local dentists but only one locally and the appliance wasn't covered under insurance.

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Permalink Reply by Dr. Richard Charmoy DMD on February 18, 2009 at 9:33pm

Gary Caselman said:

I have been searching for an alternative to the CPAP machine which I hate by the way. I end up fighting that all night. I live in the midwest and have searched for local dentists but only one locally and the appliance wasn't covered under insurance.

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Permalink Reply by Dr. Richard Charmoy DMD on February 18, 2009 at 9:35pm

Gary Caselman said:

I have been searching for an alternative to the CPAP machine which I hate by the way. I end up fighting that all night. I live in the midwest and have searched for local dentists but only one locally and the appliance wasn't covered under insurance.

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Permalink Reply by Dr. Richard Charmoy DMD on February 18, 2009 at 9:36pm

Dr. Richard Charmoy DMD said:

Gary Caselman said:

I have been searching for an alternative to the CPAP machine which I hate by the way. I end up fighting that all night. I live in the midwest and have searched for local dentists but only one locally and the appliance wasn't covered under insurance.

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Permalink Reply by Dr. Richard Charmoy DMD on February 18, 2009 at 9:39pm

Health insurance is tough to deal with a good sleep dentist knows his way around using medical insurance under dental codes. There is a crossover which allows for dentist to fabricate these appliances for medical purposes.

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Permalink Reply by Linda Osborne on April 8, 2010 at 9:40am

Thanks so much for that info. I just went to my dentist to investigate this. I am seriously considering it so that is good to know.

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