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Dental Sleep Appliances
I have made close to 200 dental appliances for sleep apnea. I am a dentist who has taken a big interest in this field. I have attented hours of lectures on the topic. I have had 100% success not one patient doesn't like the appliance. Everyone and studies show improvements. It is a option that anyone who can't wear CPAP should look into.
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Replies to This Discussion
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Permalink Reply by Dave on
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You mention the ambulatory sleep studies. Which device do you use and why?
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Yup,,,, at least 80 appliances.
Probably 5 to 10 appliance are used by Dentist,,,, TAP, Somnomed, Respire, EMA, Full Breath and Suad (The are lab fabricated) and the Norad as a boil and bite (must be from a doctor)
The docotrs should ask you some qeustions and then figure what will work better for you. Also its not always the appliance and it is WHAT Position did the dentist put you in.
You can look at www.dentalsleepclinics.com to find a dentist
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Dr. I was under the impression dental devices should be considered for patients with Mild obstructive sleep apnea. Not anyone who cant tolerate cpap therapy.
Are you recommeneding the dental device for Moderate or Severe OSA? How about patients with mixed sleep apnea such as Central / Obstructive or those diagnosed with only Central sleep apnea? Do you recommend this device to patients who use Bi-level therapy? How do you address (identify or treat) possible nocturnal oxygen desaturation asscociated sleep apnea?
Lastly, how do you measure 100% success, clinically or patient report?
Thank you.
Donnie B. RRT-RCP
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I have used the SomnoMed in mild and severe OSa. It is my belief if a patient isn't going to use CPAP at all, then whatever I am able to achieve with a oral device then it would be aiding the patient to some degree. I have been amazed at some patient who come in classified as severe OSA over weight and I amke an SomnoMed oral device and we eliminate the snore and get there AHI and RDI below 10 when initially they were above 60. Each patient responds differently and can not be classified one way or another when treating with an oral device.
When I state a 100% success it is a combination of patient and quantifying results through a multi night study with a Watermark/Ares ambulatory sleep study. I hav enot had any patient who have not been satisfied or who have stated in six years of follow up that they have stop wearing thetre appliances in fact they state they can't sleep with out them. The sllep study which is done at home is done for three nights again it is my belief that every night gives a different pattern of sleep, so getting multiple nights allows me to see what is really going on. Many of the sleep docs who refer to me in the begining use to require the patients to have a PSG after my treatment and titration of appliance, they were getting great result with conclusion of absent of OSA as long as patient use sleep appliance.
Donald R. Byrd said:Dr. I was under the impression dental devices should be considered for patients with Mild obstructive sleep apnea. Not anyone who cant tolerate cpap therapy.
Are you recommeneding the dental device for Moderate or Severe OSA? How about patients with mixed sleep apnea such as Central / Obstructive or those diagnosed with only Central sleep apnea? Do you recommend this device to patients who use Bi-level therapy? How do you address (identify or treat) possible nocturnal oxygen desaturation asscociated sleep apnea?
Lastly, how do you measure 100% success, clinically or patient report?
Thank you.
Donnie B. RRT-RCP
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Permalink Reply by Mary Z on
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Dr. Charmoy, how many of your patients have been lost to follow up? I can't think of many medical/dental procedures that can claim 100% success and 100% follow up. I just cannot believe that not one of your patients has had less than 100% success and not one has been lost to follow up.
Mary Z.
cite>Dr. Richard Charmoy DMD said:I have used the SomnoMed in .
When I state a 100% success it is a combination of patient and quantifying results through a multi night study with a Watermark/Ares ambulatory sleep study. I hav enot had any patient who have not been satisfied or who have stated in six years of follow up that they have stop wearing thetre appliances in fact they state they can't sleep with out them.
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Mary Z said:Dr. Charmoy, how many of your patients have been lost to follow up? I can't think of many medical/dental procedures that can claim 100% success and 100% follow up. I just cannot believe that not one of your patients has had less than 100% success and not one has been lost to follow up.
Mary Z.
cite>Dr. Richard Charmoy DMD said:I have used the SomnoMed in .
When I state a 100% success it is a combination of patient and quantifying results through a multi night study with a Watermark/Ares ambulatory sleep study. I hav enot had any patient who have not been satisfied or who have stated in six years of follow up that they have stop wearing thetre appliances in fact they state they can't sleep with out them.
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You are right over the period of time that I have been making these devices not all patients have returned for follow up. We use a dual method for those who do not come in we send a survey to and or we follow up with there referring doctor. Using this method has allowed me to have contact with minimal % of no responce or follow up. Even had patient who was transfered t China who has continued to keep in touch on progress. Let me retract and say that 100% is with a margin or error of +/- 5-10%. Still great success. In my book
Dr. Richard Charmoy DMD said:Mary Z said:Dr. Charmoy, how many of your patients have been lost to follow up? I can't think of many medical/dental procedures that can claim 100% success and 100% follow up. I just cannot believe that not one of your patients has had less than 100% success and not one has been lost to follow up.
Mary Z.
cite>Dr. Richard Charmoy DMD said:I have used the SomnoMed in .
When I state a 100% success it is a combination of patient and quantifying results through a multi night study with a Watermark/Ares ambulatory sleep study. I hav enot had any patient who have not been satisfied or who have stated in six years of follow up that they have stop wearing thetre appliances in fact they state they can't sleep with out them.
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I use the Somnodent successfully for my diagnosis of UARS. I was desperate to find help, as the CPAP seemed to be making my symptoms worse. I have seen UARS described as a hypersensitive nervous system that causes arousals due to increased efforts to breath. In that case it only makes sense that adapting to a CPAP would be extra challenging. When I woke up the first morning after using the dental device, my arms and legs felt heavy and relaxed (I couldn't remember feeling like this before) and I wanted to stay in bed, not because I was tired, but because I felt so good. My body had not been struggling to breath all night long. I stopped falling asleep whenever I sat down and could watch an entire tv show or go to a performance without missing out. I love to read, and I was no longer falling asleep on my book.
I would like to see more studies on treatment of UARS with the adjustable mandibular advancement devices.
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I do agree Dr. Charmoy, wish you were in VIrginia. I have a question, Due to surgery on the top of my head (DBS implant, surgery in two parts) incisions on top of my head I have not been able to wear my mask due to incisions on the top of my head where one of my mask straps goes. After an extended period without my CPAP I am feeling lousy and am facing another three to four weeks without CPAP. Can you recommend any over the counter/mailorder appliance available (boil and bite) which might at least help somewhat during this period?
Thank you for your kind response to my query about your follow up numbers. I guess I was expecting some cons along with the advantages of sleep appliances, but maybe those cons come more at the hands of a Dentist without your expertise.
Thanks, Mary Zimlich
Dr. Richard Charmoy DMD said:You are right over the period of time that I have been making these devices not all patients have returned for follow up. We use a dual method for those who do not come in we send a survey to and or we follow up with there referring doctor. Using this method has allowed me to have contact with minimal % of no responce or follow up. Even had patient who was transfered t China who has continued to keep in touch on progress. Let me retract and say that 100% is with a margin or error of +/- 5-10%. Still great success. In my book
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Thst is great Doctor Charmony,,,,,, if you need a doctor not in Doctors Charmos area just look at www.dentalsleepclinics.com If i was you i would use more then just the somnodent. Some patients will do and feel better with other appliances.
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If you can't use your cpap machine for whatever reason - you might consider consulting with your doctor and trying just going on O2 via nasal cannula. Your doctor should be able to get you that prescription, then, have them do a couple nights of pulse oximetry to see how you're doing. Better yet - there are newer, smaller PSG machines around like the Alice PDx that actually do more than just pulse oximitry - they have breathing straps and ekg leads/etc are optional. This is for patients who don't do well in a "lab" setting.
Just thought I'd toss that out there for you as well...
Carl
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Mary,
There are several over the counter boil type devices, some use a velcro type of material to position your lower jaw in a forward position. What is good about this type or any that allows you to adjust the position is that if you have any discomfort in you TMJ ( jaw joint) you can reposition the lower portion so your jaw isn't advanced so far forward. Be careful of any device which you can not adjust. google for these. Good luck
Mary Z said:I do agree Dr. Charmoy, wish you were in VIrginia. I have a question, Due to surgery on the top of my head (DBS implant, surgery in two parts) incisions on top of my head I have not been able to wear my mask due to incisions on the top of my head where one of my mask straps goes. After an extended period without my CPAP I am feeling lousy and am facing another three to four weeks without CPAP. Can you recommend any over the counter/mailorder appliance available (boil and bite) which might at least help somewhat during this period?
Thank you for your kind response to my query about your follow up numbers. I guess I was expecting some cons along with the advantages of sleep appliances, but maybe those cons come more at the hands of a Dentist without your expertise.
Thanks, Mary Zimlich
Dr. Richard Charmoy DMD said:You are right over the period of time that I have been making these devices not all patients have returned for follow up. We use a dual method for those who do not come in we send a survey to and or we follow up with there referring doctor. Using this method has allowed me to have contact with minimal % of no responce or follow up. Even had patient who was transfered t China who has continued to keep in touch on progress. Let me retract and say that 100% is with a margin or error of +/- 5-10%. Still great success. In my book
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