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the kind of message that erodes dentists' credibility
below is the kind of marketing i object to from dentists. notice that the description of CPAP is: a "gas mask-like device which forces air into the lungs of apnea suffers through a mask or a nose appliance." contrast that with the description of the oral appliance: "A simple intraoral device."
the dentist goes on to say that CPAP is "uncomfortable," and "noisy." i don't think this language paints a fair portrait of the choice between CPAP and an oral appliance -- it also pits one treatment modality against the other, as if it's one or the other. what do you guys think of this PR?
A simple intraoral device called a TAP 3 appliance may be a more suitable treatment choice for many patients who suffer from sleep apnea than the traditional CPAP device. CPAP is a gas mask-like device which forces air into the lungs of apnea suffers through a mask or a nose appliance. As many as 20 million Americans suffer from sleep apnea, a potentially deadly disease which ruins the quality of life of those who suffer from it as well as the lives of those around them. People with sleep apnea frequently snore very loudly as well and stop breathing for 10 or more seconds five or more times per hour during their “sleeping” period, rarely achieving the deeper stages of sleep necessary for wellness.
Colleyville dentist Dr. John Vinings has successfully treated hundreds of sleep apnea sufferers with the TAP 3 appliance over the past three years. Dr. Vinings says fewer than 40% of those who have been diagnosed with sleep apnea use the CPAP on a regular basis. Vinings says “the mask is uncomfortable and frequently dislodges when the patient turns to the side in their sleep making it ineffective. Additionally, the machine is noisy and the patient feels air being forced through their mouth and onto their face if the mask doesn’t seal properly.” All this creates a situation which many patients find is impossible to tolerate, even though without treatment, sleep apnea can lead to many other health problems such as heart disease, type 2 diabetes, depression, erectile dysfunction in men, and decreased libido in women. People with sleep apnea also have a higher number of automobile accidents than average due to the fact that they do not get restful sleep and fall asleep at the wheel frequently.
There are countless millions of Americans with sleep apnea who remain undiagnosed and untreated. In many cases, this is due to their fear that they will have to sleep each night for the rest of their lives attempting to wear a CPAP. Now, there is an effective alternative worn inside the mouth which will provide an airway which relieves the symptoms of sleep apnea. Dr. Vinings says the TAP 3 is easy to fabricate, more portable than a CPAP, and much more comfortable. Dr. Vinings works with several area physicians who specialize in sleep disorders. Many recommend the TAP 3 as treatment of choice for their patients and send patients directly to Dr. Vinings. Following initial adjustment, Dr. Vinings returns the patient to their sleep doctor for a follow-up sleep study and final adjustment of the TAP 3 appliance to insure maximum effectiveness.
The TAP 3 appliance may be your best choice in treating sleep apnea and enjoying the benefits of improved health and well being.
For more information, please visit www.drvinings.com.
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Views: 931
Replies to This Discussion
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Permalink Reply by Dr Eng on
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Hi Jay,
Oh yes, this is even after all adjustments are made to the dental appliance. Some patients who either have pre-existing TMJ issues and are slowly titrated still don't like the slight discomfort as well as those who are sensitive to any pressure against the teeth eventually stop wearing the appliance. They are also the same type of patients who refuse to wear orthodontic retainers or night guards because they are simply not as comfortable as wearing nothing at all. I even had a patient who couldn't wear it because he believed he would accidentally swallow or choke on it during sleep. He knew that it would be impossible but it was his phobia. They are a minority in the group but they still exist.
As far as occlusal adjustments for headaches, that's a whole different treatment not related to the OSA dental appliance itself. There are many causes to headaches and I do agree that if the occlusion is skewed it can be a cause. It can also be a cause to TMJ issues. Since you mentioned how bite alignment can have such a large influence on head (and I include neck and shoulder) pain, I would like to add that the teeth alignment and arch size are major contributions to OSA development. When the upper and lower arches (jaw size) are narrow, then there is less room for the tongue to reside. So during sleep when muscle control is diminished, the tongue tends to fall back and due to lack of space would crowd towards the airway. Addtionally, the width of the oropharynx is also narrower creating a smaller opening to the rest of the airway. Major oral surgery can be done where the upper and lower arches (maxilla and mandible) can be brought forward and can cure most OSA patients. An alternative to this is much more conservative but would take time is to widen the arches via a functional orthodontic appliance. Children who have obvious underdevelopment definitely should undergo such treatment preemptively to avoid having the side effect of OSA. Plus, orthodontically, the dentition would need the space for function and esthetics. For adults where the palatine suture is already fused, there is a new functional appliance that will still work. Without having to describe the mechanism involved, you can look up DNA appliance or Homeoblock appliance online. Widening the arches to create more space will certainly improve OSA severity and may even cure those with mild to moderate OSA.
Jay Polatnick said:Dr. Eng,
Have you ever considered adjusting your patients bite ? This is often the underlying cause of the issue and my wonderful dentist is going to take this route with me. I think there is another choice beyond simply a. CPAP b. Oral Appliance c. Surgery. Readjusting one's bite alignment also has effects on the central nervous system as well as frequency of tension headaches. I consider my dentist to be on the cutting edge in this regard and I feel blessed to have come across him. (see www.wholehealthdentalcenter.com
Jay
Dr Eng said:There are pros and cons to all OSA treatments, nonsurgical and surgical. There is certainly no one size fits all in any of these treatments. As far as oral appliances are concerned, most of my patients do well but not all. I've read in the past from dentists who claim 100% success rate. I have to ask to define what success is. There are many factors relating to comfort and tolerance which applies to both CPAP and oral appliance users. There is no such thing as 100% acceptance and adherence for either treatment. For me, most patients who don't do well are those who are noncompliant due to jaw or teeth discomfort even after many adjustments. Then on the other side of the spectrum, I have patients who adapted easily and refuse to sleep without the dental device. The same applies to CPAP. My patients who see me just for the dental appliance are usually those who are intolerant of CPAP and refuse to have surgery. I tell them the statistics that it is not as efficacious as CPAP especially as the OSA severity is increased. However, some improvement is better than no improvement such as when the CPAP is not used. Then again, I do have my own general dental patients whom I have refered to the sleep physician who return with the diagnosis of severe OSA and I tell them their best option is CPAP. There are also patients of mine who have large tonsils and snore and I send them to Dr Park, the otolaryngologist, for possible tonsillectomy. Then it will be his call to treat or to also refer to the sleep physician. OSA treatment should definitely be approached with a multidisciplinary teamwork amongst the health professionals. Individually we don't have all the options which is why it's critical for the patients well being that the doctors communicate and plan together with the patient.
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Permalink Reply by Rock Conner RRT on
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I worked with an AADSM-boarded dentist & became a proponent of oral appliance therapy (OAT). There are limits with regard to severity of OSA, but I've seen dozens who were frustrated w/ CPAP get relief from OAT. T used in conjunction w/ CPAP to reduce unusable pressures w/ CPAP alone (>20 for example) to manageable pressures with CPAP + OAT. It's not for everyone, but OAT is a valid therapy.
As for the slant to the article about Dr. Vinings, that's retail marketing & is similarly practiced by Respironics, ResMed, & the surgeons who seek to treat OSA with knives. Everybody pushes their own discipline to benefit their own bottom line.
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Permalink Reply by Jay Polatnick on
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Dr. Eng,
Thank you very much for this detailed reply. I think you and my private dentist see 'eye to eye' on this topic and it's good to hear another professional affirming this opinion. Your analysis was almost a mirror image of his assessment. My airway has been narrowed due to the alignment of my jaw in addition to narrow arches. You're certainly in the minority in your diagnosis. My military dentists seem to want to take the more aggressive (and more risky) approach of surgery. I don't think that latter approach is necessary nor prudent.
Thank You,
Jay
Dr Eng said:Hi Jay,
Oh yes, this is even after all adjustments are made to the dental appliance. Some patients who either have pre-existing TMJ issues and are slowly titrated still don't like the slight discomfort as well as those who are sensitive to any pressure against the teeth eventually stop wearing the appliance. They are also the same type of patients who refuse to wear orthodontic retainers or night guards because they are simply not as comfortable as wearing nothing at all. I even had a patient who couldn't wear it because he believed he would accidentally swallow or choke on it during sleep. He knew that it would be impossible but it was his phobia. They are a minority in the group but they still exist.
As far as occlusal adjustments for headaches, that's a whole different treatment not related to the OSA dental appliance itself. There are many causes to headaches and I do agree that if the occlusion is skewed it can be a cause. It can also be a cause to TMJ issues. Since you mentioned how bite alignment can have such a large influence on head (and I include neck and shoulder) pain, I would like to add that the teeth alignment and arch size are major contributions to OSA development. When the upper and lower arches (jaw size) are narrow, then there is less room for the tongue to reside. So during sleep when muscle control is diminished, the tongue tends to fall back and due to lack of space would crowd towards the airway. Addtionally, the width of the oropharynx is also narrower creating a smaller opening to the rest of the airway. Major oral surgery can be done where the upper and lower arches (maxilla and mandible) can be brought forward and can cure most OSA patients. An alternative to this is much more conservative but would take time is to widen the arches via a functional orthodontic appliance. Children who have obvious underdevelopment definitely should undergo such treatment preemptively to avoid having the side effect of OSA. Plus, orthodontically, the dentition would need the space for function and esthetics. For adults where the palatine suture is already fused, there is a new functional appliance that will still work. Without having to describe the mechanism involved, you can look up DNA appliance or Homeoblock appliance online. Widening the arches to create more space will certainly improve OSA severity and may even cure those with mild to moderate OSA.
Jay Polatnick said:Dr. Eng,
Have you ever considered adjusting your patients bite ? This is often the underlying cause of the issue and my wonderful dentist is going to take this route with me. I think there is another choice beyond simply a. CPAP b. Oral Appliance c. Surgery. Readjusting one's bite alignment also has effects on the central nervous system as well as frequency of tension headaches. I consider my dentist to be on the cutting edge in this regard and I feel blessed to have come across him. (see www.wholehealthdentalcenter.com
Jay
Dr Eng said:There are pros and cons to all OSA treatments, nonsurgical and surgical. There is certainly no one size fits all in any of these treatments. As far as oral appliances are concerned, most of my patients do well but not all. I've read in the past from dentists who claim 100% success rate. I have to ask to define what success is. There are many factors relating to comfort and tolerance which applies to both CPAP and oral appliance users. There is no such thing as 100% acceptance and adherence for either treatment. For me, most patients who don't do well are those who are noncompliant due to jaw or teeth discomfort even after many adjustments. Then on the other side of the spectrum, I have patients who adapted easily and refuse to sleep without the dental device. The same applies to CPAP. My patients who see me just for the dental appliance are usually those who are intolerant of CPAP and refuse to have surgery. I tell them the statistics that it is not as efficacious as CPAP especially as the OSA severity is increased. However, some improvement is better than no improvement such as when the CPAP is not used. Then again, I do have my own general dental patients whom I have refered to the sleep physician who return with the diagnosis of severe OSA and I tell them their best option is CPAP. There are also patients of mine who have large tonsils and snore and I send them to Dr Park, the otolaryngologist, for possible tonsillectomy. Then it will be his call to treat or to also refer to the sleep physician. OSA treatment should definitely be approached with a multidisciplinary teamwork amongst the health professionals. Individually we don't have all the options which is why it's critical for the patients well being that the doctors communicate and plan together with the patient.
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Permalink Reply by Banyon on
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Jay, Are you undergoing palatal expansion? Upper and lower? What is the cost.
Thanks.
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Permalink Reply by SleepMBA on
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I would like to see more people who get oral appliances in the sleep center in order to see the effect of the device. I've been performing sleep studies for 10 years and have not had such a patient. I've done studies to see the effectiveness of breathe-rite strips, UPPP, medications, and "other" types of surgeries. Why doesn't the dental community send people to sleep centers to see the effectiveness of their treatment?
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Locally, the most prominent sleep dentists are using portable home testing units. The sleep dentists own the units. There are other dentists who have an alliance with a sleep doc and the sleep doc provides a prescription for the oral appliance and does a followup home study.
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Permalink Reply by Mike on
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they might be worried about the patient being referred out to someone else from the sleep lab.
SleepMBA said:I would like to see more people who get oral appliances in the sleep center in order to see the effect of the device. I've been performing sleep studies for 10 years and have not had such a patient. I've done studies to see the effectiveness of breathe-rite strips, UPPP, medications, and "other" types of surgeries. Why doesn't the dental community send people to sleep centers to see the effectiveness of their treatment?
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Permalink Reply by Mark Douglas on
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Ink --- Can you give a primer on what AHI numbers mean, and what is low, moderate, and high? Do "normal people" have any AHI's at all? What AHI number would indicate you need your CPAP pressure adjusted? And what does "Periodic breathing" have to do with AHI? TYVM
j n k said:"3.4.2 To ensure satisfactory therapeutic benefit from OAs, patients with OSA should undergo polysomnography or an attended cardiorespiratory (Type 3) sleep study with the oral appliance in place after final adjustments of fit have been performed. (Guideline)
". . . data has shown that even relatively low AHI are associated with adverse health outcomes, and especially in patients with comorbid disease or risk factors, may be important. Since the rate of treatment success is not predictably high with OAs, treatment should be assessed for efficacy with objective testing. Additionally, some patients experience an increase in AHI with OA treatment. This recommendation is based on 2 level I and 5 level V studies. The reader is also referred to the recent practice parameter paper regarding indications for polysomnography."-- Practice Parameters for Oral Appliances—AASM Practice Parameters; SLEEP, Vol. 29, No. 2, 2006.
http://www.aasmnet.org/Resources/PracticeParameters/PP_Update_OralA...
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Permalink Reply by Tim on
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My dentist has oral devices available, but he says that he doesn't recommend them and he only fits them for patients who are unable to tolerate xPAP. He said that currently available oral devices are not as effective as xPAP and he won't recommend a second-best treatment unless the patient is truly unable to use or tolerate xPAP.
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Permalink Reply by Kath Hope www.hope2Sleep.co.uk on
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My dentist has sleep apnea himself and has made his own oral device. He was quizzing me about CPAP machines, as he's going to transfer to this. He told me that the oral device has been fine for a few years, but his OSA is getting worse now and he feels CPAP will be better due to this. He did point out that the oral device is not awfully comfortable either, but he did get used to it. He told me that he treats people with mild OSA with the oral devices, but moderate to high cases he always recommends they use CPAP.
Tim said:My dentist has oral devices available, but he says that he doesn't recommend them and he only fits them for patients who are unable to tolerate xPAP. He said that currently available oral devices are not as effective as xPAP and he won't recommend a second-best treatment unless the patient is truly unable to use or tolerate xPAP.
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Good to hear about those two dentists!
It would be interesting to know whether any of the many dentists beating the drum about the high effectiveness of oral appliances, will choose an oral appliance or CPAP when they develop sleep apnea. :):):)
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Permalink Reply by Connie B on
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My dentist who fits and treats with oral mouth devices for OSA also uses the device. From earlier post- My follow up sleep study was wearing the device and my severe OSA results improved incredibly. My reason for my first sleep study in 1995 was to figure out why my fibromyalgia brain will not let me go to sleep. I have had chronic insomnia for many years. After three days of sleep deprivation I was allowed short cat naps during these catnaps it was discovered I had OSA. Now due to fibro effects, as we have learned that fibro affects the CNS, I have developed central sleep apnea. If I am ever given medications that are very sedating, or have meds for a surgical procedure or treatment etc when I go to sleep I stop breathing. That is why my docs hope that if I ever get to the point I can sleep trough the night with my mouth device maybe I could tolerate wearing the CPAP mask with it for the extra O2 benefit it would provide. Some CFS patients wear nasal O2 at bedtime. My fibro/CFS specialist in Atlanta wanted this prescribed for me but my local sleep docs can’t make the connection that fibro/CFS brains work differently than the average OSA brain so they won’t prescribe it for me. However I am told there are doctors in Nashville who are more familiar with the science or treating fibro/CFS patient’s sleep apnea and they do prescribe nasal O2. Next stop Nashville…
Banyon said:Good to hear about those two dentists!
It would be interesting to know whether any of the many dentists beating the drum about the high effectiveness of oral appliances, will choose an oral appliance or CPAP when they develop sleep apnea. :):):)
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