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Oral Appliance - Teeth Shifting, Pain, Wisdom Teeth, Space Between Teeth


     I've been using an oral appliance and have been happy with it for the most part.  The first few weeks were tough (uncomfortable teeth sensitivity), but it got better.  I feel like my teeth have shifted a bit.  Especially the ones in the back.  I'm using the Somnodent.  I had some pain in the region at border of my molars and hidden wisdom teeth (still got em) on upper right side last night and decided not to use the appliance last night.  The pain went away.  What have you guys seen?  How much can I really expect from my dentist to sort all this out?  I had them thin out the front part of the appliance touching my front bottom and top teeth.  I feel like the fit will never be ideal...not saying isn't worth it, just curious about people's experiences.

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good question -- i am inclined to conduct an informal poll on this if nobody responds soon. we'll get you an answer. no worries.
Hi,

I have been using a Somnodent for a year now with fabulous results...I LOVE my appliance. The appliance is similar to a retainer, and it has been custom-fit, so maybe the shifting you are experiencing has more to do with your bite changing. My sleep dentist specializes only in this area. They issued specific mouth exercises to do in the mornings to prevent/minimize alignment changes. I had not been doing them because I had no morning-after issues, and they emphasized that the exercises were critical...they are very simple and very specific. A dentist fitting and issuing this type of appliance should be knowledgeable about changes associated with it. FYI: One issue I did experience occurred 6 months after starting with the Somnodent...my cheeks along the upper lip line became very irritated and inflamed. The area matched the track of the rubber bands, which contained Latex. Since then, my dentist has switched all of his rubberbands to latex-free.
I was on the CPAP for a couple of years, (full face mask) with no problems. Then recently I started to notce sensitivity in my teeth and shifting of my teeth. I asked my sleep doctor and dentist. They were both clueless. They said that adult tetth do shift at some point. I stopped the CPAP as I did not want to have "buck teeth". The sensitivity continued and my teeth continued to shift outward. My speech changed. I now realize that during my sleep my tongue stiffens and puts forward pressure on my front teeth. Whether this is due to interior tongue conditioning during my CPAP usage or just plain tension, I do not know, but I have been very upset with the lack of concenr from the medical field.

I have taken other actions to reduce the need for a CPAP including losing 20 pounds so far with another 30 to go. I would really like to keep using the CPAP, but want to make sure it is not the cause of my problem.
The Somnodent is an excellent appliance for the mandibular advancement type of appliance therapy. One of the best in my opinion. Worn nightly for long periods will cause a risk of changing the bite. This is one of the first things your professional who delivers the appliance should debrief you on.
In most cases, the patient has preferred this to the options.
One thing that I will add to my comments, is the new Oral Breath appliance developed by Dr. Keropian in the L.A. area. It is a single (one piece) appliance being used largely on the lower arch that uses tongue depression instead of mandibular advancement to achieve the desired open airway.
One would think that this would feel "gaggy". It does not. I depresses the tongue in a non-sensitive area that does not touch the soft palate which causes the gag reflex. This is also an option in patients who deal with TMJ issues.
I've been using the Somnomed since last June. I had no problem getting adjusted to it, which has made compliance easy for me. I do feel there has been some shifting of teeth, which is apparent when I floss between certain teeth. My main issue is that it hasn't helped much. At one point, we had to send it back to permit further advancement. When it came back, it was uncomfortable, and the dentist had to file the part in front that you are describing. We now have it fully titrated (advanced to the maximum position) and I'm still experiencing a poor quality of sleep. I am currently considering giving CPAP another chance, using it in conjunction with the oral applaince. (See my discussion on CPAP Second Trials). By all means, speak to your dentist and tell him about the problems you are experiencing. He should be able to help you.
I am a dentist who has made hundreds of SomnoMed oral devices. I have not had one patient who has experience what you are stating. If you think your teeth have shifted then the appliance is acting like a orthodontic movement device. When in your mouth the device should not exert any pressure on any teeth. If after you take it out your bite doesn't feel correct that is normal and should correct it self, by using the excercise bite tabs, or chewing sugar less gum. If you are unsure of your dentist, find out if he is a trained SomnoMed dentist and if he is a member of the America Academy of Dental Sleep Doctors.
Thank you for your insight. My sleep doctor has told me that I have several issues and that just the relocation of my jaw will not resolve all of the issues. The CPAP, unfortunately solves all of the issues, except for one, teeth shifting. I do not feel comfortable having to chew gum or rubber pieces in the morning just to bring my bite back to normal. There is something about putting my jaw in an unatural position then ahaving to put it back that troubles me.

I wil just continue to lose weight and find a dentist that will give me a retainer type of device to get my teeth back to where they were.
Did you discuss your concerns with your sleep dentist? You seem to be concerned about "a bit" of shifting of the posterior teeth but you also have a concern about discomfort in the region of the molar teeth and impacted wisdom teeth. Both concerns should be discussed with your sleep dentist and addressed by your sleep dentist- the appliance should not be the cause of pressure on unerupted teeth. Minor shifting of teeth is possible with all oral appliances and are treated on an individual bases. Again, best speak to your sleep dentist who should be able to give you proper direction.
Very interesting discussion. I lost 30 lbs between Jan 09 and June 09, which lead to the process of exploring the option of using an oral appliance as an alternative to using a CPAP for my OSA.

Unfortunately, after being fitted with a TAP appliance, the sleep study using the appliance showed that it was not effective for controling my sleep apnea. I went through a lot to get fitted and accustome to the oral appliance only to learn that is was not a viable option.

I hope things work out for you.

Simanc
I am not convinced that oral appliances do what they claim to do. I haven't seen any PSG results after the appliances are in use. Unless the AHI is reduced to zero by the appliance, in my opinion, it is not successful. I seriously doubt that any of them completely eliminate all obstructive apneas.

Loving your oral appliance and getting fabulous results doesn't mean that your AHI has been reduced to zero. I wouldn't be satisfied with any oral appliance unless a sleep study proves that it is actually eliminating all apneas.

Show me the proof that they are actually doing what they are supposed to do and I'll support them.
Dental Oral appliances can provide relief to many who suffer mild OSA. The thrusting forward of the jaw is similar to the head tilt chin lift used during ACLS-or CPR.
There have been a few of my patients that have complained of headaches, tooth pain, TMJ etc with their use. The oral device is safe but the application and attempted teeth grinding may cause some teeth to shift. Not unlike invisline braces. Talk with your Dentist and I am sure the problem can be resolved quickly. If not it maybe time to talk with your Physician about mask and treatment options.
I have seen the results Dr. Mack. They are not good. I have very little evidence that an oral device by itself will produce the needed effect. I have seen some very good results in studies using both a PAP and an oral device. However I did not do any of the studies on these pts prior to them using both devices. I have never had a dentist refer a pt for a sleep study. Everytime someone tells me that they have an oral device I look for the dentist name. Have yet to find one in any chart.

Mack D Jones, MD, SAAN said:
I am not convinced that oral appliances do what they claim to do. I haven't seen any PSG results after the appliances are in use. Unless the AHI is reduced to zero by the appliance, in my opinion, it is not successful. I seriously doubt that any of them completely eliminate all obstructive apneas.

Loving your oral appliance and getting fabulous results doesn't mean that your AHI has been reduced to zero. I wouldn't be satisfied with any oral appliance unless a sleep study proves that it is actually eliminating all apneas.

Show me the proof that they are actually doing what they are supposed to do and I'll support them.

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