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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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Replies to This Discussion
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Permalink Reply by dr. martin bassiur on
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All my patients are referred for follow-up sleep studies with mandibular advancement appliances and I request a copy of the study and report be sent to me. If the appliance can reduce a patient to AHI <5 and also establish Oxygen saturation >94 would that not be a successful criteria when the patient was orignally mild-moderate AHI and having an Oxygen saturation <89?? Appliance therapy may help a severe apneic patient and bring them to a level of mild -moderate apnea, if they are not compliant with CPAP, is that not still helpful? Patients can also use nasal pillow therapy with oral appliance therapy as an adjunct to the nasal therapy. Is the criteria for cure a zero AHI? If that be the case do you believe all patients who have AHI 1-5 should be put on CPAP?
Rock Hinkle said:
applianceI 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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My first post... Here it goes.
I have been using a Glidewell Laboratories oral appliance since 2006. When I received it, it was not adjusted to do anything to benefit my OSA condition. I adjusted it forward a lot as I have severe OSA. During the initial sleep study, I had 58 choking episodes during the first two hours: about one every two minutes! For a few weeks, my occlusion changed a lot and my teeth hurt whenever I ate and even without eating. But, guess what? I slept like a dream! I started dreaming again and felt energized during the day. I did not mind my crazy occlusion and the pain. After about two-three months, my occlusion had adjusted and my bite got strong again. I have had no problems since. I tried using a CPAP machine for over two years without success-only twice in around 1000 days I woke up with the mask still on my face! I was feeling almost desperate. My memory was deteriorating, my sexual potency had gone south significantly and I was falling asleep in the middle of meetings and even during normal conversations with others. My oral appliance saved me from all of this. The first one cost me $750 and I lost it after a few months. The second one cost me $600 as the Dentist took pity on my loss. I still have it and it has been way over three years since I got it. The screw broke once and the repair cost me $125.
I recently went for another titration study and got a new CPAP machine which I received less than a week ago together with a nasal pillow "mask". Every night I try to again adapt to the CPAP but it is not working. Each night after more than an hour "trying" to sleep with the CPAP which is set to a pressure of 12 with the humidifier full of water. I turn it off and use my oral appliance to sleep. It is just not for me. The oral appliance works well for me.
I even bought the one that you fit yourself from puresleep.com and even that one works great and this one only costs $60!. In my humble opinion, far too few OSA sufferers do not consider an oral appliance as a solution to this problem. I hope that my post will help these population.
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Permalink Reply by Banyon on
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dr. martin bassiur said:If the appliance can reduce a patient to AHI <5 and also establish Oxygen saturation >94 would that not be a successful criteria when the patient was orignally mild-moderate AHI and having an Oxygen saturation <89?? .... Is the criteria for cure a zero AHI? If that be the case do you believe all patients who have AHI 1-5 should be put on CPAP
I have just over four years usage of a CPAP and this year will likely procure an oral appliance to be used in conjunction with CPAP. My sleep doc is optimistic that the appliance would be so effective as to eliminate my need for CPAP. I am not so optimistic.
Now hypothetically, if the appliance alone would reduce my AHI below 3.0, I would experiment without using CPAP and make subjective judgements about how I sleep, how I feel the next day and how "robust" my participation in life is.
If the appliance alone reduced my AHI to the range of 3.0 to 5.0, I would not discontinue CPAP. An AHI in this range means 24 to 40 disturbances in eight hours of sleep. Years or decades of this would have an effect on mind and body that I would not want to suffer. Dealing with all the problems of CPAP would be worth it.
I also believe that many people are using oral appliances and are still having quite unhealthy sleep-breathing. But I am sure the same can be said of CPAP since the great majority do not have the equipment and self-education to monitor and adjust their therapy.
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Permalink Reply by RockRpsgt on
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Did you wear the device during your titration?
A Goldsmith said:Forgot to mention that the puresleep.com dental appliance only costs $60!
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goldsmith, I hope you are legitimate and are not spamming for puresleep. You just made your first post and the employees of puresleep have a reputation for dishonest self-promotion on blogs and forums.
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is this site for advertising or for patient education- why do you keep discussing fees for an appliance that is not a custom made appliance and is not under professional supervision? A proper oral appliance should be custom made by a dentist and the patient should be monitored by the dentist during the application of the appliance- over-the -counter products are good if one wants to establish the efficacy of the technique
Rock Hinkle said:Did you wear the device during your titration?
A Goldsmith said:Forgot to mention that the puresleep.com dental appliance only costs $60!
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dr. martin bassiur, Those results would be amazing. I would even be satisfied with o2 >90% instead of 94%. I have not seen results along those parameters. Not even close. My last study with an oral appliance only improved the AHI by 5. The original was over 50. I applaud you for sending your pts for a sleep study. As I said I have yet to see a dentist referral in my lab.
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Permalink Reply by Kit Datson on
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Great discussion folks.
I just recieved my first, custom fit, appliance two weeks ago for the TMJ problems I have developed over the last year. I have been using a CPAP or Bi PAP for about 8 years now and other problems have been arising.
The teeth grinding, that the appliance is suppose to address continues, although some of the pain in my jaw has lessened. Also, at times I produce an exhorbitent amount of saliva, awake or asleep. At times I have the yearning for someone to hit me in the jaw so that there would be a known reason for the anguish and pain.
I am hoping that the appliance performs as some have mentioned on this blog as I am becoming desperate.
I really do think that losing wait is the real answer.
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Permalink Reply by Mack D Jones, MD, SAAN on
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Yes, a patient with an AHI of 1-5 should be put on a PAP machine for the treatment of their OSA. Read my book, "Deadly Sleep," and you will see where I stand on this subject and the evidence I present to support it.
All too often we take the AHI from one study as if it were chiseled in stone and assume that it is a static or unchanging number. The truth is that it is a dynamic, ever changing physiologic function, influenced by many things such as body position change, fluid retention, weight gain or loss, age, colds, flu, allergies, sinus infections, excess salt intake, medications, alcoholic intake and the list goes on. One large study found a group of men with AHIs in the 1-4 range, had AHIs in the 5-20 range six months later.
The point is, we are dealing with a very dynamic process, not a static condition defined by a number obtained during a single PSG. If you have OSA, then you should do everything in your power to eliminate it, not partially, as some physicians are more than willing to accept in their patients, but completely, as if they are treating themselves or their loved ones.
It would be great if there was an oral appliance that would eliminate all apneas, but unfortunately, there is none.
dr. martin bassiur said:All my patients are referred for follow-up sleep studies with mandibular advancement appliances and I request a copy of the study and report be sent to me. If the appliance can reduce a patient to AHI <5 and also establish Oxygen saturation >94 would that not be a successful criteria when the patient was orignally mild-moderate AHI and having an Oxygen saturation <89?? Appliance therapy may help a severe apneic patient and bring them to a level of mild -moderate apnea, if they are not compliant with CPAP, is that not still helpful? Patients can also use nasal pillow therapy with oral appliance therapy as an adjunct to the nasal therapy. Is the criteria for cure a zero AHI? If that be the case do you believe all patients who have AHI 1-5 should be put on CPAP?
Rock Hinkle said:
applianceI 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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Permalink Reply by terri on
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I went to a Sleep Dentist and my SomnoMed is supposed to be ready on April 14th. We will see.
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I am using the mandibular advancement device for UARS with excellent results. Both my husband (who also has UARS) and I found that CPAP made our symptoms worse.
Rock Hinkle said: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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Permalink Reply by Rock Conner RRT on
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I have seen good results on follow-up validation studies, but those patients were in a program in which they were seen only by American Board of Dental Sleep Medicine diplomates. Some of those patients happily returned their rental CPAP devices. I'm no expert in the field, but I believe there is a limited range in both OSA severity & CPAP pressure required to splint the patient's airway. So while not for everyone, I think there is a place for properly administered Oral Appliance Therapy (OAT). I'd stick with boarded providers only (www.abdsm.org).
As for Dave's initial inquiry, I advise followup with an OAT provider who knows what he or she is doing. As evidenced by some of the entries above & my own experience, they are out there.
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