No one will argue that continuous positive airway pressure (CPAP) is for everyone with sleep apnea. In fact, many people struggle valiantly to overcome early compliance difficulties. For those who do not find adequate solutions, the CPAP may be boxed up and set aside. Persistent symptoms may encourage a conversation with your sleep doctor to review alternative treatments, including the use of an oral appliance for those with mild or moderate sleep apnea. What is the experience of getting and using an oral or dental appliance like? The oral appliance is an appealing treatment for sleep apnea and snoring, but what do you need to know to find an effective option? What side effects should be avoided? Learn about getting and using an oral appliance.
Finding the Right Oral Appliance for You
There is no shortage of available oral appliances — the sheer variety of options can be confusing. Some work by holding your tongue forward, while others reposition the lower jaw (or mandible). How can you find the right oral appliance for you? And whom should you trust to make it for you?
With a few clicks on the internet, you'll find a variety of suppliers of oral or dental appliances, and you may even find some for mail-order. These are often of a "boil and bite" variety: the plastic can be heated in boiling water and molded to fit your bite. They're relatively inexpensive, but unfortunately, they're often not maximally effective.
Alternatively, you can find a dentist or orthodontist in your area who can provide an appliance. Not every dentist is fully qualified, however, so you should seek one who is a member of the American Academy of Dental Sleep Medicine. Additionally, not all dentists use the same devices: some are more effective, while others pad profit margins without offering much in the way of therapy. How do you recognize if you're getting a proper appliance?
Getting Your Oral Appliance Specially Fitted
Your oral appliance should be specially fitted for you: do not accept a generic sizing system that doesn't account for the uniqueness of your teeth and bite. You are not a "medium," and appliances that assume you are will likely not be as comfortable or as effective as they should be. The appliance should be made based on plaster molds of your teeth. These higher quality models are adjustable over time, and although more expensive — sometimes costing several thousand dollars — these devices are more reliable.
When you visit the dentist to get your device, he or she will make plaster molds of your teeth. Initially, a quick-drying plastic material will be mixed and placed into a tray that is sized to your bite. Although there may be a variety of flavors for the rubbery plastic, none of them taste particularly good, and it may be most tolerable to stick with the mint option. This will be the closest to a toothpaste flavor, and will minimize the gag factor. If you do have a prominent gag reflex, let your dentist know. Excessive plaster may overflow from the trays, and a conscientious dental assistant will minimize this.
Based on these initial molds, your dentist will construct firmer plaster molds of your teeth and gums. This plaster replica will be used to recreate your bite, which will be further assessed and measured at this appointment. You will also be asked at this fitting to jut your lower jaw forward as far as you can — a key indicator of how effective treatment with these mandibular devices may be. By moving the lower jaw forward, the upper airway (especially the throat) opens up, and snoring and sleep apnea can be reduced. If you are unable to move your jaw forward adequately, the treatment may be ineffective.
After this first assessment, your plaster molds will be used to create your oral appliance; the molds will most likely be sent out to a specialized laboratory where the appliance for both the upper and lower teeth will be made from a hardened plastic. Much like a retainer, these will fit over your teeth, and maintain a modified bite.
At your second appointment, the oral appliance will arrive from the manufacturer and be adjusted. You'll be shown how to put it in, and based on comfort, the appliance can be slightly modified in the dentist’s office. An edge may be smoothed to prevent pain in the gums, for example. Once you find the oral appliance to be comfortable, you will be ready to start using it.
The Use of an Oral Appliance
Once properly fitted, your oral appliance is ready for use — but the work does not end there. Higher quality adjustable models are not only specially fitted but, importantly, adjusted over a period of months. During this period, you should also be aware of any adverse effects you might experience.
Oral appliances are slightly uncomfortable, but they should never be painful. If you develop pain in your jaw joint (the temporomandibular joint), you should let your dentist know immediately. This TMJ pain may become chronic and lead to clicking, popping, or dislocation of the jaw. If you have TMJ dysfunction, it is actually a contraindication to the use of an oral appliance (meaning you should not use one). Some people will experience movement of their teeth — this should also be closely monitored by your dentist with regular evaluations.
Over a period of about 6 months, the amount of advancement of your jaw will be increased. Initially, it will slightly pull your lower jaw forward, and as you get used to this and your jaw muscles relax, this tension will be increased. This is done gradually so that there are fewer risks of side effects. At the end of this time period, your oral appliance treatment will be optimized.
In order to determine if your oral appliance treatment is effectively eliminating your snoring or sleep apnea, it is advisable to undergo a second sleep study with the oral appliance in place. You should have this done at the same location where you had your first diagnostic study. The two studies can then be properly compared to assess the oral appliance’s effectiveness.
An oral appliance can be an attractive and useful treatment for snoring and sleep apnea. Be sure to select a qualified provider of an appliance that is properly fitted and adjusted over a period of months. At the conclusion of this period, you should undergo a proper reassessment to establish its effectiveness; you can then know for sure that your efforts and expense have been justified. If the treatment is insufficient, you may need to repeat the consultation with your sleep doctor.
"Find a Dentist." American Academy of Dental Sleep Medicine. Last accessed: November 27, 2012.
"Oral Appliances." American Academy of Dental Sleep Medicine. Last accessed: November 27, 2012.