dental appliances

[Karen Urbany]

Hasn't anyone tried dental appliances for OSA? I know they aren't supposed to be quite as effective as CPAP, but a whole lot more comfortable and convenient. I'd like to know anyone's experiences with this.

[Mtnviewer]

If you do a search you'll find some threads on this. I've used one and still do, but not for OSA as much as just a better way to keep my mouth closed than a chin strap. I bought into a very expensive one called the Klearway, had it custom fit by the "inventor" Orthodontist. I used it for a year plus before I gave up because of poor results, bite change due to teeth movement (I had a perfect bite before this fiasco) and then I made a firm commitment to CPAP and to learn more about it and to make it work. The difference in therapy was huge. CPAP was also much more comfortable and easier and faster to get used to than the oral appliance.

Whether it will help you or not depends on your severity of OSA, and what exactly is causing your OSA. If your OSA is caused by relaxed throat parts and your tongue, I'd suggest that the oral appliance will not help much or at all unless it pulls your jaw so far forward that you'll regret doing so. The oral appliance cannot effectively defeat gravity.

IME, it was not comfortable for most of a year, like having a mouth full of marbles, as well as constant drooling, a claustrophobic feeling at times, teeth aching, possible jaw pain and for sure teeth movement and bite changes if you use a jaw advancement oral appliance. CPAP in comparison is like sleeping with my favourite pillow, though even it isn't 100% perfect for me (again sleeping on one's back can influence APAP, CPAP).

If your OSA is mild, then I'd suggest that you save your money and explore ways to stay off your back when sleeping than on trying an oral appliance, unless it is an inexpensive one to just keep your mouth closed. An oral appliance and sleeping on your back just doesn't work (remember gravity pulling your throat closed or tongue down) and the body parts sag more with age, again which the oral appliance can't really do much with. Air pressure with PAP therapy is more effective as is a side sleeping position.

Do your research. I'd suggest using PAP therapy which is more effective, less money, no real side effects, and far more comfortable than a jaw advancement oral appliance. Either way, let us know how you're making out. Maybe you'll be one of the lucky ones?

[montana user]

Hi Karen,

I am hoping to have more information on the dental device. I am working with a dentist right now and were going to do some sleep studies on the mild ( dental device is only for mild OSA) patients and see if the device works. Well keep you posted.

[jezzicaz789]

Thanks you for the post.
Hi guys, Im a newbie. Nice to join this forum.

[Marietjie]

I am working with a dentist right now and were going to do some sleep studies on the mild

Well keep you posted

... WOW, hope it is going to be good news - how soon?

[montana user]

Well my first patient is scheduled in about 2 weeks I beleive. The dentist is going to sit and watch the whole study with me so she can educate herself how sleep studies work! Im excited she is coming to watch!

[Mtnviewer]

Hopefully you'll be doing more than one overnight sleep study with a variety of people to test "your" version of a dental appliance? One night with one patient I wouldn't think would provide much for certain results as there are just so many variables with OSA, people and sleeping, never mind the likely extreme newness of having a dental appliance in one's mouth for the first time (mine isn't that bulky and yet it still felt like a mouth full of marbles for several months, never mind the constant drooling) which is hopefully not the night that one is also having a sleep study?

I would also hazard a guess, that those with "MILD" OSA, to beneift from a dental appliance, will just as likely also be prone to "positional" OSA as the main cause of their OSA (and treatement). Positional OSA can be treated IME, with and without the dental appliance. How does one test the effectiveness of a dental appliance in one sleep study on one person? A dental appliance will not combat gravity effectively enough of sagging tissues or tongue, and especially not likely on the first night of one's sleep study and in any but a very forward jaw advanced position, and then I'd argue that it still wouldn't make much difference. Never mind the appliance being very uncomfortable for anyone other than months down the road from incremental jaw advancement. So with that in mind, is your study going to be with people sleeping on their sides, their backs, or any position, and so how then do you determine the effectiveness of your dental appliance related to or not related to one's sleeping postion? And which proves what, the sleeping position or the dental appliance?

I use a very "reputable", studied and approved dental appliance called the Klearway, and I was once (out of two studies) diagnoised with "mild" OSA. And due to a horrid DME, and due to my one month trial with CPAP being just as horrid, both prompted me to try a dental appliance and for over a year. The trial was hellishly expensive and time consuming with next to poor results. After giving up on the dental appliance as an effective and sole therapy for my OSA, and after getting a 2nd sleep study and THEN after finding this fantastic forum, I tried CPAP again, with MUCH greater results and successful therapy. I still use the dental appliance, but only instead of using a chin strap, and I have backed off any jaw advancement (which ruined my bite).

However, it is only recently that I've come to see how even with successful CPAP therapy, how my side sleeping position is even more important as to how successul a night of sleep I get with CPAP/APAP.

So it will be very interesting to me to read your findings and of your test methodology and results and especially how you determine whether your dental appliance is successful or not, and over what time period and ater how many studies to interpret the many variables? My 2 sleep studies, 2 years apart in hospital labs both produced very different results and these were only to determine the base level of OSA, not to address the effectiveness of any therapy on me, such as CPAP, APAP, a dental appliance or sleeping position or a myriad of other influencing variables.

So, in the end, for those with "mild" OSA (or any level of OSA), look into your sleeping position as much or more than looking for magic bullets from technology. Because in the end, isn't it gravity that is the main influence? My experience is that a dental appliance just can't defeat the 24/7/365 effects of gravity.

[Velbor]

viewtopic.php?f=1&t=42480&p=374282#p374282

[montana user]

Ah, let me clarify a few things. good comments.

First the Pt. is diagnosed with mild OSA, in any position. Then they see the dentist. She has some new tools! One takes a scan of the mouth,throat, nose area to make sure there is no blockage where surgery may be needed. Then she has a scanner that she puts in the mouth and has the pt. breath in and hold their breath. This shows if and where the collapse (apnea) is. This lets the dentist know if the dental device is going to work properly or not. Then she takes numerous Xrays and measurements of the mouth so the dental device is fit perfect for the pt. Not one of those boil in water and bite down things. Then after several weeks of wearing the device the pt comes back with device and another sleep study is done to make sure it is working properly. This dentist has put thousands of dollars into the testing equipment and seminars to make sure it is going to work. She is very understanding that very few people may benefit from this. But she wants the option to be available for those that would meet the requirements.

I am not a believer in the dental device yet, so am excited to see several people come through the lab wearing one!

[Mtnviewer]

I had some or all of what you described done in the fitting of my Klearway. Despite a super custom fit, it still felt like a bunch of marbles in my mouth for months and caused constant drooling, though much less so now, a few years later. In the end, IME and for ME, the Klearway at $2,600 plus many expenses like my travel, time off for follow up visits (most of which were 10 mins or less and useless as the Dr. would not address my Q's nor add to my education), etc., the Klearway only helps me keep my jaw from opening full wide. A simple and MUCH less expensive boil & bite would likely do the same thing for ME, maybe it does help others, but other than the one poster above, I've read over next to zero others that it's helped much. There are also many other variables such as sleeping position, pillow, room temperature, fitness, other medical or anatomical problems and so on. What worked for Velbor didn't work much at all for me, why not? We were both diagnosed with "Mild" OSA and the inventor of the Klearway told me that I was an "Ideal" candidate to benefit from it's use after all the measurements and x-rays, and jaw advancement and visits and so on.

I'd caution any patient to seriously do their research and keep asking the questions, "Whom is this dental device REALLY benefitting, Me or the Dentist?" The PROFIT margin for the dentist is obscene IMO and for many patients a real hardship financially and then a blow to their hope in aiding little to not at all in their OSA. Your dentist may be different, but mine had 6 chairs full at any one time, plus a waiting room often full and he flitted from person to person (I hesitate to call us patients as that would imply "care" vs. "profit") and it seemed like an assembly line to pay for his next extended vacation (which we had to work around to get appointments made which often caused longer time periods between visits) or his fancy car or the renos that he talked about, likely in an expensive area of Vancouver, but then most areas are expensive there.

Sorry, but my experience with this dentist and dentists in general, has been proven to be as poor as with the DME's, as both are just too greedy with their time and my money IME. Nothing wrong with profit, but where is the REAL care that they are keen to sell but not be responsible for, especially if the device doesn't work? Where is the money back guarantee, which the Dentist would insist on if their 7 series BMW didn't work or if their world cruise vacation had problems? No, you sign away those rights of responsibilty and guaranteee as you do with your changed bite and tooth movement when you sign the waiver before any work is done. Hope and Faith based on Need of relief of OSA by the desperate and tired patient, is a powerful tool for the dentist and no downsides to the dentist. No repsonsibility unless they really screw up and inflict injury, vs. if the device is simply not effective in treating OSA? I still suggest that gravity is more powerful and consisant than what oral devices can treat.

I'd also suggest that your dentist try the device on herself for a year or more to really learn of it's ins and outs and to pay for the treatment in full under the "care" of another dentist, and then she might understand how it "all" works or doesn't work for a patient.

Sorry this is getting off topic and into a bit of a rant, but I caution those with hope to be more skeptical than hopeful and to also look at less magical and less expensive solutions not being offered by magicians selling "Hope" and without a warranty.

[montana user]

Hey I think rants are ok! Thats where I learn allot from. Yeah like I said I am not sold on the idea yet and until I can see in my lab and the person states they feel great, I will not push the idea. I do give allot of credit to the Dentist for doing her research on apnea and wanting to help people, but I need 100% proof that this device will work before I am sold on it! Thank you for you input, as this is new to me and my manager, so we are trying to keep an open mind, but we have our doubts.

[tom92580]

I was not able to adjust the CPAP machines very well. I found a dentist that specializes in the oral appliances. This has been a great alternative for me. The CPAP was like having my head out the car window at 40 mph and trying to sleep. The dentist I went to had all the computer stuff and was able to demonstrate how it all works. He demonstrated on me how I could not even snor if I wanted to. It really opened up my breathing passage. I would like to take another sleep study with it on to see how much good it really does. I know I feel alot better. Good luck.