Dental Devices

I know this is a CPAP related site but does anyone use a dental device? and what is the devices overall success rate with it's users?

I have a good friend that went to a dental device and eliminated his use of cpap. He loves it.

Not likely. In fact, there's a .0000001 chance of "curing" OSA.
There are only TWO persons I've ever read about who "cured" OSA. That is William Howard Taft,
and some other feller in England who runs a site called "Singing for Snorers". He will tell you if you send some money for the CD.

If I ever find a cure, you can be sure that I will tell all of you FOR FREE.
Cheers,
Jay

I had been using the Klearway appliance for 3+ years with mixed and declining results. (Search this site & web via Google). I was diagnosed with mild and moderate OSA (2 different studies at 2 different hospitals over a 4 year period), ignorantly (meaning I was ignorant) I tried CPAP with no help from it 4 years ago and so after the trial I decided on trying the oral appliance route. I can't say that after 3 years I ever got a good night's sleep as I have with the one month that I've been using APAP (which itself is a learning curve and not every night is yet good or great, but some nights are so that's promising as I learn more). I got an APAP perscription from the doctor of my 2nd but supposedly inconclusive sleep study and thus the "mild OSA" result, after I expressed my frustrations with how I was doing all this time later.

I have no chin or jaw problems, no large neck, no throat problems other than loose tissue with age, I'm not overweight at all, BMI of 23, but I've snored my entire adult life. After about a year of use and incremental jaw advancement, I realized that my one large problem was with my jaw dropping open when I sleep and thus further pushing the airway closed, along with the loose tissue, which the appliance doesn't help. This was the case whether there was jaw advancement or not! The Klearway IMO, also has too much ability for the jaw to move, left and right, forward and back and for the mouth to open, which aids comfort but reduced effectiveness for me. The orthodontist and claimed inventor of the Klearway out of Vancouver, B.C., didn't believe my observations nor did he want to work with me in this regard and also could not provide proof to me that I was getting any more air with jaw advancement than without it. I wasn't getting better sleep if my jaw was allowed to open as much as it could with the appliance. In the end, I insisted that I'd modify it myself and so he reluctantly drilled holes in the appliance and to this day I have it sewn shut with dental floss, and that proved to be MUCH MORE helpful than using the appliance as he wanted me to or as he designed it to be used. I still use it sewn shut along with my full face mask, as otherwise my jaw still opens wide and I mouth breathe and gape horribly. Also with the device I can use suction to tuck my tongue up against it, but who know how long that lasts when I'm asleep? Side sleeping is still a must, and if I sleep on my back the the appliance and a closed jaw still don't stop apneas. APAP while sleeping on my side with the appliance has given me half a dozen good nights.

Side effects of jaw advancement appliances are mild to severe tooth movement depending on how far the lower jaw is advanced, and so possibly big bite changes (and the resulting loss of good chewing ability , which itself is a health hazard that they don't mention), discomfort that took ages to overcome akin to sleeping with a mouth full of marbles, hard to sleep with for many months, LOTS of drooling for the first months to year and which still goes on to this day but less so and finally, HUGE expense at $2300+ travel and time for office visits and it's to last only 1-2 years, replacements are $800+, and the main side effect for me was little actual help with my OSA. I also felt that the entire procedure was an overpriced rip off and that the doctor was dismissive of my experiences and kept delaying and delaying a follow up sleep study, which in the end I never could get as he didn't have hospital privlages or referral privlages, despite being part of the university sleep study program, nor was there any other scientific way of evaluating the appliance's effectiveness. It's all based on how you felt and I kept telling him I felt no different or just plain tired. The answer was always, "lets advance it more and give it time". Also, I would drive 500 miles one way, for the 6+ follow appointments for less than a 10 min sit in his chair, while mostly twiddling my thumbs while he flitted around the office and between 4 other patients. I probably got 2-3 real minutes of his time for most checks until I wisened up and asked more questions and searched and probed and insisted for more answers. He was always vague, delaying and of little help to my specifics and the appliance's effectiveness and in the end, after a year of this, I feel he was also lying to me. The bizarre thing is that the Klearway appliance may be one of the best of them all.

Before you get an appliance, especially an expensive one, video tape, record and study your sleep situation so you can better understand what you do. My sleep studies told me nothing, I was not allowed to see the results (nor at the time would I have understood them), the sleep study night tech's won't tell or show you anything and though it may have changed today, 3+ years ago the doctors told you very little and knew very little. I'd suggest trying an inexpensive version like $100-150 device after you figure out if your main OSA problem could be helped by jaw advancement or by just keeping your jaw closed. For naps, I use a soft neck collar, $12, and nap in an elevated position, or in the car when stopped and maybe that too will tell you a bit of your situation.

So it depends on your bone structure, but my experience is that for an oral appliance to really work, you will either need to accept SEVERE jaw advancement (but that won't totally help sagging relaxed tissue), have extremely mild OSA, or use it as I do, solely as an aid to keep your jaw closed with the use of PAP therapy. I DO NOT recommend jaw advancement and tooth movement. I miss my bite and will require braces to get it back, which I can't afford right now. My experience is that PAP therapy is FAR more beneficial, but I know that I also need something to keep my jaw shut with PAP therapy. The 4 chin straps that I've tried have not been helpful enough in comparison to the oral appliance, but way less expensive. I will try a chinstrap or make my own, that is in use with my headgear. BTW, I find that the APAP and Quattro FF mask is also MUCH easier to get used to and more comfortable than the oral appliance and actually effective.

Proceed with caution and skepticsm and please don't go in blindly as I did. Try an inexpensive one first.

The dental specialist I went to early in my cpap-using days said they can help sometimes if you have mild or moderate OSA (but not severe OSA), but cpap is still the best. After my consultation, he said he usually likes to go forward with dental devices only if cpap has been tried and not tolerated by patients, or for someone to use who travels a lot and doesn't want to lug the cpap along on the trips. Since I don't travel and cpap was working for me, he suggested I stick with cpap. (He also only charged me half of the $50 consultation fee, I guess since I wasn't going to try it. Don't see that much. )

Pam

Respironics (Phillips) portrays one on their OSA page, and a dentist and orthodontist I've talked to say they have been getting a good result from their patients. The idea of the device is to push your lower jaw forward, thereby opening the airway. Both had me, with a normal jaw, force a snore. Then they had me me advance my jaw and it was almost impossible to snore and easier to breathe. So, they are not a scam by any means

In your dentist's test did you do your lower jaw thrust while you were sitting upright or laying down as when sleeping? BIG difference between the two positions on how far your tongue and tissue can be pulled and held forward. Laying down, gravity has more pull than you might think? Next, did you measure how many centimeters that your jaw was actually thrust forward where you were not able to snore? I'd bet that it would be an awful long distance when converted over to an oral appliance for you to deal with for 8 hrs of sleep, 365 nights a year. Doing the jaw thrust for a few seconds seems pretty benign and so you might not think that it is much movement at all but being held in that position over 8 hours every night it will be a lot of movement for your jaw and teeth. You would reach that distance slowly a few millimeters at a time but before long you could find that your teeth would move, especially your lower teeth as the appliance pulls them forward and as they're anchored at the bottom, they can only really tilt forward from the top, so you will now have your lower teeth leaning further forward than your top teeth. Your ability to chew will be changed, maybe for the better for some people, but possibly for worse if you had an otherwise normal bite to start with. Then you'd find if you slept on your back at all, that your throat tissue would likely sag back to some degree or a lot and your choices would be to either keep cranking the lower jaw forward, or find as I did that the appliance did not stop apneas or snoring in certain sleeping positions or after a while, it would hardly stop them at all. So, I'd recommend trying any dental appliance or their tests while you are in your various sleeping positions and not to discount lightly how they will affect your jaw and teeth movement. Some people report severe jaw pain and headaches from excessive jaw movement.

No they may not be a true scam and so may work for some people, but at $2000+ IME of 3+ years, I feel that they are pretty much a scam, as they don't work for near everyone they claim that they will, mild OSA or not, to prevent, reduce or eliminate OSA. They do help with keeping my jaw closed, though they also do loosen up over time and as the Klearway has a bit of metal skeleton, I can use pliers to retighten it to some degree as the acrylic loses it's ability to hold its shape after the months and months of heat and cool cycles that they require each day to get them in and out of your mouth. Buyer beware is all I'm saying and just like with CPAP, take control of your own therapy and don't just trust the doctors and the hype to do what they think is best for you. Good luck.

[quote][/quote]No they may not be a true scam and so may work for some people, but at $2000+ IME of 3+ years, I feel that they are pretty much a scam, as they don't work for near everyone they claim that they will, mild OSA or not, to prevent, reduce or eliminate OSA.

The same could be said for CPAP this site is proof of that NO therpay works the same for eveyone and look how much money the average person put into their CPAP diffrent masks, types etc. CPAP is over prescribed and has MANY complications I am not saying dental devices are the answer but if CPAP is not working you are not alone. GOOD LUCK

CPAP SUCKS wrote:

No they may not be a true scam and so may work for some people, but at $2000+ IME of 3+ years, I feel that they are pretty much a scam, as they don't work for near everyone they claim that they will, mild OSA or not, to prevent, reduce or eliminate OSA.

The same could be said for CPAP this site is proof of that NO therpay works the same for eveyone and look how much money the average person put into their CPAP diffrent masks, types etc. CPAP is over prescribed and has MANY complications I am not saying dental devices are the answer but if CPAP is not working you are not alone. GOOD LUCK

You failed to quote that paragraph in it's entirety, or at least another important point. You forgot:

Mtnviewer wrote:Buyer beware is all I'm saying and just like with CPAP, take control of your own therapy and don't just trust the doctors and the hype to do what they think is best for you.

Den

CPAP SUCKS wrote:

No they may not be a true scam and so may work for some people, but at $2000+ IME of 3+ years, I feel that they are pretty much a scam, as they don't work for near everyone they claim that they will, mild OSA or not, to prevent, reduce or eliminate OSA.

The same could be said for CPAP this site is proof of that NO therpay works the same for eveyone and look how much money the average person put into their CPAP diffrent masks, types etc. CPAP is over prescribed and has MANY complications I am not saying dental devices are the answer but if CPAP is not working you are not alone. GOOD LUCK

You're just spewing. Offer some alternatives. I tested at an AHI of 74. I need something. Do I WANT CPAP? Hell no. But I've got two kids to think of so denial isn't an option. So instead of name calling and spewing of dis-info, go ahead and tell us what you're selling. I'll investigate anything that has potential, but until I find something else it's the machine for me...

Mtnviewer wrote:In your dentist's test did you do your lower jaw thrust while you were sitting upright or laying down as when sleeping? BIG difference between the two positions on how far your tongue and tissue can be pulled and held forward. Laying down, gravity has more pull than you might think? .

No, I asked him about it. He said with the device fixed on your teeth, postion makes no difference.
And for those who says its a scam because of the $2000 price tag, that infers buying a Cadillac is a scam because its $25K more than a Sentra

"Not likely. In fact, there's a .0000001 chance of "curing" OSA. "

I guess you're ignoring the weight loss that would cure a large proportion of people. Of course, it's a touchy subject or so it seems. Giving up McDonalds and exercising every day isn't nearly as American easy and putting on something while you aren't even conscious.

No, I asked him about it. He said with the device fixed on your teeth, position makes no difference. And for those who says its a scam because of the $2000 price tag, that infers buying a Cadillac is a scam because its $25K more than a Sentra

A couple of things, I said it was a scam and I tried it and I take your point about the car analogy, but once you get your device and you see that it's less than $1 worth of acrylic, and that while the molds are worth more in labour and materials, and there is value in his/her office overhead and staff, their exotic vacations, the BMW, even further profit etc., then if your experience was like mine that you have follow up appts. that last only a few minutes after they ask you, "Do you have any problems?", No, not really, but I'm still always tired, "Well then advance it 1 mm and come back in a month and see how you do.", then you may see my point that it's a lot of money, and fantastic profit for them, for little in materials, service and not great results. Obscene profits to me are a scam of the dupes like me that are so desperate to find relief. I admit that I was an idiot and did not do enough research, though I thought that I did, and I believed the Doctor's hype, and had too much faith in his credentials. I've only myself to blame.

You don't immediately thrust your jaw forward in a locked position like you did in the dentist chair. The advancement is gradual taking weeks and months and it still plays havoc on your teeth, not to mention the weeks and months (or years) of poor sleep, continued OSA while you try to reach the jaw advancement where it will provide less OSA and less snoring. As I also said before, the advancement didn't help me as much as keeping my jaw closed, which if you also try in any position, jaw closed vs. jaw dropped way down, this jaw down position closes my airway off completely, vs. with my jaw drawn back my airway is very open.

Don't get me wrong, I really wanted it to work, (I paid the dentist a fee of $2300 and if I add travel cost for 6+ follow up 10 min. visits at 1,000 miles round trip I probably paid out over $3500 to try and get the device to work, not to mention days off work to travel to those 10 min appts.). But I found that unless the device stretches the jaw out to an EXTREME end, where you likely will not want to reach due to the side effects noted earlier, then sorry but not all of the tissue in the throat will be pulled forward along with your teeth and jaw, when you are sleeping on your back or even your side. If it worked, I wouldn't be discussing it's inefficiencies here. I wouldn't even be on this forum.

I'm a slim, trim guy, with a great jaw line and smile, so I've been told, I'm still very athletic, very healthy otherwise. I'm very health concious anad I've been eating a low fat vegan diet for 10+ years, meaning that I should be a pretty healthy candidate for this device to work, as I have no real impediments vs. others with more physical impairments or blockages, but my experience is that UNLESS my jaw was stretched out REALLY FAR, and even then the nights that I tried it that way, for me it JUST DIDN'T STOP OSA, nor snoring nor apneas. Some nights it reduced them, and it did reduce my overall fatigue from not having the device at all, but only by maybe a few percent. Maybe 10-20%? As well, and sorry for the language, but after the jaw advancement and bite change that I was willing to work with but still regret, there was no way in Hell that I would ever stretch my jaw and misalign my teeth and really badly ruin my bite even more by racking the device out to it's full extent or to where the orthodontist suggested that it could go to. Which is perhaps more like what you did in the dentist's chair.

Which is why I am back to working with PAP therapy, which in the few weeks of use, vs. the 3+ years with the oral device, has given me some great results, sleep, rest, whatever you want to call it. Pardon the pun, but the difference for me was like night vs. day and which is why I'm writing of my experiences here. Remember too, that I tried CPAP before the oral appliance, but without any info, and without this forum. But now after working 3 years with the oral appliance, I am now starting again with APAP and am having success due solely to the info and encouragement gleaned from the generosity of folks on this forum. So this time for me, PAP therapy is working so much better in the first week than the oral appliance did in 3 years. PAP therapy vs. the oral appliance has proven to me in a very short time to be so much more restful, easier to get used to such as mask vs. mouthpiece, FAR more comfortable to sleep with, MUCH less expensive to buy (I used cpap.com and cpapauction.com) AND WITH NO DAMAGING OR PERMANENT SIDE EFFECTS like misaligned teeth or a permanently ruined bite (which you will have to sign a waiver accepting both as part of the oral appliance therapy, nice huh?).

So in the end, I really really wish anyone who tries the oral devices all the best and I really hope that it works for you all better than it did for me, and that it provides the relief that we all seek, which is why we're even here, that is looking for relief from the horrid burden of OSA. I just hope that others are not as desperate as I was. It's good to do one's homework. All I can do is relate my experience with an oral appliance and the rest is up to the readers to take it for what it's worth.