Dental Care Sleep Apnea Solution

Hi Everyone,
I just happened to one an ad pak in the mail. It has a picture of a unhappy person wrapped around a CPAP/BIPAP. They state having a FDA approved treatment for OSA, no machines, covered by insurance. Any ideas if this works? I was thinking of calling up this dentist.

thanks in advance,
regards
LHP

Only rarely works for anyone truly needing Cpap, i.e.someone with documented OSA (rather than just snoring). There's a reason we're all here doing this dance ! Of course they'll knock Cpap, they want your money.

Thanks for your input. I love my bipap and own it, great results.

I'm not sure what that is. But since the discussion is about denistry, I just came upon a dentist in our city who is really knowledgeable about OSA.
I went to see him at the suggestion of my dentist, who, upon an innocent statement about my mouth, asked if I knew of any dentists who made mouth pieces, because he didn't. But, he told me of a new dentist who had recently moved into an office a few doors down from him. On a lark, I decided to visit his office. WOW, I hit the jackpot. He has had advanced training on OSA, specializes in implants, and gives talks about OSA to various groups and conventions.

After a (free) consultation, we discussed sleep apnea for about an hour. This was very refreshing. I found out that he is the leading dentist around here on dental treatment of OSA. I will soon be having a customized mouth piece made. Medicare may or may not pay for it. From what I can find out, there is about a 50-50 chance it will. I have begun the paper work. My sleep doctor was very supportive and agreed to send the dentist any necessary work. I thought it might be worth a shot. Anyway, if it doesn't, I will still probably have it done, even at a cost of $2000 plus. Looking forward to it.

Jay

The trouble with 99% of dental 'solutions' to OSA is that they don't (can't) address the fact that your airway is narrowed, whatever they do to your teeth or mouth or tongue.

"3.3.3 Although not as efficacious as CPAP, oral appliances are indicated for use in patients with mild to moderate OSA who prefer OAs to CPAP, or who do not respond to CPAP, are not appropriate candidates for CPAP, or who fail treatment attempts with CPAP or treatment with behavioral measures such as weight loss or sleepposition change. (Guideline)
". . . In the reviewed studies, CPAP when used is routinely more efficacious than OAs in reducing measures of respiratory disturbance (AHI, oxygenation), but may be equipotent with OAs in improving subjective and objective measures of sleepiness. Stratification of the severity of OSA was not performed in most studies, but in patients with a mean AHI greater than 10 and less than 30, success (internally defined within each study, but considering only those with a reduction of AHI to less than or equal to 10) occurred in 52.6 ± 2.5% (mean ± SEM, range 19.0% - 81.0%)."--SLEEP, Vol. 29, No. 2, 2006.

"3.4.2 To ensure satisfactory therapeutic benefit from OAs [oral appliances], patients with OSA should undergo polysomnography or an attended cardiorespiratory (Type 3) sleep study with the oral appliance in place after final adjustments of fit have been performed. (Guideline)
". . . data has shown that even relatively low AHI are associated with adverse health outcomes, and especially in patients with comorbid disease or risk factors, may be important. Since the rate of treatment success is not predictably high with OAs, treatment should be assessed for efficacy with objective testing. Additionally, some patients experience an increase in AHI with OA treatment. This recommendation is based on 2 level I and 5 level V studies."-- Practice Parameters for Oral Appliances—AASM Practice Parameters; SLEEP, Vol. 29, No. 2, 2006.

http://www.aasmnet.org/Resources/Practi ... icance.pdf

Actually, in the right patient, I think some of the appliances are well researched and do help some patients. Usually these patients have mild OSA and have an overbite with a receded jaw. I think the dental appliance that is the most researched is the TAP appliance. The idea is to rock the lower jaw forward, which brings the tongue with it and opens the airway. This works if the tongue is the problem--not if the nasal airway or some other part of the airway is the problem.

I actually tried the TAP appliance and I just couldn't get it to work for me--but my mouth is very, very small. It was just too big for my mouth and it was difficult for me to disengage and remove from my mouth and made me feel claustrophobic. In the right patient, though, this might work very well. I just went back to bipap and kept looking.

I'm currently looking into orthodontia as an answer. Here is a thread started by Rooster about some of the research into orthodotia and OSA.

viewtopic/t53983/Discussion-of-Small-Ja ... Apnea.html

I have a local dentist here who is very big on OSA. She has commercials of people wearing CPAP and tearing them off, and talking about the dental device. I understand the American Academy of Sleep Medicine states the oral MAY work for mild-moderate apnea. My only problems is this- I have had patients with mild apnea come in for a titration and it took alot of pressure to keep the airway open. What this dentist doesnt understand is the amount of pressure the airway has when it closes. She looks at numbers only. Just because you stop breathing 8 times an hours, doesnt mean the airway closely ever so gently. It may really clamp down, therefore taking a pretty good pressure to keep it open. What I do love is the fact that you HAVE to have another sleep study after you have been fitted with the dental device! If you can show me that the apnea is reduced to normal limits...Im all for the dental device. What I'm not for is the false information that ANYONE with mild-moderate apnea can be fixed with dental device.

I make no money on CPAP machines, I only care that the person is getting the right treatment and using whatever device it takes to make them feel better and live longer.

montana user wrote:you HAVE to have another sleep study after you have been fitted with the dental device! If you can show me that the apnea is reduced to normal limits...Im all for the dental device.

So have you seen any patients being studied while using a dental device, and did any of them successfully show that they no longer needed CPAP? I'm a little skeptical about the dental devices, except the long-term palate-changing things, but I'm still open-minded.

packitin wrote:I'm not sure what that is. But since the discussion is about denistry, I just came upon a dentist in our city who is really knowledgeable about OSA.
I went to see him at the suggestion of my dentist, who, upon an innocent statement about my mouth, asked if I knew of any dentists who made mouth pieces, because he didn't. But, he told me of a new dentist who had recently moved into an office a few doors down from him. On a lark, I decided to visit his office. WOW, I hit the jackpot. He has had advanced training on OSA, specializes in implants, and gives talks about OSA to various groups and conventions.

After a (free) consultation, we discussed sleep apnea for about an hour. This was very refreshing. I found out that he is the leading dentist around here on dental treatment of OSA. I will soon be having a customized mouth piece made. Medicare may or may not pay for it. From what I can find out, there is about a 50-50 chance it will. I have begun the paper work. My sleep doctor was very supportive and agreed to send the dentist any necessary work. I thought it might be worth a shot. Anyway, if it doesn't, I will still probably have it done, even at a cost of $2000 plus. Looking forward to it.

Jay

If that doesn't work you can always cut a potato in half, rub it on your throat and bury the potato in the ground one foot deep, in a month that has 30 days and under a full moon, The treatment costs $2,000 less than the customized mouth piece. The success rates are close to the same, and if you get really lucky you can make french fries with it's babys. Jim

I too am interested in hearing about sleep studies done while wearing the dental devices. Jay, let us know how this works out for you. I know you'll do things "decently and in order" so I look forward to your report.
Kathy

I actually have a patient right now that had a sleep study 7 years ago, but has had a hard time using her CPAP. I have a feeling she will not fall under the Mild category, but if she does, she already has the appointment for the dental device. I am very eager to get some patients in here on the device, but as of now I have not seen any. I love to hear any success or failure stories so I can share with my patients.

I doubt that it will work for you or many others based on my own experience with a very reputable, researched, studied, expensive and custom fit device called the Klearway. Sorry but these devices just can't open the airway enough nor defeat gravity, compared to CPAP air pressure. Besides the tongue doesn't really get pulled that far forward if at all and if one sleeps in a supine position then the tongue being so soft and large will just fall back anyway. These devices do next to nothing with the jaw unless they are advanaced SUPER far forward and even then it might only help those with a severe bite problem. My jaw / bite was normal, the device altered my bite after being advanced a few millimeters, which I regret. The dentist makes you sign a waiver saying that your bite will be ruined, and your teeth may move.

Save your $2000 or give it to me as I could sure use it and regret every day spending that much and more on this wasted treatement or give it to charity. Also don't waste your time and your valuable sleep while off CPAP. As well, these devices aren't exactly comfortable and take weeks if not months to get used to and to even mildly benefit from, all the while you may be off CPAP TRYING DESPERATELY to get the device to work and meanwhile being dogged tired and possibly endangering yourself and others.

But if you happen to still go for it and it happens to help you, then please keep us posted over time.

Yes, I will keep you informed. I never had any faith in dental devices either, until the consultation session with this young, enthusiasitc, and energetic dentist, who is obviously on top of the latest treatments for OSA. This will be a customized device for my particular jaw structure. The adjustment and alignment will be ongoing, not just an installation and out the door you go. The goal is to "train" my brain, through this device, to keep my jaw forward so that my lower teeth will be meet my uppers. This will be a gradual process. My brain has to "relearn" how to hold the jaw forward. That's what this is supposed to do. I also have a small neck size - up until I was about 40 yrs. old, my neck size was 14.5. I'm also hoping my tongue will not collapse backward so easily. I'm praying this will work. Apap has not done the job I hoped it would. (past year: AHI 3.7; leaks 2.2; usage 4:40 hrs per ngt) My goal is to use both Apap and the mouth piece.

Always interesting info here. I had a dental device but it only kept my tongue down and my soft palate up. It didn't really work very well (though at first it seemed to help). So I am always skeptical of dental devices.

And on the coattails of what montana was saying.... although I have "severe" apnea it consists exclusively of hypopnea's with very little desat's. Yet I need 10.5cm to keep my throat open and my sleep optimal. Go figure.

And goodluck packitin! I hope you find what works... pls keep us updated.