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Dental devices

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Devices to Help Get You A Good Night's Sleep


July 31, 2007; Page D5

A good night's sleep may come from an unexpected place: your dentist. Makers of custom-fitted mouthpieces say the devices help alleviate sleep apnea and snoring. Sleep experts say the devices are a good option mainly for mild-to-moderate sleep apnea.

Sleep apnea is a disorder in which breathing stops briefly during sleep. The causes vary, but often involve blockage of the throat by the tongue and soft tissue. In the short term, apnea can result in sleep deprivation. Over time it can cause serious health effects ranging from heart failure to stroke.

Traditionally, sleep apnea has been treated by a machine that blows air into the nose through a mask in order to keep the airway open. The treatment, called CPAP, is nearly 100% effective, but many patients dislike wearing a respirator-like mask. As a result, doctors say, many CPAP machines end up in the closet.

Doctors say patients are more likely to actually use oral appliances, which are similar to sports mouth guards. The devices generally work by pulling the jaw forward to keep the tongue out of the way of the airway and are significantly less effective than CPAP machines.

The devices got a big boost last year when the American Academy of Sleep Medicine, a trade group of sleep specialists and centers, endorsed their use for mild-to-moderate apnea. The group's new practice parameters, published in the journal Sleep, were accompanied by a review article of 87 studies, which concluded the oral appliances were successful in treating an average of 52% of patients.

If a patient with severe apnea doesn't want to use CPAP, an oral appliance may be worth a try, says Lawrence Epstein, medical director of Sleep HealthCenters LLC in Boston, but if it doesn't work he'll suggest other options, such as CPAP or surgery.

The process of getting one usually starts with a sleep study, in a lab or at home, to document the problem. Then the dentist takes an impression of the teeth and has a laboratory fit a device to the mold. Several visits are needed to get the adjustment right.

While most devices work by advancing the jaw, patients who find that uncomfortable can find other options. One newer device, invented by Tarzana, Calif., dentist Bryan Keropian uses a bar to keep the tongue in place instead of pulling the jaw forward.

Look for a dentist who is board certified by the American Academy of Dental Sleep Medicine, a trade group that provides training and gives exams.

Possible side effects include jaw pain, an altered bite and salivation, which usually goes away after a few weeks. The cost of an appliance can range from $800 to $3,000 or more, and is often covered at least in part by insurance. Some insurers require that patients first try CPAP, since it is more effective.

Dental Devices are for mild cases of sleep apnea.