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What You Need to Know about Oral Appliances for Snoring and Sleep Apnea

Snoring is often a sign of life-threatening sleep apnea. Oral appliances for the treatment of obstructive sleep apnea (OSA) are NOT available over-the-counter in the United States. They are only FDA approved and available through a qualified dentist once a physician has made an obstructive sleep apnea diagnosis.

How Do You Know if You Have Sleep Apnea?

There are three types of sleep apnea, all considered serious sleep disorders:

  • Central sleep apnea: CSA is resulted when the lungs don’t receive a command from the brain that tells them to breathe

  • Obstructive sleep apnea: OSA is the result of an obstruction in the upper airway

  • Complex sleep apnea / Mixed sleep apnea: A combination of central and obstructive apneic events

If you have central sleep apnea or complex sleep apnea, using an oral device could cause severe adverse health effects, including death. Whether or not you think you have sleep apnea, getting a sleep study is highly recommended before using a snoring mouthpiece, and can often be done in the comfort of your own home. If your sleep study results show an apnea hypopnea index (AHI) not indicative of sleep apnea, a dentist can still provide a custom mouthpiece to help you stop snoring.

Why Choose a Custom Oral Appliance?

The American Academy of Sleep Medicine says so: Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint, dental occlusion and associated oral structures. (3)

It may be more than snoring!: Only a custom appliance can treat obstructive sleep apnea. In a 2008 study comparing the efficacy of prefabricated anti-snoring devices with custom-made oral appliances, AHI was only reduced with the custom-made oral appliance.(2)

Comfort and effectiveness: In the same 2008 study, the custom oral appliance reduced snoring to a greater extent. The initial success rate with the custom-made oral appliance was 100% higher than with the pre-fabricated device. Total failure rate with the pre-fabricated device was 69%, and the majority (63%) of these were subsequently treated successfully with the custom-made device. At the end of the study, 82% of the patients preferred the custom-made device, and 9% had no preference. (2)

Health Risks and Side Effects: Snoring mouthpieces or dental night guards may help you stop snoring, but potential side effects such as TMJ disorder, worsened sleep apnea, silent apnea, bruxism and shifting of the tooth position may outweigh the benefits of not snoring. Grinding night guards have been shown to increase OSA by as much as 50%. They also increase teeth grinding in sleep apnea patients.

Potential Side Effects of Oral Appliances

Finding a qualified dentist, trained in treating snoring, sleep apnea and TMJ disorder, to monitor your care is the best way to minimize or avoid complications such as:

Sleep Apnea without Snoring (Silent Apnea): You can still have sleep apnea without snoring. By reducing or eliminating the snoring sounds before a sleep study has been done to determine if sleep apnea is present, you could be masking the symptoms but not the disease. This is sometimes referred to as silent apnea. It would be like disconnecting the fire alarm and going back to sleep instead of addressing the fire itself!

Temporomandibular joint (TMJ) disorder: Appliances hold the jaw in a forward position, which could lead to shifting of tooth position and pain in the joints. TMJ disorders can cause jaw joint, ear, and tooth pain and can be caused by misaligned bite, bruxism, cartilage wear-and-tear and joint dislocation. Common consequences of living with the debilitating disease include missed time from work, school, family and loved ones. While choosing an over the counter or seen on TV anti-snoring device may seem easier than seeing your dentist for a custom fitted oral appliance, choosing a dental professional trained in recognizing symptoms of TMJ disorders to monitor your treatment could prevent a lifetime of pain.

Sleep Bruxism: Bruxism means grinding your teeth. It is common not to realize you are grinding your teeth while sleeping. Bruxism may cause TMJ disorders, muscle pain, tooth sensitivity or worn teeth. In some cases, the pressure to the TMJ from constant grinding of teeth leads to ligament injuries, which might cause the disc to dislocate. Sore jaw muscles when waking is an indication that you are grinding your teeth in your sleep.

In fact, oralfacial pain is reported by 66-84% of sleep bruxism patients (1). Research has shown strong links between bruxism and obstructive sleep apnea. Many nightguards for teeth grinding solve the problem of tooth wear and tear, but could actually cause you to grind your teeth more, and do not treat underlying medical conditions or prevent damage to the facial joints and muscles. A qualified dentist involved in monitoring your treatment and adjusting the positioning of the sleep appliance can detect bruxism before too much damage is caused and develop an appropriate treatment plan.

Tooth movement and bite changes: problems like shifting of tooth position may occur

Tooth and gum pain: Pain may also occur within the teeth and gums if the appliance presses firmly against the gum tissue. Your device should be properly fitted by a qualified dentist to reduce this risk.

Dry mouth: Once the oral appliance is in place, mouth dryness may occur overnight. This is more likely if you have nasal congestion or difficulty breathing through your nose (often related to allergies, a deviated nasal septum, or enlargement of the Turbinates). If the appliance is large enough, it may not allow your lips to close over it. As a result, parted lips may lead to dryness of the mouth or tongue as breathing occurs.

Oral Appliance Costs Considerations

While over the counter boil and bite mouthpieces may appear to be a cheaper and easier snoring solution, you get what you pay for. The cost of TMJ treatment or much worse, the cost of treatment of untreated sleep apnea health consequences such as heart disease, may exceed the savings from choosing a non-custom snoring mouthpiece. In addition, an oral appliance may be covered by your medical insurance if provided by a dentist who is trained in dental sleep medicine and whose office is experienced in documenting medical necessity and billing medical insurance for oral appliance therapy. Medical insurance does not cover over the counter snoring mouthpieces.

Choosing a Sleep-Disorders Dentist

A qualified sleep-disorders dentist must:

  • Be willing and able to work closely with physicians and other health care professionals

  • Have appropriate knowledge of sleep medicine as well as jaw joint function

  • Have adequate training/education in oral appliance therapy. Ask about Certificates of Attendance from continuing education courses taken

  • Be able to treat effectively with different appliance types

  • Have experience with medical insurance reimbursement and documenting medical necessity

  • Have a solid relationships with local sleep labs and sleep physicians

  • Have a team approach with other healthcare professionals

  • Have a proven follow-up system to ensure healthy results long-term

  • Have an in-depth knowledge of oral appliance research

  • Provide statement of informed consent, explaining all possible contraindications and potential side effects

  • Realize that oral appliance therapy is not always the most beneficial treatment and should suggest alternate therapeutic modalities (CPAP, surgery) when appropriate

Source 1: Bader G, Lavigne G. Sleep Bruxism; An overview of an oromandibular sleep movement disorder. Sleep Med Rev 2000;4:27-­‐43 • Camparis CM, et al; Sleep Bruxism and TMD: Clinical and polysomnographic evaluaEon. Arch Oral Biol 2006;51:721-­‐728
Source 2: Vanderveken, O. M., A. Devolder, et al. (2008). "Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea." Am J Respir Crit Care Med 178(2): 197-202.
Source 3: Kushida CA; Morgenthaler TI; Littner MR et al. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: An Update for 2005. SLEEP 2006;29(2): 240-243.


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