Sleep Medicine & Oral Appliance
Frequently Asked Questions
In a perfect world, if a patient wears CPAP all night long and keeps it on in all body positions and uses it every night, it has higher efficacy than treatment with an oral appliance. Since patient acceptance and compliance with CPAP is about 50% and patients often don’t wear their CPAP on a nightly basis, Oral Appliance Therapy may be equally effective. Similar results in terms of health outcomes (sleepiness, quality of life, driving performance and blood pressure) suggest that although the two treatments have different efficacy and treatment usage profiles, the result is similar in overall effectiveness.
Patients often report preferring oral appliances to CPAP treatment, with better usage rates.
Dr. Sall recommends this article published in the Journal of Dental Sleep Medicine for a more complete discussion of the topic:
All Patients with moderate and severe obstructive sleep apnea are required to have a follow up sleep study while using the appliance to confirm the effectiveness of the device.
The sleep study may be done in the patient’s home or in an accredited sleep lab depending on the patient’s preference, health history, and insurance requirements. The position of the jaw may be adjusted or modified with the appliance to increase treatment success. After the sleep study with the oral appliance in place, the patient should meet with the sleep physician or dentist to discuss the results and any further treatments, if necessary.
An oral appliance is a small and comfortable acrylic device that fits over the upper and lower teeth. It is similar to retainers used in orthodontic therapy or night guards used for grinding of the teeth at night.
At night the appliance is used while sleeping to prevent the soft tissues of the throat from collapsing and obstructing the airway. Oral appliances work by gradually advancing the lower jaw forward, which in turn moves the base of the tongue forward. This opens the airway to improve breathing and reduces the snoring and apneas that occur during sleep.
Oral appliances are about 85-90% effective when the problem is limited to snoring.
When treating obstructive sleep apnea, oral appliances are 60-80% effective, depending on the severity.
While oral appliances tend to be more effective for treating mild to moderate obstructive sleep apnea, they may be successful in patients with severe apnea as well.
As a rule, the appliances generally last 2-5 years. Warranties against breakage range from 1-3 years, depending on the manufacturer, lab, and appliance selected. In some patients the appliance may last over 5 years but they do continue to wear over time.
Over 90% of the patients will adapt to the appliance within the first 2-4 weeks.
It is not uncommon to take several days to get used to having a device in your mouth while sleeping. Patients who have worn orthodontic retainers or appliances for bruxism tend to adapt easier to Oral Appliance Therapy.
The initial consultation involves a complete medical and dental history, a detailed head and neck and dental exam. In addition, the sleep study is reviewed with the patient if it is available at that time.
At the second visit, impressions, photographs, radiographs and measurements are obtained. Informed consent for Oral Appliance Therapy is obtained at that time.
The third visit consists of the delivery, insertion, and initial adjustment of the appliance with detailed instructions on the use and care of the appliance. There may be 2-3 more adjustments over the next 2-6 weeks, depending on the patient.
Since we utilize 5-6 different appliances and each appliance is customized to the individual patient, the cost may vary depending on the individual appliance selected.
If Oral Appliance Therapy is a covered benefit under your plan then you will have coverage but if you have not reached your maximum out of pocket expenses then you may be responsible for the entire cost of treatment.
Since medical insurance plans are constantly changing and evolving, we will have to contact your insurance company prior to treatment to accurately address your coverage concerns and determine your financial responsibility with your current plan.
Prosomnus Oral Appliance Use & Care Instructions
- Patients should not insert until just prior to sleep.
- Patients should inspect the device prior to each use.
- Patients should brush their teeth, floss, and rinse device with water before insertion of
- Use the arch devices selected by your doctor. Upper and lower devices can be inserted as
one device like a sandwich or inserted separately. If separately, insert upper arch first, then
lower arch. Use thumbs and forefinger to gently seat the appliance arches. Close mouth slowly.
- Each morning after use, thoroughly clean the device with a soft bristle toothbrush, cool or lukewarm water, and a mild detergent (dish soap). Warning: Do not use hot water or denture cleaners as they may damage the device.
- Rinse thoroughly and store dry in the container supplied.
- Patients may use ultrasonic cleaner weekly with these devices following the above instructions.
Note: Daily soaking is not necessary and may harm the device. Don not use mouthwashes or any other chemicals or solutions. These may penetrate the resin material of your appliance adding unwanted odor.
Somnomed Oral Appliance Use & Care Instructions
- Rinse in cool or lukewarm water. Clean with a soft toothbrush and a mild dish detergent (i.e. Dawn). RINSE WELL. Pay particular attention to cleaning the metal components and the fitting surface to ensure that it is free from all scaling deposits. Avoid skin contact with the metal components where possible.
- Store in the capped container provided filled with clean water. By storing in water, the Somnodent flex material will not dry out and this will help prevent cracks and corrosion. The device should be fully submerged.
- Once or twice per week, soak in a partial denture cleaner, such as Somtabs (Amazon) or Polident for Partials, available in many pharmacies. Soak for approx. 5 minutes, then rinse and store in water or insert appliance for use. Ensure that you are using a Partial denture cleaner.
Note: You may experience a mild plastic taste during your first use of the device. This will disappear
with storage and use. Cleaning with soap and denture cleaner before use is helpful. Replace water
Routine dental work usually does not present any significant problems with the fit of the appliance.
When there is extensive dental work or loss of teeth after the appliance is fabricated, the appliance may be further adjusted but often may need to be remade.
The design and materials of some appliances will accommodate changes in the dentition better than others and this may be taken into account in selecting your appliance.
Most soreness in the gums or teeth resolves within 1-2 weeks. When soreness persists beyond this time, Dr Sall can easily adjust the appliance to make it more comfortable.
Medical options include: positional devices, positional therapy, and weight loss, avoiding alcohol before bedtime, CPAP therapy as well as surgery.
Dental options include:
- Oral Appliance Therapy (OAT or MAD’s)
- Tongue Retaining Devices (TRD)
Oral Appliance Therapy is covered by medical insurance because OSA is a medical condition and not a dental condition. Dr Sall is a licensed physician and dentist in New York State and is board certified in sleep medicine. Our office will bill your medical insurance carrier directly and does not bill dental insurance carriers.
Since medical insurance plans vary widely, we work with all our patients to obtain maximum reimbursement allowed by their plans. After the initial consultation with Dr Sall, our office will contact your medical insurance carrier to obtain authorization and explanation of your benefits for your treatment. We make every effort to make the patient understand their financial responsibility after contacting their insurance company and determining their benefits for Oral Appliance Therapy. Since we are a medical office, we will bill your medical insurance company directly to obtain reimbursement for your treatment.