About Oral Devices

Snoring or CPAP struggles? Custom dental devices may be your best solution to peaceful sleep!

What is an oral sleep appliance for snoring and apnea?

In the medical field, custom dental devices or mouthguards that treat snoring and apnea are called oral appliances. This type of custom dental device is medically referred to as:

• Mandibular advancement device
• Mandibular repositioning device
• Nandibular advancement splint, and more

Oral appliances that treat snoring and apnea are small custom devices worn in the mouth similar to sports mouth guards or orthodontic retainers. Oral appliance therapy involves device choice, fabrication and guidance with dentists educated in dental sleep medicine.

These devices may be worn alone or used in combination with other sleep apnea or snoring treatments, such as weight management, surgery and CPAP (continuous positive airway pressure) therapy.

There are approximately 80 such devices available to dentists, and no one particular device is best for all individuals. A sleep disorders-trained dentist can guide you through the process needed to obtain one best-suited.

Who are professional oral appliances recommended?

Many dentists, physicians, and sleep technicians may not be aware of the newest medical guidelines involving oral appliance therapy (valid in 2019). The guidelines have been documented by a sleep physician and dental expert panels who set the standard of care for treatment for apnea patients.

The following individuals are good candidates for oral appliance therapy:

• Patients that snore but have no apnea (verified through testing or medical consultation)
• Patients at all levels of obstructive sleep apnea that have attempted CPAP therapy unsuccessfully
• Any obstructive sleep apnea patient that prefers to seek out oral appliance therapy as an alternative to CPAP therapy

Unfortunately, many patients are not given the option of oral appliances or incomplete information is given once apnea is diagnosed. 

It is important patients are made aware of all treatment options, including oral appliance therapy.

Why do some apnea patients choose an oral device if CPAP is the 1st line of treatment?

Here are some of the reasons why patients seek oral appliance therapy:

Typical apnea patients’ comments: 

• I wore my CPAP but it didn’t work. I tried many masks
• I HATE my CPAP, it keeps me up all night
• I refuse to wear a CPAP. I’d rather die a few years early
• I’m still dating and don’t want to wear a mask
• The CPAP gave me major sinus issues
• My CPAP left marks on my face hours after I took it off in the morning
• I developed rashes on my face from the mask
• I hate taking my CPAP during travel. I usually leave it behind
• I have panic attacks when I strap the mask on my face
• I would like to have something so I don’t snore on airplanes
• I’d rather wear a oral device when my grandkids are staying over

Snoring patients’ comments:

• I don’t have apnea, but I snore and feel tired all the time
• My spouse can’t handle my snoring any more. We’re tired of sleeping in separate rooms
• It’s expensive traveling and getting a separate room
• On my golf trips, I didn’t want to be THE ONE snoring
• I’m going oversees on a mission strip and will be sharing room with others

How to find a “QUALIFIED” Oral Appliance Therapy Dentist?

Here are the recommendations of what it takes to be a qualified oral appliance therapy provider according to the newest medical guidelines (2019). They should:

• Have post-graduate certification in dental sleep medicine by a non-profit organization.
  • Very little if anything is currently being taught in dental schools in regards to dental sleep medicine
  • Unfortunately, many profit based dental organizations are guiding dentists training and providing certifications in dental sleep medicine that are product-biased and not with the full scope of training that is recommended
• Be a dental director of a dental sleep medicine facility accredited by a non-profit organization
• Every 2 years have a minimum of 25 hours of continuing education for a non-profit organization or accredited dental school
• Be a licensed dentist (vs a physician)
  • The physician’s’ role is to diagnose and prescribe an oral device, but the dentist is to administer the oral appliance treatment

The easiest current way to find a qualified dentist is to visit the American Academy of Dental Sleep Medicine’s Find-A Dentist tab and type in your zip code. Usually, the order of amount of dentist training on this site from most to least are:

• 1st choice – Board Certified Dentist
  •  Also known as Diplomate of the ABDSM
• 2nd choice -Accredited Facility
• 3rd choice – Qualified dentist

If no trained dentists are listed in your area, see article:
Not All Sleep Dentists Are Created Equal: Where to Find a Qualified Sleep Apnea Dentist

How do oral devices for snoring and apnea work?

There are 2 basic categories of oral devices (Oral Appliance Therapy):

• Mandibular Repositioning Devices (MRD’s) also known as Mandibular Advancement Splints.
  • These custom made devices reposition and stabilize the jaw in a forward position helping to prevent muscles and tissues from collapsing back into the airway that causes the obstruction
  • MRD’s are far more commonly researched and are the primary type of device that is prescribed for obstructive sleep apnea patients
• Tongue Retaining Devices (TRD’s)
  • These devices actively hold the tongue in a forward position helping to prevent the back of the tongue form collapsing into the airway that causes the obstruction
  • These are sometimes favored for patients with very large tongues, poor dental health or chronic joint pain
  • TRD’s are rarely recommended in comparison to MRD’s.

What are the pros and cons for professional oral devices?

The pros of oral devices:

• Small and easy to travel with, even to remote areas
• Easier to get used to compared to CPAP masks
• Quiet
• Easy to clean
• Easy to sleep in any position
• Can often provide drastic improvements in quality of life
• Can help protect your teeth if you are a ‘teeth grinder’ during sleep
• Depending on type, you may be able to drink water or talk with it while inserted
• May be more cost effective than CPAP. No hoses or parts to keep purchasing
• If the person is diagnosed with apnea, it is usually covered by medical insurance
• Often unnoticeable when wearing
• You can get up freely to use the bathroom without ‘unhooking and re-hooking’ yourself
• Minor jaw “TMJ” symptoms can be improved

The cons of oral devices

• Can cause short term drooling or dry mouth
• Can cause short term tooth or jaw discomfort
• Minor-moderate shifting of the teeth / jaws can occur, especially if patient does not have proper instructions on prevention or does not attend follow-up visits
• Many dentists are not formally trained in dental sleep medicine, nor in the details of after care involved. It may be hard to find a qualified dentist
• Insurance reimbursement may be cumbersome, especially if the dentist is not in the medical network
• Poor fitting dental restorations may be dislodged
• In a very small percentage of device users, the apnea could be made worse
• Although very rare. some patients can’t sleep with anything in their mouths
• Minor jaw “TMJ” symptoms can be made worse or resurrected

What does successful treatment look like?

Successful treatment for snoring and apnea can have a large positive impact on the quality of your life. And your relationships! 

For those that suffer with noticeable symptoms, successful oral appliance therapy (OAT) can result in:

• Improved sleep quality
• Feeling refreshed when you awaken
• Feeling more awake later in the day or during driving
• More peace in relationships with eliminated or improved snoring levels
• Deeper, more peaceful sleep
• Couples are rejoined in bedroom
• Less trips to the bathroom during sleep
• Improvement in chronic health conditions such as high blood pressure
• Improved oxygen blood levels during sleep
• Absence or improvement of the number of apnea events

How effective are oral sleep appliances?

In approximately 70-85%  of cases, oral appliances will effectively reduce or eliminate apnea events. Snoring is eliminated or considerably reduced in approximately 90 % of cases.

Factors such as the dentist’s experience providing the service, limitations of the device chosen, the severity of apnea, natural jaw movements, and the weight of the individual can all impact success levels.

Compared to CPAP therapy, oral devices overall stack up quite high in ‘effectiveness.’ CPAP therapy may be more effective when used.

Still, oral devices are tolerated considerably and worn for more hours than CPAP therapy. In other words, they might be similar in the overall effectiveness of treating obstructive sleep apnea.

How much do oral appliances cost? Are they covered by insurance?

If the diagnosis is apnea:
Doctor fees and oral appliance fees vary depending on the quality of the devices, the geographical area, and the provider’s experience. Total costs can range from $1500 to $5000, and possibly more.

In most cases, medical insurance covers a large portion of the fees if the patient was diagnosed with apnea.

However, being successful with insurance coverage can often be cumbersome, especially if the dental provider is not in-network with the medical insurance carrier.

If the diagnosis is snoring in the absence of apnea:
If the patient were tested and found to have snoring without apnea, insurance would not pay for the devices in most cases. 

However, often these individuals would greatly benefit from wearing an oral device.

It is fairly common for these patients to experience significant symptoms such as excessive daytime sleepiness or poor sleep.

If these symptoms are documented, and the patient is diagnosed with upper airway resistance syndrome or UARS, medical insurance reimbursement may be applied in select cases. 

Dental insurance should not be used for oral appliance therapy as these devices treat the medical (not dental) conditions of snoring and apnea.

Which oral device is best for me?

• There are MANY (over 80) professional oral devices available for a dentist to construct
• Not any one device is more effective than the rest regardless of what is being advertised
  • There is very little to no research comparing specific devices
• A trained sleep apnea trained dentist can help sort which device would be best suited for an individual
• It is advised that the oral device is adjustable in small increments as recommended by the medical guidelines
• Most dentists that are knowledgeable in dental sleep medicine have at least a few types of oral devices that they have chosen to work with
• The patients should ask details on the warranty of the device that the dentist has chosen for them

Are sleep oral appliances comfortable?

Most patients find oral appliances to be comfortable to wear. The adjustment period usually lasts just a few nights.

What are the most common side effects of oral appliances?

The most common early side effects of oral appliances are increased salivation or dryness and minor jaw stiffness.  These are usually resolved after the 1st couple of weeks of use. 

Long-term side effects may include small tooth movements, which can often be prevented with a trained dental sleep medicine provider.

How will I know if my oral appliance is working?

In most cases, your sleep apnea dentist will have you adjust your device until there is an elimination of symptoms related to apnea such as snoring, poor sleep quality or daytime sleepiness.

At this point your sleep health physician or medical provider may then schedule a sleep study to verify treatment success beyond symptom relief.

The type of sleep test that is recommended to verify the effectiveness of the device may vary. Both home sleep tests and lab tests (polysomnography) are currently being performed with the patient having the oral device inserted.

Can I wear an oral sleep appliance if I grind my teeth?

Yes, patients that wear a nightguard currently or have been told they grind their teeth are often excellent candidates for oral sleep appliances. 

If successful, oral appliances can treat the apnea and manage the bruxing (teeth grinding) while eliminating the patient wearing a CPAP (Continuous Positive Airway Pressure Device) simultaneously with a nightguard.

Wearing both at the same time can add more difficulty to CPAP usage.

For more info, read: I already have a nightguard for grinding. Will I still be able to wear an oral device for apnea?

If I have had “TMJ” jaw pain in the past, can I have an oral appliance made?

Yes, patients with a history of TMJ or jaw pain symptoms often transition nicely into regular usage of an oral appliance.

Many patients with current mild “TMJ” symptoms often feel improvement after wearing an oral sleep appliance. 

Read this article to learn more.

What kind of dental condition do I need to have to support an oral appliance?

Usually, a minimum of eight healthy teeth on each upper and lower jaws are best to support custom oral appliances.

It is recommended that you have had a recent general dental examination establishing a healthy dental condition to prevent delay in treatment and minimize potential side effects of oral appliance use. 

How are custom sleep appliances different then self-molded devices available through the internet?

There are large differences between professional oral devices and over-the-counter(OTC), or internet-based mail-order anti-snoring mouth devices.

Self-molded internet devices often have significant side effects, including tooth movement and mobility, and can cause jaw pain.

Although these symptoms also occur with custom dental devices, there is no supervision of a dentist to help guide through the process and help prevent or manage side effects.

One of the biggest complaints with internet self molded devices is that they are often not retentive and fall out easily. 

Additionally, custom oral appliances are often made adjustable to allow for needed advancements of the jaw in very small comfortable increments. Custom appliances are often made to allow for much freedom of movement, adding to comfort and compliance.

Devices purchased through mail order media sites can put people at risk of hiding’ apnea while reducing snoring levels.

Read my guidance about using an over the counter mouth guard for oral appliance theraphy.

Ready to find a dentist that can provide a custom dental sleep device?

The easiest current way to find a qualified dentist is to visit the American Academy of Dental Sleep Medicine’s Find A Dentist tab and type in your zip code.

Usually, the order of amount of dentist training on this site from most to least are:

• 1st choice- Board Certified Dentist
• also known as Diplomate of the ABDSM
• 2nd choice-Accredited Facility
• 3rd choice- Qualified dentist

If there are no providers listed on the AADSM website near your location, consider these steps:

• Call a sleep specialist medical doctor is in your area
  • Your primary care physician should be able to connect you with one.
  • Ask the sleep specialist for a referral to a dentist that follows the AASM (American Academy of Sleep Medicine) medical guidelines for oral appliance therapy
• Ask your general dentist to help you find a referral.
• Contact a credentialed sleep facility through the American Academy of Sleep Medicine and ask for a referral of a dentist they have worked with