Oral appliances that treat snoring and apnea are small custom devices that are worn in the mouth similar to sports mouth guards or orthodontic retainers. Oral appliance therapy involves the device choice, fabrication and guidance with a trained dentist. These devices may be worn alone or used in combination with other sleep apnea 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 well-trained dentist can guide you through the process needed to obtain one best suited for you.
If you are searching through the internet or even talking to sleep professionals, this is the confusing part! Many dentists, physicians, and sleep technicians may not be aware of the newest MEDICAL GUIDELINES (valid in 2018). The guidelines have been documented by sleep physician and dental expert panels who set the standard of care for treatment for apnea patients. Here is a summary of which individuals may be considered for oral appliance therapy:
- Patients that snore but have no apnea (verified through testing)
- Patients at all levels of apnea that have attempted CPAP therapy unsuccessfully
- ANY patient that PREFERS to seek out oral appliance therapy instead of CPAP therapy
Unfortunately, many patients are not given the option of oral appliances if apnea is diagnosed. It is important patients are made aware of all treatment options including oral appliance therapy.
When a medical provider discuses oral appliance therapy as an option for apnea treatment, often inaccurate information is given to the patient in regards to oral device success rates, side effects and where to find a qualified dentist to deliver therapy.
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
Here are the recommendations of what it takes to be a “QUALIFIED” provider of oral appliance therapy according to the newest medical guidelines (2018). He or she 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 Medicne’s Find-A Dentist tab and punch in your zip code. (http://www.aaadsm.org/findadentist.aspx). 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
There are 2 basic categories of oral devices:
- 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.
- Tongue Retaining Devices- 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.
The pros of oral devices:
- Small and easy to travel with, even to remote areas
- Easier to get used to compared to CPAP masks
- 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
- Ill 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
Successful treatment for snoring and apnea can change your life! And your relationships! We have seen it thousands of times!
For those that suffer with noticeable symptoms, successful therapy 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
Overall there is approximately 70-85% chance that an oral appliance will be effective for you. Factors such as experience of the dentist providing the service, limitations of the device chosen, severity of apnea, natural jaw movements and 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, but oral devices are tolerated considerably and worn for more hours than CPAP therapy. In other words, they might be similar if overall effectiveness in treating apnea.
If the diagnosis is apnea:
Doctor fees together with oral appliance fees vary depending on the quality of the devices, the geographical area, and the experience of the provider. 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 a very cumbersome process, especially if the dental provider is not in network with the MEDICAL insurance, which is often the case.
If the diagnosis is snoring in the absence of apnea:
If the patient was tested and found to have snoring without apnea, in most cases insurance will not pay for the devices. 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.
- 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 him/her.