Oral Appliance Therapy
Unlike most offices that use a single appliance, Dr. Rogers uses several different oral appliances, choosing the one that is best for you. The choice of oral appliance is made after a through medical history and oral examination.
Oral appliances have been in use for over 20 years to effectively treat snoring and obstructive sleep apnea. Currently, over 100 different appliance designs are available to specially trained dentists for this use. Many scientific studies have been published that demonstrate the effectiveness of these appliances when utilized by trained and experienced sleep-disorders dentists.
Oral appliances are placed in the mouth much like an orthodontic retainer or an athletic mouth guard. They are utilized during sleep to prevent the collapse of the tongue and soft tissues in the back of the throat so that the airway stays open during sleep. The appliances promote adequate air intake thereby helping to provide normal sleep for those who suffer from snoring and/or obstructive sleep apnea. Oral appliances can be used alone or in combination with CPAP or after surgery. Determination of proper therapy can only be made by joint consultation between your sleep-disorders dentist and your sleep physician.
All appliances and devices are FDA approved.
Types of Oral appliances
Of the many appliances available today, each falls under one of two categories based on mode of action. The first and largest category is that of the "mandibular repositioning device". By far the majority of all appliances in use today fall into this category. These devices serve by gently repositioning the lower jaw forward during sleep. The second category is that of the “tongue retaining device”. These appliances are seldom used but can be very effective for many people, especially those with few or no teeth or jaw joint problems. Tongue retaining devices function by protruding the tongue forward during sleep.
Appliances used in our office
The Thornton Adjustable Positioner (TAP®) oral appliance is a mandibular advancement device composed of two separate arches (maxillary and mandibular) containing an advancing mechanism which permits unlimited advancement of the lower jaw. The arches are custom fit to a patient's models. The advancing mechanism is engaged and the screw mechanism in the upper tray is then turned to advance the mandible until the patient begins to feel any discomfort in the temporomandibular joint or in the facial muscles (maximum mechanical protrusion which is an average of 2.5mm beyond maximum protrusion). The advancing screw is then turned back until patient is comfortable.
The Adjustable PM PositionerTM utilizes materials and a design that minimize office chair-time and provide the patient control of adjusting the jaw position under the dentist's supervision. Research studies have shown that this appliance is successful in treating 77% of patients with moderate obstructive sleep apnea. The appliance fits over all maxillary and mandibular teeth and is made of a special acrylic material (Bruxeze) thatsoftens in hot water to provide a combination of comfort, strength, and retention. This material has proven to be very durable. Expansion screws are located on the right and left buccal areas to allow maximum space for the tongue and easy anterior-posterior positioning of the mandible to achieve optimal effectiveness. This design permits ample lateral and protrusive movement to maintain jaw comfort.
The device uses a unique method of retention consisting of small projections of acrylic within the device that comfortably grip the undercut areas of two posterior teeth in each quadrant. Therefore, no metal clasps are necessary.
The Tongue Retaining Device is lab constructed of a flexible polyvinyl material adapted to the general contours of the teeth and dental arches. It does not depend on teeth for retention. Rather, the tongue is held forward by the negative pressure created in the vacuum bulb on the front of the appliance.
The appliance is available in four tongue extensions and with or without air way tubes for patients with compromised airway patency. It is constructed in conjunction with the Kel Gauge (described in another section of this program.)
Since the mandible is not rigidly or firmly held by the appliance, freedom of movement is possible during use. This would seem to make the TRD a good choice for the edentulous patient, the patient with periodontal disease and the patient with temporomandibular joint dysfunction.
There is ample research available documenting the effectiveness for treatment of snoring and OSA in certain patients.
The SomnoMed MAS is a custom-made device, consisting of upper and lower dental plates with a unique patented fin-coupling component, which allows normal mouth opening and closing. If required, a part can be added to make the device adjustable. This feature provides incremental and adjustable levels of lower jaw advancement, which improves the effectiveness and comfort-level of treatment as the jaw is moved only as far as is required to alleviate snoring and reduce OSA. Key features and benefits of the device include: Permits normal mouth opening Allows speech and drinking Provides full lip-seal Easily adjustable Safe and effective Clinically proven Custom-fitted Additionally, the SomnoMed MAS is made from durable fade-proof acrylic that retains its shape and color for at least four-five years and is covered by a two year manufacturer's warranty.
FDA Approval received July 2005
The EMA® Custom Appliance is a simple, patient-friendly oral appliance created for noninvasive treatment of snoring and OSA. The primary treatment mechanism of opening the bite and gently moving the mandible forward is achieved with the use of interchangeable elastic straps that offer varying degrees of mandibular advancement. The flexibility of these elastic straps provides unsurpassed lateral movement and overall TMJ comfort. The 2 mm thick pressure formed bases offer orthodontic retention (resulting in no tooth movement) and maximum anterior tongue space because there are no projections in the palate.
The Elastic Mandibular Advancement (EMA®) appliance uses elastic force to advance the mandible. Hand plastic trays are pressure formed to the patient's models and utilize the undercut areas of the teeth for retention. This insures that there will be no movement of the patient's teeth. Bite planes are used to open the bite. Mandibular advancement is achieved with different length straps. The elastic pull can also be adjusted to suit the patient's musculature. The straps provide complete lateral movement.
The EMA® Custom is available only to dental professionals
FDA Approval: Approved for both Snoring and OSA
Date of FDA Approval: Sept. 29, 1997
FDA Registration Number: K971794
The SUAD appliance has been in use for many years and has proven itself to be a comfortable, effective appliance. It is constructed to be much more wear resistant than most appliances and is especially good for patients who grind their teeth excessively at night.
What to Expect During Treatment
The first step in being treated for snoring or obstructive sleep apnea is to obtain an evaluation by a sleep physician who will provide a formal diagnosis based on a medical sleep study. After that, an evaluation by a sleep-disorders dentist will determine whether you are a good candidate for oral appliance therapy and which oral appliance will be most effective.
Your first dental appointment will involve a discussion of the problem, review of your medical status and a detailed focus on the advantages, limitations and risks of oral appliance therapy. Different appliance types will be discussed and one x-ray will be taken of your teeth and jaw joint. A thorough examination of your teeth, jaw joint and bite will be performed. Impressions will be taken of your teeth for fabrication of the appliance and a photograph will be taken of your bite.
Your second appointment will involve custom fitting the oral appliance and learning how to use and care for it. After that, you will return in approximately 4 weeks for a follow-up visit to monitor the effects of the appliance and to make any necessary adjustments to ensure comfort and effectiveness.
Ultimately, when the snoring and daytime sleepiness have been resolved you will be referred back to your sleep physician for a follow-up sleep study to ensure the effectiveness of the appliance. You will then be examined annually by Dr. Rogers to ensure adequate long-term success and to monitor any possible side effects.
Choosing a Dentist
Snoring and obstructive sleep apnea can be serious medical problems. Improperly treated obstructive sleep apnea can increase the risk for heart attack, stroke, diabetes and other serious illnesses. Choosing a sleep-disorders dentist who is qualified to work with your physician is essential to your health or the health of a loved one.
The dentist you choose to treat your problem with sleep disordered breathing must be properly educated and with adequate experience. Legally, any dentist can treat snoring and/or sleep apnea with an oral appliance, however, that does not mean that every dentist has the necessary experience and training to provide proper therapy. Because no special qualifications are required it is your responsibility to choose your dentist wisely and, If possible, work with a dentist that is board certified by the American Board of Dental Sleep Medicine.
A qualified sleep-disorders dentist should have:
- Appropriate knowledge of sleep medicine
- Adequate training in oral appliance therapy
- Years of experience with many different appliance types
- Solid relationships with local sleep labs and sleep physicians
- Current knowledge of emerging trends
- Ability to derive maximum insurance benefits for you
- A team approach with other professionals
- A proven follow-up system to ensure healthy results long-term
- In-depth knowledge of oral appliance research
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