Custom Fit Appliances Provide Alternatives to the CPAP for Snoring and Sleep Apnea

Originally published in South County Magazine

Today, the best treatment for treating Snoring and Sleep Apnea when the CPAP mask is not indicated is Oral Appliance Therapy or OAT. 

OAT is the process of finding the appropriate dental appliance for the patient to wear at night to resolve his or her Snoring and or Sleep Apnea, and following up with the patient and making appropriate adjustments to the appliance so as to achieve your goal of stopping the snoring and or reducing the sleep apnea. 

What type of appliances are available. One type is what is called “Boil and Bites”. These are the appliances one sees on T.V. Infomercials that you pretty much make on your own. I have seen hundreds of patients who have tried these appliances. What I hear over and over is, “It kind of worked for while but then it got loose and kept falling out of my mouth and was too uncomfortable to wear”. Since they are not custom fit, they typically end up in the trash can. 

Another type is the custom appliance made by a dentist. Custom fit appliances are divided into three categories. 

Category one is the tongue suppression only appliances. They work on the principle of inhibiting the tongue from falling back and blocking the airway and consequently stopping the snoring or lessening the Sleep Apnea. I choose this appliance when the patient has significant problems with their jaw joint (or TMJ). 

The second category is called Mandibular Advancement Devices or MAD’s. The mandible is your lower jaw. For most people if you move your lower jaw down and forward it will open up your airway. If you have ever taken a CPR class you would have learned this principle. This is the most commonly prescribed type of appliance.

The third category of appliances are called a Hybrid Appliances. A hybrid appliance combines the features of both Tongue Supression and Mandibular Advancement. If a patient tests well for both tongue suppression and mandibular advancement, I find we have the best odds of success, because you have 

2 modalities to work with and therefore you statistically have a better chance of success. I have had case after case, where I found that with the second feature on the appliance I was able to avoid failure on a case. 

How do you determine which appliance is right for you? A thorough exam and testing. The testing is very simple patients often times tell me after the tests, which appliance would be right for them, because the tests make it so obvious. 

Most often the patient has had a Sleep Study. Patients are very appreciative when I can help them understand what this test reveals and this also helps me determine the which appliance design would best suit the patient. 

After the appropriate appliance is selected, then it’s a matter of follow-up. We typically see patients 5 or 6 times before we feel the situation is handled. For patients who snore we have them down load an app that allows us to monitor their snoring. 

Having knowledge and experience with several appliances and appliance designs has dramatically in- creased our success rate. 

It is also important that the dentist staff has experience working with Medical Insurance. This field although completed by a dentist, does not utilize your Dental Insurance, but your Medical Insurance. Consequently, the staff must be well versed in Medical Insurance and the dentist should be a Medicare Provider for those who are on Medicare.