What You Should Know About Sleep Apnea Oral Appliances
After being diagnosed with sleep apnea, you tried the CPAP machine without much success. (It’s been reported that up to 50% of patients cannot tolerate a CPAP.) You knew you couldn’t keep that mask on the entire night, much less every single night for the rest of your life.
Or maybe your sleep apnea is mild and can be treated with something other than a CPAP.
Regardless, your doctor suggests an oral appliance. Also known as a mandibular advancement device (MAD), mouthguard, or by the appliance’s brand name, these devices move your lower jaw forward to open the airway. Sometimes they allow for side-to-side movement of your mouth or provide freedom so your mouth can open slightly.
Are you a candidate for an oral appliance?
The sleep apnea appliance may NOT be suitable if:
You don’t have enough teeth to support the mouthguard. A minimum of 6 to 8 teeth are required in each arch.
You have active periodontal (gum) disease or your teeth are loose.
You need extensive dental work.
You are currently wearing braces or aligners for orthodontia.
You have temporomandibular joint disease (TMD) or advanced arthritis in your jaw joints.
You have many implants that cannot withstand lateral forces.
Your sleep apnea is “central,” meaning it stems from your brain and not your oral or airway physiology.
Not all mouthguards are created equal.
The sleep apnea oral appliance is actually two mouthguards, fitting your top and bottom teeth, respectively. The material is usually made out of a hard acrylic. When the appliance is worn, the two pieces are connected via acrylic attachments, rubber bands, wires, or the like.
Go to a dentist who has experience and knowledge with sleep apnea appliances.
Every dentist knows how to make a mouthguard. The process is identical whether the appliance is for grinding or to protect expensive dental work. However, most dentists have not been trained in sleep apnea or understand the differences among the many sleep apnea devices and their manufacturers.
Every dental laboratory knows how to make a mouthguard. But it’s important that your dentist work with a laboratory that understands the nuances associated with a sleep apnea device.
Your sleep physician, pulmonologist, or general dentist may be able to refer you to a dentist who performs this treatment. That individual will almost certainly be working with a qualified lab technician.
The appliances need adjustment.
This treatment is a process, not once-and-done. The appliance itself may need some adjustment to fit your teeth comfortably. Quite commonly the distance your lower jaw juts out will need to be fine tuned and either increased or decreased.
The appliance should also be examined and adjusted as needed on an annual basis.
How do you know the sleep apnea appliance is working?
Maybe you’re waking up more rested or you’re no longer fatigued during the day. Possibly you’re snoring less (to your bed partner’s relief!). Those are subjective impressions though.
To determine the effectiveness of your appliance, you need a follow-up sleep study with objective data showing that you have less frequent or shorter duration episodes where you’re not breathing.
Watch out for any bite changes.
Because your lower jaw has been thrust forward the entire night, your bite may feel awkward in the morning. It may be challenging to find your “home” bite.
Your dentist should provide you with a repositioning aligner, or jig, to assist with the reorientation in the morning. It is something you put in your mouth for 5 to 15 minutes that locates your original bite and maintains it there. Allow for extra time in the morning or incorporate this routine into your commute.
You may also experience other tooth movement where food gets habitually stuck in new places in your mouth. A skilled dentist and lab technician will have made accommodations to prevent or minimize this in the fabrication of the appliance.
The appliances can be costly.
Sleep apnea appliances can run into thousands of dollars. While dental insurance rarely covers such an expense, appliances are sometimes covered under medical insurance. They may also be covered by Medicare, the government healthcare plan for people over age 65. There are, however, restrictions on the type of mouthguard covered.
Not every dentist who makes these appliances will be familiar with the required medical billing. But dentists who treat a lot of sleep apnea patients will usually be familiar with the billing procedures.
What if you need dental work under an existing appliance?
It’s unrealistic to expect that your dental needs won’t change and you won’t need any further dental work. If an isolated tooth requires a new filling or crown, the restoration can often be made to fit the appliance. Or the appliance can be retrofitted and adapted to the new dental work. If more extensive treatment is necessary, then a new sleep apnea device may be in order.