Q: Are oral appliances an effective treatment option?
Research has proven that oral appliance therapy (OAT) is as effective as CPAP for mild to moderate obstructive sleep apnea (OSA). It reduces cardiovascular mortality rates similarly to CPAP and has shown to have a self-reported compliance rate of nearly 80%. For patients diagnosed with severe OSA, oral appliance therapy is also a viable alternative treatment for those who are CPAP-intolerant.
Q: How do mandibular advancement appliances (MAD) work?
Using the support of the teeth, a mandibular advancement device works to protrude the mandible and associated soft tissues. When the base of the tongue is positioned anteriorly, the oropharyngeal and hypopharyngeal airway size is increased. Additionally, physiological changes occur, as there is an increase in the baseline activity of the genioglossus as well as the pharyngeal constrictors, creating a splinting effect of the upper airway.
Q: Does the style of the MAD appliance make any difference?
Due to a number of variabilities such as the dental condition of a patient, we find much greater patient acceptance and compliance when a patient is fitted with an appliance that aligns with their anatomical characteristics. At the Snoring and Sleep Apnea Center of Greater New York, we offer several different appliances so we can select the most appropriate option to effectively treat the patient’s condition while also preserving their comfort.
Q: What type of patient would be best suited for an oral appliance?
Most patients would be candidates for oral appliance therapy—particularly if they are PAP-intolerant—but those who have the best chance of success include:
- Younger age groups
- Lower BMI
- Lower AHI
- Retrognathic Patients
Q: How much will it cost my patients?
We know how important it is that patients pay as little out-of-pocket as possible. We work with all major medical plans including Medicare, and are able to maximize a patient’s benefits and minimize their out-of-pocket cost, which is often dependent on their deductible balance.
Q: What does the Snoring and Sleep Apnea Center’s treatment protocol and process consist of?
Following the protocols defined by the American Academy of Dental Sleep Medicine and assuming the patient has had a baseline polysomnogram or HSAT, we complete a thorough consultation with the patient to determine the suitability of oral appliance therapy for their condition. We then perform a digital image of them and select the appliance that will most effectively treat the patient’s condition. After the appliance has been delivered, we perform follow-ups with the patient at one, two, and three month marks. During the initial phases of treatment, we assess the patient for efficacy through a patient report and bed partner reports, and sometimes using telephone apps. Once the appliance has reached maximum clinical efficacy, the patient is returned to the sleep physician for a full polysomnogram to verify efficacy. We then follow up with the patient and six-months and then annually.
Q: How will the Snoring and Sleep Apnea Center of Greater New York communicate with me regarding a patient I refer to the practice?
It’s important to us that you receive comprehensive updates about a patient you’ve sent to us. You will receive a letter when the patient has scheduled, and a letter after each visit relating what was accomplished at the appointment, as well as how the patient is doing with treatment. We will also let you know if, for some reason, the patient is not an appropriate candidate for an oral appliance. If there is any specific information you would like for patients you refer to us, or if you’d prefer fewer pieces of communication, we are happy to customize our protocol for you and your patients.
Q: If I send my patient to the Snoring and Sleep Apnea Center to be fitted for an oral appliance, will he/she undergo additional screening protocols or treatment?
When we are referred a patient by a physician or specialist, we are committed to delivering superior patient care that takes into consideration and respects the treatment and care the patient may already be receiving from our partners in the medical community. We work closely with all our referring physicians to ensure our treatment protocols and follow-up fulfill their expectations. If you have specific wishes for how we care for your patients, please don’t hesitate to contact us or specify them on the referral form.
Q: Why not just have a patient use a "boil-and-bite" appliance?
Every study has shown dramatically lower efficacy and compliance with boil-and-bite options when compared to custom-made appliances. When treatment is performed under the supervision of a trained dentist, the patient receives consistent follow-up to ensure their sleep apnea is under control, as well as careful monitoring and resolution of any potential side effects such as exfoliation of dental crowns, TMJ symptoms, and occlusal changes.
Q: What are some contraindications for an oral appliance?
The number of teeth a patient has is the primary contraindication, especially those on the lower arch. A patient must have at least three stable teeth on each side of the bottom arch to help stabilize the lower part of the appliance. A compromise to these parameters would require implants to help retain the device.
Other issues to consider:
- A severe gag reflex that may prohibit a patient from wearing an appliance.
- The inability to open beyond 30 mms or to protrude without pain would require some TMD therapy prior to appliance wear.
- Severe TMJ complications.
Q: Do oral appliances change the bite of the patient (the way the teeth come together)?
This is certainly possible with all appliances, but we prefer types that are the least likely to do so. Additionally, we take a full set of photos for every patient so that we know what their baseline is, and we check this at every appointment. We also give patients an option of four different exercises they can do to help maintain their normal bite relationship.