Why Choose a Custom Oral Appliance?Last updated : March 26, 2017
Posted by: Reading Dental Associates
The American Academy of Sleep Medicine says so: Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint, dental occlusion and associated oral structures.
It may be more than snoring!: Only a custom appliance can treat obstructive sleep apnea. In a 2008 study comparing the efficacy of prefabricated anti-snoring devices with custom-made oral appliances, AHI was only reduced with the custom-made oral appliance.
Comfort and effectiveness: In the same 2008 study, the custom oral appliance reduced snoring to a greater extent. The initial success rate with the custom-made oral appliance was 100% higher than with the pre-fabricated device. Total failure rate with the pre-fabricated device was 69%, and the majority (63%) of these were subsequently treated successfully with the custom-made device. At the end of the study, 82% of the patients preferred the custom-made device, and 9% had no preference. (2)
Health Risks and Side Effects: Snoring mouthpieces or dental night guards may help you stop snoring, but potential side effects such as TMJ disorder, worsened sleep apnea, silent apnea, bruxism and shifting of the tooth position may outweigh the benefits of not snoring. Grinding night guards have been shown to increase OSA by as much as 50%. They also increase teeth grinding in sleep apnea patients.
Potential Side Effects of Oral Appliances
Finding a qualified dentist, trained in treating snoring, sleep apnea and TMJ disorder, to monitor your care is the best way to minimize or avoid complications such as:
Sleep Apnea without Snoring (Silent Apnea): You can still have sleep apnea without snoring. By reducing or eliminating the snoring sounds before a sleep study has been done to determine if sleep apnea is present, you could be masking the symptoms but not the disease. This is sometimes referred to as silent apnea. It would be like disconnecting the fire alarm and going back to sleep instead of addressing the fire itself!
Temporomandibular joint (TMJ) disorder: Appliances hold the jaw in a forward position, which could lead to shifting of tooth position and pain in the joints. TMJ disorders can cause jaw joint, ear, and tooth pain and can be caused by misaligned bite, bruxism, cartilage wear-and-tear and joint dislocation. Common consequences of living with the debilitating disease include missed time from work, school, family and loved ones. While choosing an over the counter or seen on TV anti-snoring device may seem easier than seeing your dentist for a custom fitted oral appliance, choosing a dental professional trained in recognizing symptoms of TMJ disorders to monitor your treatment could prevent a lifetime of pain.
Sleep Bruxism: Bruxism means grinding your teeth. It is common not to realize you are grinding your teeth while sleeping. Bruxism may cause TMJ disorders, muscle pain, tooth sensitivity or worn teeth. In some cases, the pressure to the TMJ from constant grinding of teeth leads to ligament injuries, which might cause the disc to dislocate. Sore jaw muscles when waking is an indication that you are grinding your teeth in your sleep.
In fact, oralfacial pain is reported by 66-84% of sleep bruxism patients (1). Research has shown strong links between bruxism and obstructive sleep apnea. Many nightguards for teeth grinding solve the problem of tooth wear and tear, but could actually cause you to grind your teeth more, and do not treat underlying medical conditions or prevent damage to the facial joints and muscles. A qualified dentist involved in monitoring your treatment and adjusting the positioning of the sleep appliance can detect bruxism before too much damage is caused and develop an appropriate treatment plan.
Tooth movement and bite changes: problems like shifting of tooth position may occur
Tooth and gum pain: Pain may also occur within the teeth and gums if the appliance presses firmly against the gum tissue. Your device should be properly fitted by a qualified dentist to reduce this risk.
Dry mouth: Once the oral appliance is in place, mouth dryness may occur overnight. This is more likely if you have nasal congestion or difficulty breathing through your nose (often related to allergies, a deviated nasal septum, or enlargement of the turbinates). If the appliance is large enough, it may not allow your lips to close over it. As a result, parted lips may lead to dryness of the mouth or tongue as breathing occurs.