[Treatment] S. Apnea caused by bad orthodontia, solve w/ dental appliance. What do folks think?

[NightOwl42]

Hi Folks,

Wondering if a dental appliance can help me, I had a consult with a local dentist who specializes in TMJ and sleep issues.

He presented the following case:

Orthodontists straighten teeth and alter jaw position, usually for kids via braces and headgear, but in doing so, they misalign the jaw, leading eventually to compromised airways (causing sleep apnea), bad posture, spine issues, and other problems.

He provided all kinds of examples of past and current patients who fit this narrative.

I asked him if current orthodontic practice acknowledges his concerns, and he said no, they are still doing the same thing, causing the same issues.

He made a convincing argument. He didn't try to sell me on anything - he said his approach at correcting the problem requires a minimum 8 month commitment to wear a dental appliance 24/7, even for eating, with the goal of correcting jaw position, which would eventually address the airway problem that causes sleep apnea.

First step is a $295.00, 2 hour visit where they do tomography and all kinds of measurements, and write you a treatment plan. Said plan comes in around $5,000.

TL;DR Sleep apnea can be treated by realigning the jaw, at substantial expense and time commitment - and then, no more CPAP!

What do folks think?

[Dawnstar]

I’ve been down this route, with no success. My endodontist built an appliance to shift my jaw so I could breathe at night. There was a significant amount of pain for me and a sleep study showed no benefit. It was also clear that over time, my teeth would shift out of alignment, though that would be a fair trade for lower apnea, if it had worked. If you grind at night, there’s also the issue of whether you’d destroy the appliances over time.

Some few of us have had dental appliance work, the last thread seemed to have a consensus that CPAP works and is non invasive.

[Crimson Nape]

It would be fantastic if an oral appliance would replace the use of a CPAP but all posts here point in the opposite direction.  A search produced these posts regarding oral appliances.

Search:  http://www.apneaboard.com/forums/search....order=desc

I hope this may provide some guidance.

[sheepless]

back when my kids were in orthodontia and the orthodontist and I were experimenting with a MAD device (this was in the early 90's before MAD was a thing), it was my impression the orthodontist's task is usually to make more room in the mouth to avoid pulling teeth. probably not all cases, but that suggests that to the extent the mouth/teeth/face/jaw whatever is expanded orthodontia is beneficial for apnea sufferers.

I've refused 3 sales pitches from my current dentist for a MAD. it's one thing to use them for snoring but they can't be anywhere near as effective as cpap for apnea. they also want to sell me implants and something for buxism. maybe your dentist is right, but the fact that so many dentists are churning them these days makes me at least a little skeptical.

just look at the price. more than 5 times the price of a resmed airsense 10 autoset.

[Stom]

Hi Folks,

Wondering if a dental appliance can help me, I had a consult with a local dentist who specializes in TMJ and sleep issues.

He presented the following case:

Orthodontists straighten teeth and alter jaw position, usually for kids via braces and headgear, but in doing so, they misalign the jaw, leading eventually to compromised airways (causing sleep apnea), bad posture, spine issues, and other problems.

People with overbites have a higher incidence of sleep apnea. One common thing that orthodontists correct is overbites. That, I would think would *reduce* obstructive sleep apnea. So it's unclear to me why your orthodontist thinks that orthodontia causes sleep apnea or what kind of specialized training s/he has in sleep disorders.

One fairly common treatment for mild to moderate sleep apnea are Mandibular Advancement Devices you can wear at night. They hold your lower jaw forward to help to treat obstructive sleep apnea. Unlike the devices your orthodontist proposes, you don't have to wear a MAD device 24/7, just at night, since, unlike orthodontia, they aren't necessarily a permanent change.

MADs are more successful in skinny people than people who are overweight, and they don't work as well as CPAP. You could get all of that treatment and still have the exact same obstructive apena, or it could really help. I don't know. But you might be able to to test the theory with a mold-it-yourself MAD and a sleep test that holds your jaw forward in the same way the orthodonist proposes trying to permanently move your JAW. (The custom MADs are a profit center for dentists, and while simple for them to cast and have made, they charge up to $4000 for them). Ask you orthodontist if the orthodontia could lead to TMJ - I'd think would be a risk of changing your bite.

[mesenteria]

I have seen an ad placed among the news items on my news page (whatever that is these days).  It has the attention-seeking caption that goes something like, "CPAP Suppliers Afraid of New Device That Cures Apnea," posing as just another news item, but with the obligatory small green box in the corner with the word "Ad" imprinted.  I would file that under fake news for two reasons: 

a. I really don't think any device is going to stanch the bleeding from wallets that support the PAP therapy market any time soon: and

b. I really don't think the CPAP suppliers know anything about this device.  If they did, and thought they had a modicum of efficacy, they'd probably offer to sell them.  As it is, this outfit might sell 2000 a year, let's say twice that.  DMEs who thought it was a good thing would be able to sell tens of thousands and make the suppliers rich.  Why aren't they doing it?

[Stom]

b. I really don't think the CPAP suppliers know anything about this device.  If they did, and thought they had a modicum of efficacy, they'd probably offer to sell them.  As it is, this outfit might sell 2000 a year, let's say twice that.  DMEs who thought it was a good thing would be able to sell tens of thousands and make the suppliers rich.  Why aren't they doing it?

They do and they do.

https://www.resmed.com/epn/en/consumer/p...ental.html

(Link to Resmed's page about their Narval CC oral appliance.)

[NightOwl42]

MADs are more successful in skinny people than people who are overweight, and they don't work as well as CPAP. You could get all of that treatment and still have the exact same obstructive apena, or it could really help. I don't know. But you might be able to to test the theory with a mold-it-yourself MAD and a sleep test that holds your jaw forward in the same way the orthodonist proposes trying to permanently move your JAW. (The custom MADs are a profit center for dentists, and while simple for them to cast and have made, they charge up to $4000 for them). Ask you orthodontist if the orthodontia could lead to TMJ - I'd think would be a risk of changing your bite.

Just to clarify - the person I saw is a dentist, and claims that orthodontists are the ones messing people up with braces and headgear.

[Stom]

Just to clarify - the person I saw is a dentist, and claims that orthodontists are the ones messing people up with braces and headgear.

It sounds like your dentist is selling you orthodontia, though.

[ardenum]

I have a custom MAD design based on Resmeds narval. Without it I used to max out my S10 because once my jaw and tongue relaxed I'd get a cluster which almost totally blocked the airway. With the MAD on, depending on my sleep position I am properly treated even with IPAP 12 EPAP 8, plus no clusters anymore.

It's a hybrid device with a double tongue retainer though, you wont find that anywhere.