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Sleep Dentistry, Sleep Apnea, and Snoring

man asleepDo you wake up with a headache? Are you tired throughout the day even though you went to bed at a reasonable hour? Does your family complain about your snoring? The loud snoring that you experience could be more than annoying. It could be affecting your health. Snoring affects 90 million American adults, almost half of them on a daily basis. What’s worse is that snoring may indicate Obstructive Sleep Apnea, a serious medical condition in which patients stop breathing during sleep.


Snoring Causes

Snoring has a multitude of causes that lead to breathing problems while you sleep. Some causes include:

All of these causes lead to the ultimate cause of snoring – the narrowing of the passage between the nose and throat which causes the soft palate and uvula to vibrate. The snoring noise is actually this vibration.

How Can a Dentist Treat Snoring?

Dr. Mogell and his staff work in conjunction with your sleep physician to help manage your snoring and sleep apnea problems. We often see patients who have suffered for years without finding relief even after receiving a diagnosis from their sleep physician because they have been unable to tolerate the CPAP (Continuous Positive Airway Pressure) machine. A team effort has proven most effective when a patient is searching for a CPAP alternative.

Sleep Apnea dentist Dr. Mogell has advanced training to treat snoring and sleep apnea by prescribing and fitting a custom oral appliance that gently holds your mouth and throat in an open position during sleep – allowing a full night’s rest with no snoring or breathing problems.

The American Academy of Sleep Medicine now recommends oral appliances for managing snoring and sleep apnea in patients with mild and moderate sleep apnea and those severe cases where a patient refuses to use CPAP or is CPAP intolerant. Additionally, they stated that oral appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint (TMJ-jaw joint), dental occlusion (the bite), and associated oral structures (muscles for chewing). Dr. Mogell has extensive training in these areas and has been treating TMJ and facial pain disorders in Palm Beach County since 1992.

Sleep Apnea Frequently Asked Questions

What is a Dental Sleep Appliance?

A dental sleep appliance for oral appliance therapy (OAT) is often described as being similar to a cross between an orthodontic retainer and an athletic mouthguard. They are custom made specifically to fit only you, and worn over both the upper and lower teeth when you sleep. Although oral appliances may not be suitable for everyone, an appliance that is properly chosen and adjusted reduces or eliminates snoring and significantly relieves symptoms of OSA.

How does the Dental Sleep Appliance work?

What we are calling a sleep appliance is a Mandibular Advancement Device (MAD). These devices work by holding the lower jaw slightly forward during sleep thereby opening the airway at the back of the throat. It is the collapse of this airway during sleep which is responsible for snoring and obstruction. The tongue is attached to the lower jaw, and with the jaw held forward. The tongue is prevented from collapsing back.

What is the best treatment for snoring?

There is NO single best treatment for everyone. That is why we work as a team with your sleep physician, to discover the best treatment for YOU. Dental sleep appliances are generally the most effective treatment for snoring and mild to moderate OSA with the least side effects, while CPAP is the treatment of choice for severe OSA. Surgery is prescribed for many people but is usually only around 55% effective with significant potential side effects including severe post-operative pain and occasional regurgitation of food through the nose. Other treatments including sprays, medications, and pillows lack scientific evidence of any benefit. However, in some patients these may be useful adjuncts to using a sleep appliance. Some combinations of weight loss, surgery, CPAP, and sleep appliances may be useful. Avoiding caffeine, nicotine and alcohol prior to sleep is also very helpful.

Are Dental Sleep Appliances effective?

The American Academy of Sleep Medicine now consider dental sleep appliances, Mandibular Advancement Devices (MAD), a first line treatment for snoring and mild to moderate sleep apnea. MAD appliances have been scientifically proven to be effective. Over 95% of people are satisfied with the level of improvement with their snoring when diagnosed and treated correctly. The appliance improves the quality of sleep, but it may take several nights of more refreshing sleep for the tiredness to resolve. In some cases, the improvement in health and alertness occur more gradually over weeks or months.

What if I am missing teeth or have bridgework or a denture?

There are appliances that can be successfully used in many different patients even if all upper teeth are missing. You will need to have at least 6-8 teeth to be able to utilize a conventional dental sleep appliance. It is important to have a thorough assessment of the teeth, gums, and jaws to ensure predictable, successful results with minimal long term problems.

Is one dental sleep appliance as good as another?

No. There are currently over 50 different dental sleep appliances. Many of these appliances have not had studies to prove effectiveness, are not adjustable, and are one size fits all. While appliances purchased over the internet may be considerably less expensive, the fit is often a problem and most people find them difficult to wear. Long term use of the one size fits all appliances may cause joint and muscle pain. Professionally made sleep appliances have been subject to scientific studies demonstrating effectiveness and comfort. It is important to note that no one appliance is ideal for each and every situation. The choice of the ideal appliance for you depends upon factors such as size, position, and number of teeth as well as the size and position of the jaws.

Are dental sleep appliances comfortable to wear?

Although the mouth is a very sensitive area, the vast majorities of patients adapt within a few nights and find the appliance surprisingly comfortable. This is because the appliance is laboratory made and custom fitted.

How much does a dental sleep appliance cost?

The initial consultation is $95.00 and includes a thorough assessment of your snoring and possible sleep apnea, your medical history and sleep study will be reviewed. The doctor also assesses the health of your jaw joints and mouth, and the suitability for a dental sleep appliance. If a decision is made at the first appointment that you are a candidate for oral appliance therapy, impressions will be taken immediately and the appliance insertion visit scheduled. The cost of oral appliances varies somewhat depending upon what appliance is correct for individual needs. Once determined, the cost will be discussed prior to beginning to process the appliance.

Will my insurance cover this?

Most of the time yes. Coverage of the therapy varies from policy to policy. Please note that this treatment is considered a medical procedure and will NOT be covered by your dental insurance. In most cases, the referral by your physician with the medical necessity is an aid to obtaining coverage. The most efficient way to determine your potential insurance benefit is to call our office and speak to our treatment coordinator who will contact your insurance company on your behalf.

How long does a dental sleep appliance last?

If you don’t clench or grind your teeth, a dental sleep appliance can last for many years. Even if you do clench and grind your teeth, the appliance can still last for years and has the added benefit of protecting your teeth and dental work. However, just like your automobile, your sleep appliance requires regular tune ups. If your appliance needs to be repaired or replaced this is usually done at a reduced fees from your original cost.

I don’t want to use the CPAP machine is the dental sleep appliance an alternative for me?

Please keep in mind, CPAP is considered the gold standard for treating severe obstructive sleep apnea and cessation of its use will only be considered in consultation with your sleep physician. Based on scientific studies, dental sleep appliances are not regarded as an alternative for patients that cannot or will not use the CPAP. Many patients dislike the noise and discomfort of the CPAP, and patients invariably find that changing to a dental sleep appliance makes them much more comfortable. Many patients with severe sleep apnea continue to use their CPAP at home and utilize a dental sleep appliance while traveling or during power outages. The possibility of changing to a dental sleep appliance can be determined at your initial visit.

Do I have to wear it forever?

No, there may be other methods to overcome your problem. These steps vary greatly by individual and will be discussed during your consultation. For many people, weight loss, exercise, or changing your sleep position can be helpful. These changes can be difficult if you are excessively tired. The use of the dental appliance increases energy levels through a higher quality night’s sleep and gives you the boost you need to implement these lifestyle changes. Because of this, regular reviews and follow-up sleep studies are very important to monitor changes.

Are there any side effects?

The vast majority of people have no side effects. A small percentage of patients have minor side effects such as excessive saliva, jaw tenderness, pressure on the teeth, and bite changes. Most side effects are temporary and disappear after a day or two or with a simple adjustment to your appliance.