Introduction

Snoring vs. OSA
(Obstructive Sleep Apnea)

What is Snoring?

What is OSA?
(Obstructive Sleep Apnea)

What is OAT?
(Oral Appliance Therapy)

FAQ's: Obstructive Sleep Apnea (OSA)

1. Am I a candidate for Oral Appliance Therapy (OAT)?
2. Can my Dentist treat OSA with Oral Appliances?
3. What are some of the benefits of OAT?
4. How long before you notice beneficial effects?
5. Are there potential side effects from OAT?
6. What are the costs involved?
7. Does my insurance cover oral appliances for sleep apnea?
8. How do I get started?
9. How do I contact you?

1. Am I a candidate for Oral Appliance Therapy (OAT)?
     According to the AASM/AADSM, OAT is appropriate for the primary treatment of Mild to Moderate Obstructive Sleep Apnea and for patients who have not responded well, have failed or are intolerant to Continuous Positive Airway Pressure (CPAP) devices and/or surgery. Severe patients are generally better served with CPAP, but for many patients CPAP compliance is difficult and in certain cases, OAT has been useful in combination with CPAP to help lower CPAP treatment air pressures. (AASM = American Academy of Sleep Medicine; AADSM = American Academy of Dental Sleep Medicine; OSA = Obstructive Sleep Apnea; Mild OSA = RDI/AHI of 5-15; Moderate OSA = RDI/AHI of 16-30; severe OSA = RDI/AHI greater than 30; RDI = Respiratory Disturbance Index; AHI = Apnea Hypopnea Index; Both RDI and AHI are determined from a sleep study).

2. Can my Dentist treat Obstructive Sleep Apnea (OSA) with Oral Appliances?
     Yes, if your dentist is well trained in obstructive sleep apnea including diagnostic sleep studies and sleep treatments. This includes a thorough working knowledge of the numerous FDA-approved appliances, each with its unique mechanism of action. The treating dentist must understand the underlying cause(s), clinical complexities and physical limitations of each patient. Oral Appliance Therapy is not for all OSA patients and no one oral appliance can fit all cases. Every patient is unique and must be carefully examined, evaluated and diagnosed before any appliance is decided and fabricated. Numerous factors must be determined... Where exactly are the obstruction(s)? Which tissues are involved? the nose? throat? tongue? soft palate? uvula? tonsils? adenoids? lateral fat pads? Are the patient's teeth, bite, gums, bone and the all important jaw joints (TMJs) ready for a mandibular advancement? Is the bite evenly balanced to begin with? Are there anatomic/physiologic peculiarities that must be addressed? Is the patient a bruxer(teeth grinder)? a mouthbreather? What techniques will the patient use to help facilitate the jaw muscles? Is the goal to just advance the mandible forward? downward? is vertical bite opening a problem? How will you monitor this therapy? the mandibular (lower jaw) advancement, the TMJs, the muscles, etc.?

3. What are some of the benefits of OAT?
     A. Higher patient acceptance with generally easier compliance than with CPAP.
     B. A medical treatment that is conservative, non-invasive and non-surgical.
     C. A cost-effective therapy, with several choices of FDA-approved appliances.

4. How long before you notice some beneficial effects?
Some patients notice a definite refreshing difference after the first night, while most typically take 1-2 weeks,a few take 1-2 months, and a rare handful may not adjust well and/or require a different type appliance or none at all... It takes time for the human body with its unique anatomy and physiology to adjust to this newly acquired jaw position. The ultimate benefits outweigh any initial discomforts and with the properly selected and adjusted appliance, OAT typically makes for a happier, more refreshed and alert "new" person. Most patients note a remarkable drop in snoring which partner, family, and relatives greatly appreciate. However, OAT must also significantly improve your critical blood oxygenation levels, which is monitored and measured by follow-up sleep studies, to be able to report any level of true success. Oxygen is energy is life. The lack of oxygen creates "oxidative stress" in the body which is thought to contribute to aging and poor health.

5. Are there potential side effects from OAT?
     Some common early side effects include increased salivation, initial tooth, gum or bone discomfort, and jaw-joint (TMJ) discomfort. Early follow-up appointments are necessary to check, adjust and correct any of these early discomforts. Certain teeth, fillings &/or crown/bridgework may initially become sore, loose, or dislodged and require adjustments of appliance, replacement of the dislodged filling &/or recementation of the dislodged crown/bridge work. Root canal treated teeth should be protected with full coverage crowns to prevent possible breakage. Over the long term (months to years), possible changes in tooth-position, jaw-position, or space changes can be expected. These problems may require further adjustments/treatments, interceptive therapies &/or some type of orthodontic therapy. It is important that the patient and appliance be re-evaluated on a regular basis, e.g. semi-annually or annually, depending upon the severity of the conditions. Please do not ignore the importance of follow-up exams, as we are talking about your life... not just your teeth, dental work or appliances!

6. What are the costs involved?
     The fees for OAT to treat Snoring &/or Obstructive Sleep Apnea (OSA) ranges from several hundred dollars for simple snoring to several thousand dollars for a complicated sleep apnea case. The actual fee depends upon the specific cause and location of the obstruction(s), the severity of the disorder, the selected appliance necessary to treat, the type and nature of material construction, the number of treatment appointments necessary to titrate/adjust, etc. It is critical to select the correct appliance that best fits the specific needs of the patient. Some basic questions that must be answered: A one-piece appliance or two-piece? adjustable or non-adjustable? what type/quality of materials? what areas to be covered? if used, which coupling mechanism? which appliance best suits the teeth? bite (occlusion)? jaw-joints?, muscles? airway? etc... Some appliances are pre-fabricated, some are semi-customized and others are fully customized requiring fabrication by a certified dental laboratory... is there additional treatment needs for bruxism (night grinding)?, mouth breathing? Some appliances may require use in combination with CPAP/BiPAP/AutoPAP for the most severe OSA patients. The sleep apnea dentist will discuss and help select the best appliance for your specific needs. Lost, broken or replacement appliances are extra.

7. Does my medical insurance cover oral appliance therapy for obstructive sleep apnea?
     If you have medical insurance, a pre-authorization request can be made for you. Some insurance companies can and will pre-authorize and partially cover an oral appliance, but many will not, at least at this present time. Because it is a new medical procedure with new insurance codes and because it is a dentist treating a medical disorder, there is considerable room for misunderstanding, confusion and controversy resulting in denials. However progress is being made in this area, so it will not hurt to ask. There is no known dental insurance coverage for OAT at this time. Our office has spent many long hours with medical insurance companies on behalf of our patients, mostly to no avail. Unfortunately, we must now operate under the assumption that your insurance company does NOT cover this service and we ask that the patient pay us directly and then be reimbursed later if there should be some medical coverage. Incredibly, this process is most time consuming and can sometimes take weeks and weeks...WE DO NOT RECOMMEND THAT YOU WAIT AS SLEEP APNEA IS A POTENTIALLY LIFE-THREATENING MEDICAL DISORDER! Our office offers several financial plans/options, including 'No Interest Payment Plans' (0%) up to 12 months. Please feel free to inquire.

8. How do I get started?
     If you suspect sleep apnea, you must first be evaluated by a physician or sleep specialist, who will make the diagnosis of snoring &/or sleep apnea. This requires an overnight sleep test. One test is the polysomnogram (PSG), which is done in a sleep clinic laboratory and will determine your sleep apnea; another test is the home sleep testing (HST) which is portable and done at home in your own bed. After diagnosis/consultation with your physician/sleep specialist, and if oral appliance therapy is deemed appropriate, you will be referred to a specially trained sleep apnea dentist. A copy of your diagnostic sleep study should be forwarded to the dentist, along with a written prescription for a sleep apnea appliance or a letter of medical necessity. After careful examination and evaluation, the treating dentist will recommend the best appliance to fit your specific OSA needs. There are over 20+ FDA-approved appliances available today to treat snoring &/or OSA.

     If you have already had a sleep study &/or have been diagnosed with OSA &/or using a CPAP device, then you must discuss your concerns with your physician/sleep specialist. Together you will make the decision of whether OAT is appropriate. If appropriate, please have sent a copy of your most recent sleep study and prescription/letter to the sleep apnea dentist.

9. How do I contact you for more information?

     Please ask for "Darlene" or "Charlene" at:

     Alan S. Tanisawa, D.D.S., Inc.
     REDWOOD DENTAL & SLEEP APNEA
     22408 Charlene Way @ Redwood Rd.
     Castro Valley, CA., 94546-7102, U.S.A.
     Tel: 510-881-1922; 510-881-4974, FAX: 510-727-1583
     redwooddentaloffice@gmail.com
     DrT@dental-sleep-apnea.com

 

 

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