Sleep Apnea
Expert Witness

What is Sleep Apnea?
The Management of Snoring and Obstructive Sleep Apnea ( OSA ) using Mandibular Advancement Oral Devices or Tongue Retaining Devices.

Typical Scenario;

  • Patient complains of chronic fatigue and daytime sleepiness
  • A physician (Sleep Specialist) Diagnosis Sleep Apnea
  • CPAP machine is recommended and tried
  • Symptoms improve immediately, but unable to tolerate the machine
  • Physician offers options, including oral devices or invasive surgery
  • Referral is made to Dental Sleep Medicine specialist (Dr Malick)

Ideal Candidate for an Oral Device

  • Loud Snoring offensive to bed partner or others
  • Mild to moderate obstructive sleep apnea 
  • Unable to tolerate CPAP machines
  • Relatively healthy mouth and jaws (adequate complement of teeth present)
  • Not under orthodontic Treatment, not wearing dentures

What exactly does a dentist do?

In the majority of cases, OSA is caused by the tongue falling back on the airway collapsing the opening to the lungs. An oral sleep apnea device simply positions and holds the jaw forward, during your sleep, gently pulling the tongue off the back of the airway allowing air exchange.  This is similar to the first step in CPR.

What Types of Oral Devices are available on the Market?

1. Tongue Retaining Devices: Custom made and Over the Counter
2. Mandibular Advancement Devices
       a.  Do-it-yourself, Boil and Bite, devices (as seen on TV)
       b.  Dentist made, Boil and Bite, non-adjustable devices
       c.  Dentist made, Boil and Bite, Adjustable devices
       d.  Dentist made, Custom, non-adjustable devices
       e.  Dentist made, Custom, adjustable devices

Which device is best?

OSA is a serious medical condition with potentially life threatening consequences.  Self-made, inexpensive devices are not effective for the treatment of Sleep Apnea, and can cause damage to your teeth and jaws.  Custom adjustable devices provide optimal opportunity to fine tune the position of the jaw for maximum airway patency while protecting your teeth and Jaws.

What is the success rate of oral devices?

Statistics show that after 5 years, less than 35% of all patients are still using a CPAP machine while 85% are still using their oral devices.  In mild-moderate Sleep Apnea, the results are very good.  In severe apnea, there is a significant improvement of symptoms but not elimination of all symptoms.

What are the advantages of Oral Devices?

     1.  Oral Devices are Conservative, Non-invasive and painless! 
     2.  Relatively inexpensive compared to CPAP and Surgery
     3.  Reversible (if it doesn't work, no damage done)
     4.  Takes 2-3 weeks to make
     5.  The size of an orthodontic retainer, easy to store and Portable for travel
     6.  No bulky equipment to wear on face or carry during travel

What are the disadvantages?

     1.  No guarantee that the oral device will work for everyone
     2.  Currently, there are no effective, low cost trial devices available to test effectiveness and tolerance
     3.  Oral and Dental conditions must allow appliance fabrication
     4.  Can cause dry mouth, minor tooth shifting, minor jaw problems, and small bite changes 
          when worn over a long period of time.

What are my options if I can't tolerate a CPAP machine and Won't/Can't wear an oral device?

     1.  Weight Loss program/excercise and diet to reduce weight, a significant factor
     2.  Surgical Procedure called UPPP ( can be painful, expensive, with limited success)
     3.  Pilar Procedure: relatively simple but surgical/expensive, not always covered by insurances
     4.  Maxillo-Facial Surgery: effective in selected skeleto-facial conditions ( Major Surgery )
     5.  Combination therapy: CPAP and ORAL DEVICE
     6.  Tracheostomy: reserved for morbidly Apnic patients

Does my medical insurance pay for it?

In most cases, YES!  However, it depends on your annual deductible and plan provisions and type of insurance (Kaiser, PPO, HMO, etc) Here are some facts:

     1.  OSA is a medical condition and as such, is covered under your medical/not dental policy
     2.  Portions of the procedures are billable to your dental insurance
     3.  HMOs are restrictive and must obtain pre-authorization (we are not a contracted provider )
     4.  In most cases, Medicare covers a portion of the fees.
     5.  Kaiser Permanente patients have no coverage at Dr. Malick's office.
     6.  You will be asked to pay for our services while we assist you in filing your claim

What is the cost of these devices?

We are unable to quote a specific price since each and every case is different.  These devices are custom made by a certified Dental Laboratories trained in Sleep Medicine.  The devices we use are also FDA approved.  The fees will be thoroughly reviewed with you before the treatment is started.

What is the procedure?

     1.  You call and make an initial consultation appointment
     2.  After thorough review of options, you decide to move forward with an oral device
     3.  Dr Malick will request a formal referral from your physician if not already received
     4.  Dr Malick reviews sleep study and sleep physician recommendations
     5.  Specific oral device will be prescribed and fees discussed with you
     6.  Comprehensive Oral/dental examination and charting
     7.  Impressions of your teeth and jaw position are recorded
     8.  Your case is submitted  to a certified laboratory
     9.  Adjust and deliver Oral Device (usually 2-3 weeks from impressions)
    10. Follow up appointments made in 2 weeks, one month, and 6 months
    11. Appliance titrated to establish optimal airway patency
    12. Dr Malick requests a follow up Sleep Study from your physician.

How long do oral devices last?

Although longevity depends on care, maintenance and oral conditions, but in general, between 2-5 years.  This means the device may need to be serviced, repaired, or replaced.

If you have any further questions, please don't hesitate to call or email us.

Hope you have a good restful sleep!

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Dentistry for the Discerning Patient 
Snoring/Sleep Apnea Facts

  • An estimated 30 million, or 1 in 8 Americans snore
  • About 18 million Americans suffer from Obstructive sleep apnea
  • 28% of men over the age of 65 suffer from sleep apnea
  • Oral devices improve or eliminate snoring almost a 100%!
  • Sleep disorders account for $15.9 billion dollars in medical costs
  • Many Children and Adolescents with Attention Deficit Disorder have Sleep Disorders
  • Symptoms of Sleep apnea are loud snoring, night-time gasping and choking during sleep, excessive daytime sleepiness, morning headaches, memory or learning problems, irritability, lack of ability to concentrate, mood swings or personality changes, early morning dry throat, witnessed apneas, and frequent urination.
  • Consequences of Sleep apnea include daytime fatigue, depression, irritability, sexual dysfunction, learning and memory difficulties, falling asleep at work or while driving, congestive heart failure, stroke, irregular heart rhythms, cardiovascular disease and fatal car accidents.

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