Because an oral appliance was one of 4 treatment options for my sleep apnea, when getting my teeth cleaned last week, I asked my dentist about it.  How much and how do we proceed.  He said $500 and he just needs to take the impressions.  The lab will make the appliance.

I got the impressions done, paid the $500 and then reviewed my bill, which read "occlusal guards by report".  I googled that and that's for teeth grinding.  So now I lost some faith in my dentist.  

I told my dentist to hold off until I get specifics from my doctor.  Well, that's easier said than done.  The nurse is trying to answer the questions, which I am trying to ask my doctor.  And I really believe my ENT who diagnosed me and is treating me needs to tell me what exactly I need in the way of an oral appliance.  

I spent only a couple of minutes on the internet to find that there are dozens of "oral appliances" that are available for treatment of sleep apnea.  I wrote and faxed a letter to my doctor to get an answer and the nurse called me back to say "it is an oromandibular that I need".  Well, I'm still at a loss because isn't that a big word for an oral appliance?  I'm still nowhere. I really would like my ENT to recommend a brand name or a certain type such as the TAP3, AveoTSD, Silencer Pro, MAD, etcetera.  

Had I known an oral appliance for sleep apnea was so involved, I would have gone to a dentist specializing in sleep disorders or at least familiar with them.  My ENT lead me to believe that it was this simple when he told me to "see my dentist".

Am I out of line to ask that of my ENT?  How have any of you gone about getting an oromandibular/oral appliance.  Do you rely on your ENT or dentist?

I am so upset right now because that $500 was so much money right now because I just took a paycut.  It can't all be for nothing.  I understand that an oral appliance may not work for me, but I would like to at least try that option starting out with the correct appliance for me.

Thanks in advance for any help.

If you ask for a dental appliance for treating OSA and he took impressions and ordered a mouthguard for "teeth grinding" I think he should refund your money.
My regular dentist knew very little about OSA and the use of dental devices for treatment. It wasn't until I got a referral to a neuromuscular dentist specializing in sleep disorders that I got the treatment I needed. Most ENT (including mine) wanted to cut or drug the problem. I tried CPAP and APAP over five different times and could not get by the suffocation feelings. There are possible side affects for the device that the dentist should warn you about. (Teeth movement, bite changes and TMJ problems.) That is why you need to see a specialist that understands all there is about dental devices and OSA. This is just my opinion and I am by no means an expert as I am five weeks into using a Somnodent device. I just finished a sleep study and am awaiting the results. I know I have improved but to what extent remains to be seen. Good luck and keep digging for information and keep asking those questions.

An oral mandibular device is a special dental device that keeps your lower jaw (mandible) advanced when worn at night.  It alleviates snoring and sleep apnea by holding the mandible forward during sleep to prevent the tongue and soft tissue of the throat from collapsing into the airway.  Your ENT should have been more specific as to which dental devices are best for you.  There seems to be a lack of communication between the medical and dental communities regarding the most effective oral devices.  I did my own research on this board and www.talkaboutsleep.com regarding which the most popular dental devices.  I found most people had success with the TAP and Somnomed (now Somnodent).  I eventually bought the TAP and have had great success with it.  I found my TAP dentist through the TAP company’s website – you can do a search as to which doctors in your area make it, same thing with Somnodent.  I also made sure my dentist was a member of the American Academy of Dental Sleep Medicine - http://aadsm.org.  You should also try www.ihatecpap.com for a list of dentists specializing in dental devices.   If possible, choose a dentist who also specializes in TMJ/TMD.   My TAP was expensive  - $2500, but it was well worth the cost.  My insurance didn’t cover it but others have been more successful.  My dentist also offered financing for it so this may be an option for you.

To phoebe and papahemi:

Great advice and great information.  Exactly what I was looking for.  I will definitely try to get a refund from my dentist and will seek out a specialized dentist.  I really I was misguided with my doctor's and my dentist's aloofness regarding an oral appliance.  It is so involved!!!

Thank you both!

I would suggest that you contact one of the sleep dentists that are accredited with the AADSM or American Academy of Craniofacial Pain. If you would like, i could suggest some in your area.

Be careful in choosing your sleep dentists as they are some that are less experienced than others.

I doubt that your DDS will refund you the money - i suggest demanding it from the ENT.


_________________
Gary J. Sagiv
Vice President
Itamar Medical Inc
sgary@itamar-medical.com

I have since spoken to my dentist and discussed my concerns with what he was making for me because I know that there are appliances that can cause teeth alignment and bite problems and TMJ or TJM and we did not first discuss those things.  He told me he was making me something with a hinge and it will make my bottom jaw move forward slightly and he will check my progress with the use of it.  If that was not what I wanted he would tell the lab to not go ahead and refund all my money regardless of his time with the impressions.  I told him that sounded good enough and let's go ahead.

I think my doctor was negligent when he advised me to "see my dentist".  He should have advised me to see a dentist specializing in sleep apnea or sleep disorders.  A bonus would have been a few referrals.  Don't they all golf together anyway.

But it seems to have turned out pretty well, and I am excited to see how the appliance works for me.

Thanks to everyone.  Great forum!

"  There seems to be a lack of communication between the medical and dental communities regarding the most effective oral devices. " Phoebe, that is an understatement.  Whats worse, is that apnea is not covered under dental, and dentists are not covered under medical.  I had to ask for a dental grinding device that hint hint, pulls the mandible forward.  I also grind, so it worked out fine.  I just don't like it any better than a few tubes up the nose.  Besides, my grinding gets worse when I take sleeping pills, so thats helping one side effect of wearing a mask.

Well, I got my Tap 3 from my dentist today.  It seems that was the best one to go with, but when he originally told me $500 I wondered what kind of !@#! he was selling me and did he know what the heck he was doing.  I thought I read that for the TAP 3 someone paid $1200 and someone else paid like $2500--not sure.

So my dentist came through.  He was straight with me today when he said "pardon me, I've never fitted anyone with this type before so I do want to refer to this"; he had some instructions from Glidewell Laboratories.  So he was reading it and fitting me.  And he also said "please wear it at least for two days, so I know that it fits you right and is comfortable."  He also asked that I definitely let him know in a couple of months if it did help my apnea.  He would really appreciate the feedback.  

So tonight's the night . . .

janbenpor

Good luck - i suggest that you have a follow up sleep test in about 3 weeks to make sure that:

1) you do not have silent apneas (this can kill)
2) that the appliance is titrated properly.

If your dentist does not know about the take home tests, ask him to contact me and we will assist.


_________________
Gary J. Sagiv
Vice President
Itamar Medical Inc
sgary@itamar-medical.com