Has anyone used a dental device and not had problems with a permanent change in their bite after 6 months or so?
Which device did you use?

maggiemae wrote:

Has anyone used a dental device and not had problems with a permanent change in their bite after 6 months or so?
Which device did you use?

It probably does not matter what type of appliance you use. If you have forward advancement of your mandible during the night, you have a 30-35% chance of having a bite change. Yes, some that allow movement within the device (soft lining) might allow some independent movement of teeth and allow some separation between teeth, but there is some controversy there, so all bets are off. So, to answer your question, if you had a bite change, there is probably no device that will not allow this to happen in your specific situation.


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Kent Smith DDS

Does that mean I have a 65-70% chance of not having this problem if I get a dental device? thanks

maggiemae wrote:

Does that mean I have a 65-70% chance of not having this problem if I get a dental device? thanks

That is correct, but this is only if all directions are followed (and assuming you are given good directions). You must begin working quickly after getting out of bed to get your mandible positioned back appropriately. We talk abaout several ways with our patients. There are bite tabs, you can chew gum while you're in the shower, and you on lean on your chin at the correct angle. Do not wait too long during the day to start resetting your jaw.


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Kent Smith DDS

How do the dentist and the patient determine how far to advance the jaw? This seems to be the key factor - not far enough and it doesn't work; too far and it increases the likelihood of problems. Could the problems be reduced by being more conservative about extending the jaw? thanks

maggiemae wrote:

How do the dentist and the patient determine how far to advance the jaw? This seems to be the key factor - not far enough and it doesn't work; too far and it increases the likelihood of problems. Could the problems be reduced by being more conservative about extending the jaw? thanks

Every patient is different, and they are not all adjusted at the same rate. Sometimes the TMJ will not allow too much at one time. The most common advancement is to 70% of your maximum at the beginning. After this, adjustments are made as you can handle them - no soreness for a prolonged time in the mornings, or the adjustments will need to back off. There are different lines of thought on the correct place to start and the correct pace at which an appliance is advanced. Some appliances also have different titration amounts possible. The SomnoMed MAS, for example, can be adjusted at a rate of .1 mms at a time. Others have a larger minimal adjustment of either .25 or .5 mms. So, your question about being conservative would lead to the SomnoMed.

As I have mentioned, adjusting too far vs far enough will not impact whether or not you ultimately have a bite change. However, too much adjustment can certainly cause some pain in your TMJ. Hope this helps you with any decisions you make!


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Kent Smith DDS

Kent Smith wrote:

That is correct, but this is only if all directions are followed (and assuming you are given good directions). You must begin working quickly after getting out of bed to get your mandible positioned back appropriately. We talk abaout several ways with our patients. There are bite tabs, you can chew gum while you're in the shower, and you on lean on your chin at the correct angle. Do not wait too long during the day to start resetting your jaw.

Why is it important to reset your jaw?  Wouldn't it be good to permanently move it if that is what is causing the problem?

I've slept the last few nights with a "Brain Pad" boil and bite mouth guard to see if I could tolerate sleeping with something in my mouth.  This morning I did feel like my jaw had moved and that it did move back.  I am feeling a big improvement today (not so sleepy) and I'm wondering why bother with an expensive devise when this thing cost $20.

Thanks!
Jeanette

Rubytwo wrote:

Why is it important to reset your jaw?  Wouldn't it be good to permanently move it if that is what is causing the problem?

I've slept the last few nights with a "Brain Pad" boil and bite mouth guard to see if I could tolerate sleeping with something in my mouth.  This morning I did feel like my jaw had moved and that it did move back.  I am feeling a big improvement today (not so sleepy) and I'm wondering why bother with an expensive devise when this thing cost $20.

Thanks!
Jeanette

If you do not mind your teeth being out of line, and have no problems chewing, then yes, it might be best to just allow your mandible to stay there permanently. Most people don't like the shift, but would rather breathe than eat at 100% capacity.

Hey if that boil and bite works for you, more power to you! It's hard to adjust those until you find the best spot, and it's a lot to put in your mouth, but you can't beat the price!


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Kent Smith DDS

Dr Kent Smith,

I have a very small airway. (4mm)  This was shown in a MRI I had with a jaw corrective surgeon in Santa Barbara last week.  He is suggesting a upper and lower jaw surgery to open up my airway.  I am 6'2" and 185lbs.  He was very suprised my airway was so small and thinks the surgery will correct my problem.

You mentioned in your last post on the bite being off and alluded to other complications.  This surgeon works in unison with my orthodondist to make sure the bite is aligned properly.  

I would be interested in any information I can get regarding this subject.  I am going to try a cpap machine first but not looking forward to the thought of sleeping with that every night for the rest of my life and I had heard the dental devices end up causing tmj.

Thanks,  Ron

ronzo14 wrote:

Dr Kent Smith,

I have a very small airway. (4mm)  This was shown in a MRI I had with a jaw corrective surgeon in Santa Barbara last week.  He is suggesting a upper and lower jaw surgery to open up my airway.  I am 6'2" and 185lbs.  He was very suprised my airway was so small and thinks the surgery will correct my problem.

You mentioned in your last post on the bite being off and alluded to other complications.  This surgeon works in unison with my orthodondist to make sure the bite is aligned properly.  

I would be interested in any information I can get regarding this subject.  I am going to try a cpap machine first but not looking forward to the thought of sleeping with that every night for the rest of my life and I had heard the dental devices end up causing tmj.

Thanks,  Ron

Hey, Ron. I know most people are hesitant to proceed with surgery, but this particular type (termed telegnathic surgery when used for airway reasons) is around 95% successful. The only thing more successful is a tracheostomy. It also usually has cosmetic benefits, so if you can afford this and don't mind the time it takes, it has more of an upside than any other surgery.

That being said, it's very sad to hear someone say "I had heard the dental devices end up causing tmj". Whoever told you this has a very limited education in dental appliances.


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Kent Smith DDS

Can someone with a Malocclusion (under bite) still use a dental appliance for sleep apnea?

Thanks


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Tom M

Definitely.


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Kent Smith DDS

Maggiemae-
I have been using the Sonodent MAS since March 28, 2008 and I am adjusting at a very slow rate.  I started out at 1 mm per adjustment every two weeks. At 3.5 MM I had a polysomnogram and I have since adjusted at .5 mm every two to three weeks.  I am now at 5.5 mm of adjustment and still feel I have more room to move. The more I move forward the better I seem to feel.  It's very tempting to adjust that sucker way out but I don't want to cause any problems, so I am taking the slow route. In the morning when I get up I use the bite tabs and gently push back on my jaw while I shower.  This returns my jaw to normal within fifteen minutes.  I sometimes use an Aqualizer when I drive to work as the stress from the traffic makes me want to clench my teeth making my jaw muscles tense till they are sore.  Other than that I have no soreness.  I believe a good dentist that is well versed in sleep apnea treatment can advise you.  You can try the boil and shape device as it is reported to work for some.  For me I wasted my money and got a sore mouth from the boil and shape device.  I hope to very soon reach my "sweet spot" and then I will have another sleep study to determine the Somnodent devices effectivness on my OSA.  I am also going to have surgery to repair a deviated septum,a collasping nose valve and turbinate reduction before this final test.  The whole objective is to get the air in as efficiently as possible.  I am hoping all this will do the trick in treating my OSA to acceptable levels.  If this doesn't work then I will look at more drastic surgeries to move my jaw forward or again try CPAP to open the airway.  Good luck to you.