If you, or someone you know, snores or stops breathing during their sleep, it is very important for health and longevity that screening and sleep testing if appropriate, are accomplished.Most people who snore have sleep apnea. Snoring and sleep apnea worsen over time. Snoring must be evaluated early and aggressively managed.Untreated sleep apnea sufferers have a tenfold increased chance of stroke, an eight fold increased chance of automobile accidents, increased risk of hypertension, arteriosclerosis, heart attack, diabetes, impotence, gastro-esophageal reflux disorder (GERD) and other chronic diseases.

1. Does dental insurance cover these types of oral appliances?
No. What most people don’t realize is that OSA oral appliances are considered to be medical devices. Therefore, any reimbursement consideration has to be done through the patient’s medical insurance. As with all insurance claims, specific guidelines need to be followed to receive or be considered for reimbursement. For instance, a diagnosis of sleep apnea, a referral from their primary care physician and a completed a sleep study are just a few of the recommended parameters needed to qualify for medical insurance reimbursement. In addition, fabricating laboratories are required to be registered with the FDA and to follow GMP standards, tracking each appliance’s history, as well as the materials and hardware used to fabricate them.

2. What about follow-up care?
For the clinician, it goes without saying that regular follow-up appointments are a key factor contributing to the success and compliance of OSA treatment with oral appliances. Therefore, every visit is an opportunity to discuss progress or regression. Besides evaluating the patient’s overall oral health, occlusion and any TMD issues, the appliance is examined for wear and tear or maladjustment. Patients are asked to demonstrate insertion, removal and adjustment techniques, as well as their use of bite tab or leaf gauge exercises which assist in maintaining occlusal integrity. The incorrect use of oral appliances is the primary reasons for diminished success, non-compliance or frequent appliance damage.

3. What is required of the patient when using an oral appliance?
It is important that the patient receive thorough informed consent regarding the use of oral appliances. Mandibular repositioning appliances can lead to bite changes. As such, morning bite exercises are recommended to insure bite consistency throughout each day. In addition, the average life of a sleep appliance is 3 years. To maximize the life of their appliance, proper insertion and removal techniques are very important. This prevents uneven stresses to the acrylic or to the hardware.

With so many appliances of various materials on the market to choose from, conservative cleaning is always recommended. It is safe to say that most are made of some type of plastic or acrylic. Since some cleansers can be too harsh, we encourage patients to brush their appliance with toothpaste or mild cleanser each time they brush their teeth, rinse thoroughly with water and then allow it to air dry. Soaking for periods longer than 10 minutes is never recommended, as water can be an abrasive and some acrylics can actually absorb water. And always, keep it away from the family dog!

4. Which oral appliance should I use?
Unfortunately, there is no easy answer to this question. A quick internet search will yield a large and diverse selection of oral appliances. Dentists who specialize in oral sleep medicine have several appliances they regularly choose from, because every patient is different. The most effective appliances are custom fabricated, supported by clinical research and are FDA registered. Key features to look for are full occlusal coverage to minimize tooth movement, hard durable materials, soft materials can break down quicker and may cause tooth movement, incremental adjustability and buccal or labial adjustment for easy access during a sleep study. Additionally, patients with limited tongue space may need a design that avoids tongue space encroachment or a patient that is a heavy bruxer may need a design that allows more lateral movement. Appliances that receive top recognition are the APM Positioner®, SomnoDent®, TAP®, Klearway®, Silencer®, EMA® and the Suad®.