Dental Sleep Meeting in Seatle

[ishapira]

A great meeting in Seattle. There are new developments coming in Dental Sleep Medicine. It appears that oral appliance titration is finalycatching on. We have talked about it here for years.

Boil and bite appliances were not very effective for apnea treatment even when snoring was improve.

Compliance was discusses as were outcomes. It appears that even when oral appliances are not quite as effective as CPAP outcomes are the same or better because of patient compliance..

I guess I am talking to the choir but a great deal of new research is proving all you appliance patients right.

Not only do you feel better with appliances but studies are showing objective improvement.

The biggest problem the sleep communityhas with oral appliances is that they can not measure hours of usage. That is probably the last piece of the puzzle to make oral appliances the first choice for the majority of patients.

Times are changing. An Austrailian physician even put up a slide of the I HATE CPAP site.

[Rachel E]

That's Wonderful!
I can't wait until this is so main stream that it will not be a hassle to treat sleep apnea with dental appliances. Keep up the great work, Dr Shapira!
Rae

[Dickman]

The reason people hate dental device is it is painful. Waking up in the morning with jaws totally out of whack is the thing of concern. One dentist told me that it is almost certain that you will develop TMJ with long term device use. People try it but pain is not trivial, when you strart hitting your bottom teeth with your top everytime you talk, then it is certainly a concern. Not always chewing a small plastic/rubber to move the lower jaw back to where it was the night before works. It is like using a tool to rearrange your lower jaw to push back every morning. There are big compromises. Are there any new technical developments? Conferences and meetings for simple findings are not that much of news.
Money is flowing but I would like some viable treatments.

[ishapira]

Dickman
You are both right and wrong. Some patients do no have problems but most do not. When given a choice patients prefer oral appliances over CPAP by a wide margin.

It was reported at the Seattle AADSM meeting that in Sweden up to 95% of apneics use oral appliances as first line of treatment.

There are reasons that patients have sleep apnea, it is due to a pathological relationship with jaw relations. When the appliance brings patients forward "healing" takes place. The exercises done in the AM are actually done to return the jaw to it's previous pathological position. We have a percentage of patients that decide to treat the pathological jaw position 24/7 but most just use the appliance at night. There are methods to overcome almost all problems associated with appliance use including the use of qualizers in the AM, spray and stretch using vapocoolants, exercise and even switching between cpap and appliances.

Studies have shown that many patients experience bite changes and are unaware of them. There is also about a fifty-fifty split in patients who find the changes favorable to unfavorable.

The NHLBI has a report
"CARDIOVASCULAR AND SLEEP RELATED CONSEQUENCES OF TMJ DISORDERS" that can be found @ http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf

There is actually a 24/7 condition that is more like in men to have patients seek treatment for snoring,apnea, gerd, High blood presssure etc BUT the same underlying conition in women is responsible for TM Joint problems chronic daily headaches,many patients migraines, neck pain , sinus pain, fibromyalgia etc.

My research at Rush medical school's sleep disordr center in the 1980's showed that male apneics and female TMD patients had nearly identical jaw positions

Read my piece
"Oral Appliances for Treating Sleep Apnea: Panacea or Pandora's Box?"
http://www.ihatecpap.com/oral_appliance_problems.html

[snork1]

Wow, probably a couple of years since I posted here, and STILLl Dickman is living up to his name and bashing away at Dental devices.
Thank gawd I didn't listen to him! He must have had a trauma involving his granny's dentures when he was a small child or something.

I did 3 years of CPAP and its been about 3.5 years of TAP now. Sure my bite is SLIGHTLY different but compare that to the negative physical side effects of CPAP!
Everyone has to figure out which side effects are their preference. It was an easy decision for me.

I never returned for titration at the sleep center because they would not deal with a dental device back then. I am glad to hear they are maybe coming around on that. I bought a dinosaur recording pulse ox from Ebay and used that for my titration. VERY recently I invested in new technology and go the CMS50-F pulse ox, which is a whole lot cheaper, at $230, and more effective than a one night sleep study.
http://www.semedicalsupply.com/cms-50f.htm
Although for insurance reasons I WILL have to have another pricey sleep study before getting my NEXT device years down the line.

I do NOT wake up in pain every morning from a dental device. I wake up feeling REFRESHED And WONDERFUL, after a great night of comfort and dreaming. Compare that to my air filled stomach pains, stiff neck, gouges on my nose, noise disturbing my wife, AND sore jaw from CPAP and the MANY various masks I tried.

Yes there are down sides. Everyone needs to make their choices. Trolls dropping unsupported conjecture does NOT help in that decision.