FAQs

There can be some discomfort associated with the appliance as you’re getting used to it. This is a pretty common side effect if you’ve never used an oral appliance before and typically resolves within a few weeks of wearing the appliance. Things that can help include ensuring that you perform your morning exercises and use your morning repositioner, as well as localized massages and hot/cold compresses as needed. If discomfort persists, please contact your trained sleep dentist for further evaluation.

Every patient is a little bit different, so there is no “one set number” that you must reach. The goal is to move the appliance as far forward as you can without experiencing any persistent symptoms in the morning, while also noticing improvements in how you feel and sleep overall. Your trained sleep dentist should provide you with a titration protocol to follow that will help you find your optimal positions. If you have any concerns, or need further adjustments, please contact your trained sleep dentist for further evaluation.

Dry mouth is a common side effect of oral appliance therapy, but doesn’t affect every patient. Here are some recommendations to help manage dry mouth:

• Keep a sports water bottle or a glass of water with a straw on your bedside table. Keep in mind it may be difficult to swallow while wearing your appliance.
• There are over-the-counter products that can coat your mouth before bed to help prevent dry mouth. Ask your dentist for their preferred products.

If dry mouth persists or becomes a significant concern, please contact your trained sleep dentist for further advice and possible adjustments to your treatment plan.

This can happen for several reasons. One possibility is that the device is unilaterally adjusted, meaning it’s not set the same on both sides. Another could be that if you are a side sleeper, you may be sleeping on the opposite side, and the pressure against your jaw can cause soreness on the other side.

While the soreness persists, make sure you:

• Perform the morning exercises as directed
• Use the morning repositioner as directed
• Apply hot and cold compresses as needed (20 minutes on and 20 minutes off)
• Use localized massages on the sore spots

If the pain continues, please contact your trained sleep dentist for further evaluation.

It can take time for your tissues to acclimate to a new oral appliance. Here are some steps you can take to address the discomfort:

• Warm Saltwater Rinses: Gargling with warm saltwater can help soothe the sore spot and reduce irritation. Try doing this several times a day for relief.
• Orthodontic Wax: You can purchase over-the-counter orthodontic wax from a pharmacy, local drug store, or your orthodontist. Apply a small amount of wax to the areas where the device is rubbing against your cheek. This creates a protective barrier and can significantly reduce discomfort.
• Comfort Caps: Your trained sleep dentist can reach out to the appliance manufacturer to inquire about “comfort caps” for the hinge and elastic mechanisms of your oral appliance. These custom designed caps are specific to your appliance and provide extra cushioning and comfort, making it easier to wear the appliance without irritation.

By following these tips, you should experience relief from the soreness caused by your oral appliance. If the discomfort persists or worsens, please contact your trained sleep dentist for further evaluation.

While your subjective experience matters, assessing the device’s effectiveness requires a follow-up sleep study while you wear it. Feeling no improvement doesn’t necessarily mean the device isn’t working. Keep in mind that sleep quality and duration can be influenced by various factors including environmental conditions, lifestyle choices, and sleep hygiene practices. Your trained sleep dentist will monitor your progress closely and adjust your appliance and treatment plan as needed based on the results of the follow-up sleep study.

It’s crucial to adhere to the suggested follow-ups and comply with all treatment recommendations provided by your trained sleep dentist and medical providers. Treating obstructive sleep apnea requires a collaborative effort and considers multiple factors. Your active involvement and commitment to follow through will enable your medical team to better assist you in improving your sleep, overall well-being, and health.

• A1: Some soreness and jaw are common when you initiate oral appliance therapy. Unless you’re experiencing sharp or painful sensations, discomfort typically resolves within a few weeks. If you are unable to wear your appliance due to pain or discomfort, contact your trained sleep dentist for further evaluation.
• A2: If discomfort persists after an adjustment, revert your appliance back to the last comfortable position and wear it until the discomfort resolves. Then, gradually adjust it forward in small increments until you reach your maximum tolerable forward position. The goal is to find a forward position that you can tolerate long term that effectively stabilizes your airway. Your trained sleep dentist will then have you complete a sleep study wearing the device in that position to assess its effectiveness.

Remember that oral appliances are custom-fit to your teeth. New restorations can sometimes affect the fit of the appliance. Your trained sleep dentist can often make adjustments to accommodate the changes, but sometimes the adjustments needed are significant. In such cases, the appliance may require relining or replacement, depending on its design. It is important to wear your oral appliance every night, please contact your trained sleep dentist if you are unable to wear your appliance so they can evaluate and discuss next steps.

• A1: Have you tried moving your appliance further forward from your current position at home?If not, work with your trained sleep dentist to attempt to adjust it forward gradually. If you reach a point that is intolerable or causes pain, revert to your last comfortable position. Once you’ve reached your maximum forward position that you can tolerate long-term, contact your trained sleep dentist so they can help schedule a follow-up sleep study wearing the appliance.
• A2: Have you reached your maximum forward position that you can tolerate long-term? There are other options you, your trained sleep dentist, and medical providers can explore to optimize its effectiveness.
  • Sleep Position: If you predominately sleep on your back and have increased apneas in this position, try sleeping on your side instead. There are products available to help you maintain a side sleeping position. You can also use a large body pillow or sew a tennis ball in the back of a t-shirt to prevent rolling onto your back.
  • Weight Management: If you are overweight, diet and exercise can reduce the mass of your tongue and soft tissues as well as the size of your neck. This opens airspace and reduces the forces compressing your airway, thereby improving overall airflow.
  • Combination Therapy: Your trained sleep dentist and medical providers may suggest using both an oral appliance and PAP therapy together. This commonly reduces the required PAP pressure and minimizes side effects and improves comfort of PAP therapy.
  • Surgical Options: There are surgical options to change jaw position, reduce tongue size, and alter the anatomy of your oral cavity to reduce airway constriction. Additionally, there is an implantable device that stimulates your tongue to help keep the airway open during sleep. Talk with your trained sleep dentist and medical providers to determine if you are a good candidate for these procedures.
  • Non-Invasive Laser Therapy: There are laser therapies available that can be used to tighten the collagen fibers in the airway potentially reducing obstructions and improving airflow. This treatment is not a permanent fix and requires maintenance visits after the initial treatment. Not all dentists provide this treatment, so it is important to find a trained dentist who will collaborate with your sleep dentist and medical providers to determine if you are a good candidate for this treatment in conjunction with your oral appliance.

Just because your oral appliance is not treating your obstructive sleep apnea on its own does not mean it is a failure. Remember that obstructive sleep apnea and overall sleep quality and duration are multifactorial. Being actively involved in your healthcare plan and working with a team of medical providers, including your trained sleep dentist, will help you to find the right combination of treatments that will enhance the effectiveness of your therapy and improve your sleep quality and overall health.

• If you recently got an appliance within the last 3 years, or if you would like to have more than 1 appliance at a time, there may be some out-of-pocket costs involved in getting a new one. Your trained sleep dentist can see if there is any warranty that applies to your appliance and the specific situation. If your trained sleep dentist is billing your insurance, they can help you determine what your replacement policy is per your plan. It is best to speak with your dental sleep medicine office to understand next steps.
• If you got your device 3 or more years ago, and your trained sleep dentist can bill your medical insurance, your insurance might cover a new one now or soon. This depends on your specific insurance plan. Most insurance plans will approve replacing an oral appliance between 3 to 5 years. To get a new appliance covered by insurance, you will need an updated diagnostic sleep study and a new prescription for oral appliance therapy to show medical necessity.
• Some medical insurance plans like Kaiser only allow their contracted providers to treat patients using their insurance. Dental providers must be independent contractors with these plans to provide oral appliance therapy under their coverage. If your trained sleep dentist is not contracted with companies like Kaiser specifically, you can choose to pay out-of-pocket. Your dental sleep medicine office should inform you if this applies when they discuss your treatment estimate.
• If you have Medicare, there are specific requirements for oral appliance, including a metal hinge (coded E0486). Some non-metal hinged appliances are approved under the K1027 code. Your dental sleep medicine office can show you the difference between these options and your trained sleep dentist will discuss the best device design for you based off of their clinical examination. Dental sleep medicine providers can choose to be Medicare credentialed or be non-participating providers. If your trained sleep dentist is non-participating, you must sign a Medicare ABN and select Option 2, indicating that you understand that Medicare will not be billed for the appliance and you are opting to pay out-of-pocket. Some Medicare patients choose to do this due to the limitations in appliance design selection through Medicare. It is ultimately up to you, the patient, on how you would like to proceed.