Below is a comprehensive list of questions regarding Merrell Clinic and the treatments we provide to our patients. Please click on the question to see an answer. If you have any further questions please do not hesitate to contact us directly.
A – This is a complex medical field and you should seek professional advice. This is a dental treatment for a serious medical condition. Improper treatment or appliance selection could have significant health consequences. The dentist should be able to tell you the medical professionals that they work with in this area. In all cases, the medical care is managed with the Family Physician only after a medical diagnosis is obtained by a licensed and experience doctor with Sleep or Respirology training. In addition often a referral is needed with other medical specialties such as Ears, Nose and Throat or Cardiologist and Allergist.
A – Buyer beware! Several are very effective, researched and reputable. After only a few minutes on the internet, looking in many stores or pharmacies; you will see dozens of appliances advertised for snoring problems. Some even say they will treat mild sleep apnea! They cost anywhere from $29 - $199. These are not the appliances recognized to effectively treat Sleep Disordered Breathing (simple snoring, upper airway resistance and sleep apnea) by the leading authorities in medical research and teaching; and organizations such as the Canadian and American Thoracic Society and the American Academy of Sleep Medicine. In addition there are over 40 custom made dental sleep appliances marketed to the dental profession. The majority of these have little or no research published in peer reviewed medical/dental journals. Ask your dentist/provider what research has been done using the appliance(s) they use.
A – The appliance is custom designed to your mouth. Research shows after 1-2 week adjustment period 1, 2, most patients find it is comfortable to wear. It is like a sports mouth guard.
A – All patients are warned about minor tooth or bite shifting. Research confirms that recognized custom appliances have a low incidence of side effects 3, 4. We also give every patient instruction about cleaning the appliance, proper use and care. It is similar to grinding/TMJ appliances that are commonly worn at night by millions of people. If a filling were to fall out it or tooth break; it would be due to the tooth’s faulty nature not problems caused by the dental appliance.
A – No. All the materials are developed by specialists in this field and are used worldwide. The materials are carefully tested for optimum health and function. Appliances are commonly used in a number of dental applications an FDA approved.
A – No. Most patients usually start with an easy to administer, convenient and comfortable test conducted in your home. Some jurisdictions require a more comprehensive test done at a hospital or private lab. Check with the office nearest you. If you have a number of other health issues (hypertension, heart attack, diabetes, depression, lung disease, etc.) and you are not under the care of a Sleep Specialist or Respirologist, we may advise a referral to one.
A – Most patients find the appliances comfortable. Mild side effects are reported in the initial period 5. The discontinuance of appliance us is less than for CPAP. Often patients who can’t sleep using CPAP can easily adjust to a dental appliance 6.
A – Yes. It is recognized by: leading medical research and teaching authorities and societies such as the Canadian and American Thoracic Society and the American Academy of Sleep Medicine. We follow the medical guidelines from these organizations. A dental appliance will not work in 100% of cases and some patients will do better with CPAP. We offer our patients many options.
A – The appliance will have an effect right away. It does need to be adjusted and titrated over a few weeks to reach its optimum effectiveness. This position and your sleep disordered breathing are checked by follow-up sleep studies.
A – Much like a grinding appliance or sports mouth guard except we use only cutom fitted appliances. They are designed to fit each individual patients teeth.
A – A temporary appliance is fitted right away in the dental chair. Usually it is made from material that is warmed in hot water and moulded to fit the patient. They are GENERIC and a ONE SIZE FITS ALL approach. It is like a sports mouth guard and they are not very comfortable. Also, they only last a few months and are not as adjustable or effective as the permanent, custom fitted appliance. Temporary appliances are sometimes used as a trial appliance; in an emergency when an appliance is quickly needed; if an unexpected trip is planned or when a permanent appliance is lost or broken and a fast replacement is needed.
A – A permanent appliance is made from moulds of your teeth. It is fabricated away from the dental office in a specialized laboratory. It usually takes 2 – 3 weeks to be made. It is not softened by hot water. It is made from very durable material and CUSTOM FITTED to your mouth and teeth. They are comfortable, last 3 to 5 years, are adjustable and are highly effective compared to a temporary appliance 7.
A – No. Beware of guarantees in brain surgery, parachutes and dental appliances. We will do everything we can to attempt different appliances and collaborate with other medical specialists.
A – Most of the appliances last about 3-5 years with proper care.
A – Sometimes the appliance can be repaired if it is damaged. In the first 6 months there is no charge. After this time the costs vary from $250 - $600 for repairs/replacement over the next 3 years. After 3 years you would be charged the usual fee for a new appliance. If it is damaged or broken beyond repair your home insurance may cover the cost of replacement. Please check with your insurance provider for details.
A – At the initial consultation you fill out a questionnaire about your sleep behaviors, medical history and concerns (1 hour). You are examined by the dentist who reviews the material and explains the different steps and costs. If you proceed, then at the next appointment (2 hours), there is a detailed examination with the doctor, impressions of the teeth, photos of the teeth, head and neck areas and x-rays of the head and neck. The Home Sleep Study is explained; you take the sleep recorder home and return it the next day (1 hour). The sleep study is reviewed with you in general terms and then the information is sent off to be evaluated by a Medical Sleep Specialist; who provides a Medical Diagnosis. This is important to understand. A dentist will provide a dental appliance if appropriate, but that is only after he has obtained a Medical Diagnosis from a licensed medical doctor.
At the next appointment (30 mins) the medical report on your sleep study is reviewed with you. Your treatment options are explained. Treatment can involve: life style changes, exercise, use of medications, Cognitive Behavioral Therapy, referral for further tests such as a Polysomnogram (advanced sleep test) referral to other medical specialists (through your Family Physician to specialists such as ENT, Allergist), possible trail of CPAP and discussion of possible dental appliances.
The Merrrell Clinic gives you options, which include:
- No Treatment
- CPAP and/or Dental Appliances
If appropriate for a dental appliance, the dentist will decide with you which is best and will then have it custom made. If appropriate a temporary appliance could be provided as an interim measure.
It takes about 3 weeks for a custom dental appliance to be made. At that appointment (1 hour) it is fitted, you receive instructions on its use, care and exercises to minimize possible side effects. You are then seen every few weeks for 2 months to ensure it is comfortable and working effectively.
After 2-3 months of use, a follow-up sleep study is performed to ensure your treatment is successful. Any adjustments or additional procedures are completed until a satisfactory result is obtained.
Treatment for Sleep Disordered Breathing is a serious, chronic, lifelong problem and you should be seen every 6 months for follow-up.
A – There are follow up visits by the dentist to ensure it works, fits properly and is comfortable. You can call us for an appointment at any time; if you have a concern before your next planned appointment.
A – Yes. We can break up the payments to coincide with your therapy schedule.
A – The symptoms of sleep apnea are very broad and so are the benefits of sleep apnea therapy. Patients often see improvements in have severe snoring, heart and blood pressure problems, depression, lack of energy, moodiness, marital problems, sore throat, mental fogginess and many other symptoms. The medical literature has hundreds of research papers that have documented the success of dental appliance therapy for snoring and sleep disordered breathing (sleep apnea) over the last 20 years 8, 9.
A – No referral is needed. We will, of course, provide your family physician with all our findings and collaborate with them to ensure you receive the best management of your concerns and disease by licensed medical physicians.
A – That is an option. Keep in mind CPAP has a 30 - 50% success rate 10, 11. No therapy is started until a thorough examination and a diagnosis made by a licensed physician is obtained. All options are discussed and then the appropriate recommendation is made. In many cases of simple snoring, upper airway resistance and mild obstructive sleep apnea, treatment with a dental appliance is often the recommended treatment from Medical Authorities such as the American Academy of Sleep Medicine.
A – No. There is not one, single therapy, even CPAP that will work on all patients 100% of the time. This is a very specialized area of medicine with significant challenges, which in some cases has no effective treatment. Research tells us that in follow-up studies, after 1 year using CPAP, for a minimum of 6 hours, the success is only 30 – 50%. Similar studies using dental appliances show 60% - 80% success. It is interesting to note that for approximately 30% of CPAP users who continue to use CPAP after 1 year (for more than 6 hours a night) they still are symptomatic 12.
A - Less than 5% of patients develop significant long term problems. In some cases patients stopp using the appliance and their concerns resolve. Others have chosen to live with the changes, and continued using the appliance because their health, sleep and quality of life were greatly improved.
In the first few weeks about 20% of patients will encounter only temporary tooth or jaw soreness.
We acknowledge and inform all our patients that some studies have reported as high as 30% of patients develop significant bite or jaw issues.
1. Letteri JCSM 2011
2. Hoekema Sleep Breath 2006
3. Phillips Am J Resp Crit Care Med 2013
4. Doff Sleep 2013
5. Doff Clin Oral Invest 2013
6. Ramar JCSM 2015
7. Almeida Sleep 2013
8. CST Guidelines 2011, Sutherland J Clin Sleep Med 2013
9. RAMARI J of Dental Sleep Med 2015
10. Wohlgemuth Sleep Review 2014
11. Wallace JCSM 2013
12. McMillan Health Technology Assessment 2015