A – This is a complex medical field and you should seek professional dental advice from someone with advanced training, experience and credentials. 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 or 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 – No. The treatments are painless. The appliance is custom designed to your mouth and is very comfortable to wear. It is like a sports mouth guard. Some patients tell us they forget they are even wearing the appliance.
A – No. The appliance is fitted by a dentist with extensive training for this procedure. 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.
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 or lung disease) and you are not under the care of a Sleep Specialist or Respirologist, we may advise a referral to one.
A – No. Most patients find the appliances very comfortable and are sleeping through the night within one week. Less than 10% have reported a period of adjustment (2 weeks) at first but after that most report they aren’t aware they are even wearing a dental appliance. Often patients who can’t sleep using CPAP can easily adjust to a dental appliance.
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. The Merrell Clinic has helped hundreds of patients overcome snoring, poor sleep and sleep apnea with this treatment. It works for most mild to moderate sleep apnea sufferers. Many of our patienst are failed CPAP users who are successfully treated with a dental appliance. Many of those patients have moderate to severe obstructive sleep apnea. A dental appliance will not work in 100% of cases and some patienst 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/titrated over a few weeks to reach it’s optimum effectiveness. This position and your sleep disordered breathing are checked by follow-up sleep studies. In some cases while the permanent appliance is being constructed; the patient receives a temporary appliance. Both produce immediate results.
A – Much like a grinding appliance or sports mouth guard.
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. They aren’t very comfortable, they only last a few months, they are not very adjustable or effective compared to a permanent (CUSTOM FITTED) appliance. Sometimes they are used as a trial appliance; or in an emergency when an appliance is quickly needed; if an unexpected trip is planned or a permanent appliance is lost/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 very adjustable or effective compared to a temporary appliance.
A – The temporary appliance is fitted right away while the permanent appliance is being constructed. The permanent appliance usually arrives within 2 to 3 weeks.
A – No. Beware of guarantees in brain surgery, parachutes and dental appliances. We will do everything we can to attempt different appliances, collaborate with other medical; specialists. We do have a 90% success rate. Sleep Disordered Breathing is a complex medical field and you should seek professional dental advice from someone with advanced training, experience and credentials. Dental appliance therapy is a dental treatment for a serious medical condition. Improper treatment or appliance selection could have significant health consequences.
A – Most of the appliances last about 5 years with proper care.
A – Sometimes the appliance can be repaired if it is damaged. In the first six months there is no charge. After this time the costs vary from $250 - $600 for repairs/replacement over the next three years. After three 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 insurer for details.
A – At the initial consultation you fill out a questionnaire about your sleep behaviors, medical history and concerns (one hour). You meet with an experienced team member who reviews the material and explains the different steps and costs. If you proceed, then at the next appointment (2 hours), there is an 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 (one 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 an 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, such as ENT, Allergist, possible trail of CPAP and discussion of several possible dental appliances.
If appropriate for a dental appliance, the dentist will decide with you which is best and have it custom made. If appropriate a temporary appliance could be provided as an interim measure.
It takes about three weeks for a custom dental appliance to be made. At that appointment (one 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 two 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 will be seen every six months for follow-up.
A –There are follow up visits by the doctor to ensure it works, fits properly and is comfortable. You can call us for an appointment at anytime ; if you have a concern before your next planned appointment.
A – It may or may not be right for you. In the Merrell Clinics the dentists who perform this work limit their practice to this field. This is their major full time occupation. It is not a sideline while they do other things (root canals, braces, dentures, fillings). That is all they do and are all extensively trained in sleep therapy. You have the peace of mind that you are seeing the best trained people in this field, that you are given many options and explained the Pro’s and Cons.
A – Yes. We can break up the payments to coincide with your therapy schedule.
A – Yes. Even though sleep apnea occurs in the throat, the appliance is fitted in the mouth, on the teeth. A dentist is the best person to conduct this procedure to ensure your dental health is maintained. Our dentists also have extensive training in sleep disordered breathing medicine and understand if referral to a medical specialist is appropriate.
A – The symptoms of sleep apnea are very broad as are the benefits of sleep apnea therapy. Many of our patients have severe snoring, heart and blood pressure problems, depression, lack of energy, moodiness, marital problems, sore throat, mental fogginess and numerous other symptoms. We have seen all of these symptoms improve with appliance therapy. 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.
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 – Not necessarily. No therapy is started until a thorough examination and diagnosis made by a licensed physician is obtained. All options are discussed and then the appropriate recommendation 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 no one therapy, even CPAP that will work in all patients 100% of the time. This is a very specialized area of Medicine with significant challenges and in some cases no treatment is effective. Research tells us that in follow-up studies, after one year using CPAP, for a minimum of 6 hours, the success is only 40 – 60%. Similar studies using dental appliances show 60% - 80% success. Interesting to note is that for approximately 30% of CPAP users who continue to use CPAP after one year, for more than six hours a night; THE PEOPLE ARE STILL SYPMTOMATIC.
A – The Merrell Clinic only sees patients for the diagnosis and treatment for sleep disordered breathing. That’s all we do. The dentists in our clinics do this as their major, full time occupation. It is not a hobby or sideline while they do other things (root canals, dentures, fillings). Our clinics are based on training and experience going back to 1995. We are leaders in this field. We are developing new technologies and protocols constantly and in fact our practice guidelines exceed those from the Canadian Thoracic Society and American Academy of Sleep Medicine. You have the peace of mind that you are seeing the best trained people in this field, that you are given many options and explained the Pro’s and Cons.
A - Our experience in treating hundreds of patients is that less than 5% of patients develop significant long term problems. In some cases the patients stopped using the appliance and their concerns resolved. Others have chosen to live with the changes, and continued using the appliance because their health, sleep and quality of life were greatly improved. Bite changes can be corrected with restorative dentistry and/or orthodontics.
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. We are currently conducting research in this area to report our patient’s findings that show a much better result. We expect this to be published in June 2010.