Apnea Dental Appliance
Question:
Good job, Doug, In article <3500b456.4359…@news.inovion.com>, dr…@inovion.com (Doug Ruth) writes: – Hide quoted text — Show quoted text ->"Oral appliances for the treatment of snoring and obstructive sleep >apnea: a review." >Schmidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, >Menn S >Department of Medicine, University of New Mexico, Albuquerque 87131, >USA. >"This paper, which has been reviewed and approved by the Board of >Directors of the American Sleep Disorders Association, provides the >background for the Standards of Practice Committee’s parameters for >the practice of sleep medicine in North America. The 21 publications >selected for this review describe 320 patients treated with oral >appliances for snoring and obstructive sleep apnea. The appliances >modify the upper airway by changing the posture of the mandible and >tongue. Despite considerable variation in the design of these >appliances, the clinical effects are remarkably consistent. Snoring is >improved and often eliminated in almost all patients who use oral >appliances. Obstructive sleep apnea improves in the majority of >patients; the mean apnea-hypopnea index (AHI) in this group of >patients was reduced from 47 to 19. Approximately half of treated >patients achieved an AHI of < 10; however, as many as 40% of those >treated were left with significantly elevated AHIs. Improvement in >sleep quality and sleepiness reflects the effect on breathing. Limited >follow-up data indicate that oral discomfort is a common but tolerable >side effect, that dental and mandibular complications appear to be >uncommon and that long-term compliance varies from 50% to 100% of >patients. Comparison of the risk and benefit of oral appliance therapy >with the other available treatments suggests that oral appliances >present a useful alternative to continuous positive airway pressure >(CPAP), especially for patients with simple snoring and patients with >obstructive sleep apnea who cannot tolerate CPAP therapy. " >*
Right on. Sally in Seattle (JSo…@aol.com) Coauthor, with Dr. Ralph Pascualy, of Snoring and Sleep Apnea: Personal and Family Guide to Diagnosis and Treatment, published in 1996 by Demos Vermande, NY. Available through bookstores, ISBN # 0-939957-82-5.
Response:
I was just minding my own business on Tue, 3 Mar 1998 11:10:43 -0800, when "Pete Reynen" <prey…@tomatoweb.com> up and shattered my reverie: >I know I’m gonna get flamed big time for this response, but so be it! >(Obvious commercial mode on) I work for Snoring Relief Labs, Inc. We make >the SnorBan dental appliance. It is sold over the counter. Our philosophy is >that people with "snoring " problems shouldn’t have to pay a fortune for >relief. Ours is sold usually for under $50 ($24.99 suggested list).
I am just curious why you put quotes around the word ’snoring’? What you are essentially saying is that you sell the device for apnea, as well; or, that if you sell it ostensibly for snoring, the patient will yet never know whether residual apnea is corrected. Therefore, what you imply is that regardless of the person’s state of sleep-disordered breathing, your only job is to just remove the snoring element of the syndrome, and whether or not the patient is apprised of the potential for ongoing underlying pathology, is irrelevent. >The references that Samuel cites are the same ones we cite, privately,. >SInce the literature is copyrighted we and I’m sure Silent Night are >prevented form using it on the websites (www.snorban.com) . >Sleep 1995 Jul;18(6):501-510
Right, medical research is sooo covert; you can get five-to-life for sharing the conclusions of a medical study! The literature is supposed to be "private"? I’ve got news for you: one cannot copyright medical research. You can investigate this at the Library of Congress. Placing a copyright on medical research is like my writing that I have discovered that water is wet or that snow is cold and then trying to copyright the idea. It is a law of nature and is therefore "protected" *from* copyright — since it is not fiction, nor is intended to be fiction, but is intended as a scientific discovery, it cannot be copyrighted. Of course, when you implied concern for copyright infringement, this wasn’t really what you meant. This was just your marketing alibi for why you would never–on your web page or otherwise–discuss the studies, since many are not as rosy regarding apnea. And this would be because your device is basically good for non-apneic snoring. I would not want to bring up research either if I were you, since it could open a can of informed-consumer worms. >Just because some of you have had bad experiences with a particular device, >don’t assume it is bad for everyone else. We have sold over 100,000 SnorBan >devices to the general public, We get calls every day telling us how much
Tobacco companies sell more packages of cigarettes than that every day. We cannot preclude that sales have come only from smart advertising, and price compulsion. Indeed, we have no way to verify this statement of yours. Unfortunately, there is no indication that you work in tandem with a sleep clinic. You sell them to the "general public"; therefore, efficacy is determined largely by patient input. Often, patient feedback is a good marker for efficacy; unfortunately, since objective determiners cannot corroborate efficacy of your devices, it remains unknown whether patients can imagine even better success, or whether there is residual apnea. A broken finger feels a lot better than a broken leg, and may even feel "normal" when the former is compared to the latter. Though the price is adequate, the cost in future time enduring residual apnea may make the bargain void. Your device would be appropriate for someone who could simply not afford to be sleep tested, and who conveyed subjective improvement following its use. For these folks, your product definitely fills a niche, and it could be argued that you are exploiting this sector. That being said, for those who cannot afford to be sleep studied, some improvement will be better than no improvement at all. Your product serves a symbiotic purpose with this "netherworld" of the uninsured or ignorant. >they appreciate that we made this available to the masses for a reasonable >price. Incidentally, we DO NOT specifically recommend our device for TMJ >sufferers, or people with apnea. BUT, we get calls from users whose doctor >has suggested using SnorBan for apnea suffers, Most call us to say it works
Hold on a second, cowboy. Let us take a quick look at your web page, where the following is written: "The founder of the company suffers from severe snoring and obstructive sleep apnea. After spending thousands of dollars trying traditional medical remedies that include surgery, positive airway machines, and dentist fit appliances, he devised a product so simple yet it incorporated all of the features required to reduce or eliminate snoring." Now I don’t know about you, but even though you claim you do not "specifically recommend [your] devices for . . . people with sleep apnea," (above) you certainly do imply that it is effective for sleep apnea! You state that you suffer from obstructive sleep apnea. This alone implies deceptively that your device can cure sleep apnea. Furthermore, when you state that you have tried positive airway machines, again you brazenly convey that your product cured your sleep apnea. It implies cure because all that people understand is "disease" or "cure". Your page goes on to reference the following study: "An American Sleep Disorders Assoc. Review: "Oral Appliances for the Treatment of Snoring and Obstructive Sleep Apnea." A Review. Wolfgang Schmidt-Norwara et al, Sleep 1995; 18(6):501-510." Well, here again, the title of the primary study you reference on your site states that it reviews obstructive sleep apnea. Here again, there is a strong implication that your product cures sleep apnea. >BETTER than their CPAP. Officially we can’t endorse this use, just reporting >what other people tell us. I agree that paying $1200 for a device is too >much. And it doesn’t guarantee results. BUt neither does buying a CPAP for >$1200. We have had many people call us and claim the CPAP didn’t work for >them. >I don’t want to turn this into a sales job for our product, mostly I want to >lend support to the dental device being appropriate for some people to solve >their problems. Incidently, our product comes with a money back guarantee.
Money back guarantee is good. >I have been biting my tongue on posting, but you guys opened the door. >Pete Reynen, Manager, Snoring Relief Labs, Inc (before you ask we are "not" >doctors, just sufferers that found an inexpensive answer)
Here is the actual abstract from Medline of the study you reference on your page: "Oral appliances for the treatment of snoring and obstructive sleep apnea: a review." Schmidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S Department of Medicine, University of New Mexico, Albuquerque 87131, USA. "This paper, which has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provides the background for the Standards of Practice Committee’s parameters for the practice of sleep medicine in North America. The 21 publications selected for this review describe 320 patients treated with oral appliances for snoring and obstructive sleep apnea. The appliances modify the upper airway by changing the posture of the mandible and tongue. Despite considerable variation in the design of these appliances, the clinical effects are remarkably consistent. Snoring is improved and often eliminated in almost all patients who use oral appliances. Obstructive sleep apnea improves in the majority of patients; the mean apnea-hypopnea index (AHI) in this group of patients was reduced from 47 to 19. Approximately half of treated patients achieved an AHI of < 10; however, as many as 40% of those treated were left with significantly elevated AHIs. Improvement in sleep quality and sleepiness reflects the effect on breathing. Limited follow-up data indicate that oral discomfort is a common but tolerable side effect, that dental and mandibular complications appear to be uncommon and that long-term compliance varies from 50% to 100% of patients. Comparison of the risk and benefit of oral appliance therapy with the other available treatments suggests that oral appliances present a useful alternative to continuous positive airway pressure (CPAP), especially for patients with simple snoring and patients with obstructive sleep apnea who cannot tolerate CPAP therapy. " *************************************************************************** * All in all, I think your product has its place so long as every one fitted with your device is reminded that it will not likely cure underlying apnea, that apnea is common in snorers, that there is a good chance that the patron has sleep apnea, and that the patient should be sleep studied as soon as possible to determine objective efficacy and residual respiratory events. Short of your doing this — which at this time I cannot discern from your post such action — your product is a medical ruse. Doug
Response:
[ ... From <6dhkeu$hm...@bigdog.eli.net>, "Pete Reynen" <prey...@tomatoweb.com> ...] ]I know I’m gonna get flamed big time for this response, but so be it! Hopefully not; your post was thoroughly benign and well stated… ]Just because some of you have had bad experiences with a particular device, ]don’t assume it is bad for everyone else. We have sold over 100,000 SnorBan ]devices to the general public, No one — or at least I hope no one — is saying that TRDs or mandibular repositioning devices don’t work. I’m sure many people have success with SnorBan and with this Thornton device. However, the claims made by this advocate of the Thornton device are too outlandish to be objective. My problem with his website is the lack of factual information and often incorrect information. Now, because you have sold over 100,000 SnorBan devices neither makes them effective nor worth the money (despite their low cost). Many thousands have bought Breathe Right strips to correct snoring and apnea as well; volume sold doesn’t speak to the efficacy of the product. ] We get calls every day telling us how much ]they appreciate that we made this available to the masses for a reasonable ]price. Incidentally, we DO NOT specifically recommend our device for TMJ ]sufferers, or people with apnea. And this is probably the reason why people were quick to jump on the previous poster. Claims were being made that their device *was* for sleep apnea. [...] ]I don’t want to turn this into a sales job for our product, mostly I want to ]lend support to the dental device being appropriate for some people to solve ]their problems. I agree; dental appliances can be effective. However, the breadth of their effectiveness cannot be stated when there aren’t many studies which demonstrate objectively their efficacy. Again, the difference between your claims and the other claims is that you have pointed out very specific caveats. And of course, the following is always welcomed: ]Incidently, our product comes with a money back guarantee. ] 
~kcw [kevin c welch | pulmonary imaging center | uphs] [phone: 349-8980]
Response:
The Somnolent Phantom (nos…@spamfree.net) wrote: : x-no-archive: yes : What’s new with you, Kevin? Any new data or discoveries from your : research work? Not much is new. I’m working still on the effects of weight loss on OSA, and now I’m starting to get into MRI’ing patients who have had UP3+GAHM+MMO and seeing how these surgeries worked. I’m going to Chicago in April to present my findings regarding breathing under conditions of very low CPAP. But, not much else is going on. Right now, it’s still the data collection phase. — ~kcw [kevin c welch | pulmonary imaging center | uphs | icq 8680662] [phone: 349-8980]
Response:
The Somnolent Phantom (nos…@spamfree.net) wrote: : x-no-archive: yes : What’s new with you, Kevin? Any new data or discoveries from your : research work? I forgot one other thing…we’re starting to image children aged 2-12 with OSA. For the moment, we’re NOT looking at Down’s Syndrome children. This presents a big challenge for us. Children and MRI machines don’t usually mix . — ~kcw [kevin c welch | pulmonary imaging center | uphs | icq 8680662] [phone: 349-8980]
Response:
I know I’m gonna get flamed big time for this response, but so be it! (Obvious commercial mode on) I work for Snoring Relief Labs, Inc. We make the SnorBan dental appliance. It is sold over the counter. Our philosophy is that people with "snoring " problems shouldn’t have to pay a fortune for relief. Ours is sold usually for under $50 ($24.99 suggested list). The references that Samuel cites are the same ones we cite, privately,. SInce the literature is copyrighted we and I’m sure Silent Night are prevented form using it on the websites (www.snorban.com) . Just because some of you have had bad experiences with a particular device, don’t assume it is bad for everyone else. We have sold over 100,000 SnorBan devices to the general public, We get calls every day telling us how much they appreciate that we made this available to the masses for a reasonable price. Incidentally, we DO NOT specifically recommend our device for TMJ sufferers, or people with apnea. BUT, we get calls from users whose doctor has suggested using SnorBan for apnea suffers, Most call us to say it works BETTER than their CPAP. Officially we can’t endorse this use, just reporting what other people tell us. I agree that paying $1200 for a device is too much. And it doesn’t guarantee results. BUt neither does buying a CPAP for $1200. We have had many people call us and claim the CPAP didn’t work for them. I don’t want to turn this into a sales job for our product, mostly I want to lend support to the dental device being appropriate for some people to solve their problems. Incidently, our product comes with a money back guarantee. I have been biting my tongue on posting, but you guys opened the door. Pete Reynen, Manager, Snoring Relief Labs, Inc (before you ask we are "not" doctors, just sufferers that found an inexpensive answer) Samuel Zwetchkenbaum wrote in message …
I almost hesitate to make a posting due to fear of attack, but I thought I’d write about my experiences providing oral appliances for sleep apnea. First, here are references from refereed journals: 1. Eveloff: Efficacy of a Herbst Mandibular advancement device in obstructive sleep apnea. Am J Respir Crit Care Med 1994;149:905-9 2. Clark and others: Effect of Anterior Mandibular Repositioning on obstructive sleep apnea. Am Rev Respir Dis. 1993; 147:624. 3. Ferguson and others: A randomized crossover study of an oral appliance vs, nasal continuous positive airway pressure in the treatment of mild-moderate sleep apnea. Chest 1996;109:1269-75 4. Clark and others: A crossover study comparing the efficacy of continuous positive airway pressure with anterior mandibular positioning devices on patients with obstructive sleep apnea. Chest 1996; 109:1477-1483 5. Nakazawa and others: Treatment of sleep apnea with prosthetic mandibular advancement Sleep 1992; 15:499-504 6. Sjoholm and others: Mandibular advancement with dental appliances in obstructive sleep apnea, J oral rehab 1994;21:595-603. I could add several others but I’m tired of writing! There is significant research being undertaken in this field. I think also of interest is the efforts by practitioners to get medical insurance to make these appliances a covered benefit. I think it’s a sin that Bear had to pay $1500 of his own money for this. We spend a great deal of time writing letters to HMO’s and insurance companies to try to get the appliance as a covered benefit if we feel that it will improve the patients quality of life. At our institution we work in a time construct with ENT’s, sleep MD’s (usually neurologists), maxillofacial surgeons, and yes, dentists. Patients with mild to moderate sleep apnea who have either failed CPAP or find it difficult for their lifestyle try the appliances. I am relatively new to the team, and of 18 appliances I have made, 10 patients were satisfied and continue to use the appliance. They are all referred back to the sleep specialist (neurologist) who prescribes a follow-up sleep study, and it is the job of the neurologist to decide if this is the definitive treatment or if another intervention is necessary. Of the 8 patients who failed, 3 were without teeth, 2 were severe apneics, and 2 were Down’s syndrome and non-compliant. A key issue is obviously case selection. Okay…got to get back to work drillin and fillin!
Response:
I was just minding my own business on Mon, 02 Mar 1998 23:34:13 GMT, when szwe…@umich.edu (Samuel Zwetchkenbaum) up and shattered my reverie: – Hide quoted text — Show quoted text ->I almost hesitate to make a posting due to fear of attack, but I thought >I’d write about my experiences providing oral appliances for sleep apnea. >First, here are references from refereed journals: >1. Eveloff: Efficacy of a Herbst Mandibular advancement device in >obstructive sleep apnea. Am J Respir Crit Care Med 1994;149:905-9 >2. Clark and others: Effect of Anterior Mandibular Repositioning on >obstructive sleep apnea. Am Rev Respir Dis. 1993; 147:624. >3. Ferguson and others: A randomized crossover study of an oral appliance >vs, nasal continuous positive airway pressure in the treatment of >mild-moderate sleep apnea. Chest 1996;109:1269-75 >4. Clark and others: A crossover study comparing the efficacy of >continuous positive airway pressure with anterior mandibular positioning >devices on patients with obstructive sleep apnea. Chest 1996; >109:1477-1483 >5. Nakazawa and others: Treatment of sleep apnea with prosthetic >mandibular advancement Sleep 1992; 15:499-504 >6. Sjoholm and others: Mandibular advancement with dental appliances in >obstructive sleep apnea, J oral rehab 1994;21:595-603.
Thank you for the citations, but we have no idea what the conclusions of these studies were. The fact that there are many studies on dental appliances does not mean that even 50% of the studies recommended the appliances. Even so, at least this data is more than that provided by the Silent-Night-Holy-Night dentistrator. >I could add several others but I’m tired of writing! There is significant >research being undertaken in this field. I think also of interest is the >efforts by practitioners to get medical insurance to make these appliances >a covered benefit. I think it’s a sin that Bear had to pay $1500 of his >own money for this. We spend a great deal of time writing letters to >HMO’s and insurance companies to try to get the appliance as a covered >benefit if we feel that it will improve the patients quality of life. >At our institution we work in a time construct with ENT’s, sleep MD’s >(usually neurologists), maxillofacial surgeons, and yes, dentists.
What exactly is a "time construct"? Why couldn’t you just leave it at: ". . . we work with ENT’s, sleep MD’s . . ." etc? George doesn’t like the terms "Time Construct"!! George is unhappy! >Patients with mild to moderate sleep apnea who have either failed CPAP or >find it difficult for their lifestyle try the appliances. I am relatively >new to the team, and of 18 appliances I have made, 10 patients were >satisfied and continue to use the appliance. They are all referred back >to the sleep specialist (neurologist) who prescribes a follow-up sleep >study, and it is the job of the neurologist to decide if this is the >definitive treatment or if another intervention is necessary. Of the 8 >patients who failed, 3 were without teeth, 2 were severe apneics, and 2 >were Down’s syndrome and non-compliant. A key issue is obviously case >selection. >Okay…got to get back to work drillin and fillin!
Now you see, your presentation is more credible on this group than the one involved in the fray. You appear to take responsibility and require that your applianced patients be followed-up with their sleep specialist to document objective improvement. This protocol alone is MANDATORY methodology for dental appliances, and this protocol alone must be adhered to in EVERY CASE. Oximetry alone is inadequate to determine device efficacy. This is all assuming that "time construct" is not some bend on words or some semantical game. For instance, in Clintonian style, for you "time construct" might mean that you look at your watch and think about the ENT, the maxofacial surgeon, and the M.D.s for five seconds once each week. To you, this means that you "work with" these physicians; so that, if not, then why embellish the relationship or complicate the sentence structure in ambiguities? If you work with them, you work with them. Doug
Response:
[snipped] For many physicians this is > controversial therapy, but my treatment has been able to manage > approximately 85% of the severe apneic cases and over 90% of the mild and > moderate cases. Management means a near normal or normal life style with > virtually normal oxygen levels while asleep.Of course no therapy is perfect > so minor side affects can occur in some cases. Good Luck.
WHERE IS YOUR PROOF? Why do people like you insist on coming onto this newsgroup out of nowhere, and making outrageous claims about how great your treatment is? Where are the published studies in peer-reviewed journals? Where are the statistics? Claims like this are dangerous if unsubstantiated, which is certainly the case here. For you normal means normal lifestyle and virtually normal oxygen (whatever "virtually" means). IMHO, normal means RDI’s in the normal range as shown on polysomnography with the device. Until dentists start doing sleep tests to prove their miraculous results, they will not be respected or accepted as sleep apnea specialists. Since you are an expert on treating sleep apnea, why don’t you apply for board certification in sleep disorders? We all know that answer to that question!! Lauren
Response:
Thanks for not mauling me! The main type of device I use is the "DeSRA", stands for Dental Snore Relief Appliance", made by a lab in Lansing, Mi. It’s made of a comfortable vinyl-like material and is not adjustable. so it is important to capture the right position. Another model I tried under a friend’s recommendation is the "Kleerway", which my friend likes because it’s adjustable, meaning if there is not sufficient protrusion this can be corrected by turning some screws. I find all these screws, bolts, etc to be bulky and interfere with tongue space. I also feel in the long term they could trap tartar and have a shorter life span…but I don’t even know what the lifespan of the "Desra" is. There are other appliances which i haven’t tried, for example the "Tongue retaining device", which is supposed to be good for patients with no teeth…. My main criteria is that the patient was referred by the neurologist who is totally aware of the situation. This weeds out any severe apnics. Multiple missing teeth may also create difficulty in use. Compliance is important. Mentally challenged children and adults may have difficulty acclimating to a device. Finally, it seems that for some patients, the sleep apnea is due to the soft palate falling back against the pharynx and closing the upper airway, where for others it is the base of the tongue that is falling back against the pharynx and closing a lower airway. A dental device would only be helpful in bringing the tongue forward. I rely on the ENT and maxillofacial surgeon to make this assessment for me. so, for example, if a patient with mild sleep apnea, has had a UPPP and still has sleep apnea, then a dental device may be helpful. Thanks for listening! -Sam
Response:
The Somnolent Phantom (nos…@spamfree.net) wrote: : x-no-archive: yes [ ... _Deletia maximus_ ] : Happy Positive CASH FLOW : $$$$$$$$$$$$…………Bear……..$$$$$$$$$$$$$$$$$$$$$$$ He’s back! And in full glory! :) — ~kcw [kevin c welch | pulmonary imaging center | uphs | icq 8680662] [phone: 349-8980]
Response:
> Has anyone had any experience with dental appliances to treat severe sleep > apnea, if so can you comment on the type you use and the results you have > had.
I have mild OSA, and I use an appliance. I have had very good results! I used to use CPAP most of the time and the appliance as a backup or for camping. In December I got the flu and a sinus infection at the same time and started using the appliance all the time then and have yet to plug in the ol’ blower since. I can’t remember the brand name, but the periodontist that made it has apnea also. — Henry Ballard hbal…@ces.clemson.edu ______________________________________________________________________ "We are often most in the dark when we are the most certain, and most enlightened when we are the most confused." M. S. Peck ______________________________________________________________________
Response:
I almost hesitate to make a posting due to fear of attack, but I thought I’d write about my experiences providing oral appliances for sleep apnea. First, here are references from refereed journals: 1. Eveloff: Efficacy of a Herbst Mandibular advancement device in obstructive sleep apnea. Am J Respir Crit Care Med 1994;149:905-9 2. Clark and others: Effect of Anterior Mandibular Repositioning on obstructive sleep apnea. Am Rev Respir Dis. 1993; 147:624. 3. Ferguson and others: A randomized crossover study of an oral appliance vs, nasal continuous positive airway pressure in the treatment of mild-moderate sleep apnea. Chest 1996;109:1269-75 4. Clark and others: A crossover study comparing the efficacy of continuous positive airway pressure with anterior mandibular positioning devices on patients with obstructive sleep apnea. Chest 1996; 109:1477-1483 5. Nakazawa and others: Treatment of sleep apnea with prosthetic mandibular advancement Sleep 1992; 15:499-504 6. Sjoholm and others: Mandibular advancement with dental appliances in obstructive sleep apnea, J oral rehab 1994;21:595-603. I could add several others but I’m tired of writing! There is significant research being undertaken in this field. I think also of interest is the efforts by practitioners to get medical insurance to make these appliances a covered benefit. I think it’s a sin that Bear had to pay $1500 of his own money for this. We spend a great deal of time writing letters to HMO’s and insurance companies to try to get the appliance as a covered benefit if we feel that it will improve the patients quality of life. At our institution we work in a time construct with ENT’s, sleep MD’s (usually neurologists), maxillofacial surgeons, and yes, dentists. Patients with mild to moderate sleep apnea who have either failed CPAP or find it difficult for their lifestyle try the appliances. I am relatively new to the team, and of 18 appliances I have made, 10 patients were satisfied and continue to use the appliance. They are all referred back to the sleep specialist (neurologist) who prescribes a follow-up sleep study, and it is the job of the neurologist to decide if this is the definitive treatment or if another intervention is necessary. Of the 8 patients who failed, 3 were without teeth, 2 were severe apneics, and 2 were Down’s syndrome and non-compliant. A key issue is obviously case selection. Okay…got to get back to work drillin and fillin!
Response:
Dr. Denbar, In article <01bd4557$362e09a0$6bbb60cc@default>, "Martin Denbar" <den…@silent-night.com> writes: > Of course success with an oral >appliance also depends on a number of anatomical factors, patient >compliance,etc. for each patient.
I would appreciate your describimg the "ideal" patient in terms of anatomical obstructions and also the effect of obesity on success/failure. Also, I know there are a bazillion oral appliances out there. What is unique about the Thornton appliance that you mention, and do you have any connection with the manufacturers? Thank you, Sally in Seattle (JSo…@aol.com) Coauthor, with Dr. Ralph Pascualy, of Snoring and Sleep Apnea: Personal and Family Guide to Diagnosis and Treatment, published in 1996 by Demos Vermande, NY. Available through bookstores, ISBN # 0-939957-82-5.
Response:
JSoest (jso…@aol.com) wrote:
: Dr. Denbar, : In article <01bd4557$362e09a0$6bbb60cc@default>, "Martin Denbar" : <den…@silent-night.com> writes:
: > Of course success with an oral : >appliance also depends on a number of anatomical factors, patient : >compliance,etc. for each patient. And I think that the general descriptions of how mandibular repositioning devices work on his web page indicates that their success depends on tongue-based based obstructors, which may be at best 20% of the apneics (at least what I’ve seen) and not for the majority of velopharyngeal obstructors. Personally, I don’t think these appliances work well beyond the mild apenic cases… : I would appreciate your describimg the "ideal" patient in terms of anatomical : obstructions and also the effect of obesity on success/failure. I wish to know as well. Frankly, I’m a little disturbed with the web site, especially the answers to the frequently asked questions. The first question on there is "Is snoring normal?" and the answer provided is "Most people snore to some degree. Generally speaking, it is quite normal." Well, snoring isn’t normal. It’s indicative of at least some pathology and may lead to the pathogenesis of sleep apnea. If one says it’s normal in the sense that it occurs widely or is the "norm", then that may be accurate. To say that it is "normal", ie not a health concern, is plainly incorrect. Furthermore, his response to what sleep apnea is is outdated. I think that’s indicative of why he thinks oral appliances are so great. And the last question regarding "Do I have to wear the appliance every night?" It’s kind of frightful. Sleep apnea is not a part time job. Wearing an appliance one night doesn’t mean you don’t have to wear it over the weekend. It’s like CPAP, you have to wear it every single night, otherwise there’s no point. : Also, I know there are a bazillion oral appliances out there. What is unique : about the Thornton appliance that you mention, and do you have any connection : with the manufacturers? I think it’s obvious that he endorses the product (he implies that as a user, but also by the fact that he is on the website a has an email address of the same domain name. — ~kcw [kevin c welch | pulmonary imaging center | uphs | icq 8680662] [phone: 349-8980]
Response:
Has anyone had any experience with dental appliances to treat severe sleep apnea, if so can you comment on the type you use and the results you have had.
Response:
I am a practicing dentist with over three years experience in utilizing oral appliance technology to treat all forms of sleep apnea and UARS. I am also a moderate sleep apneic and have worn the Thornton Adjustable Positioner for over three years. I work virtually exclusively with physicians to treat the C-PAP and surgical failures in our community. Check out the web site www.silent-night.com. Oral appliance technology is very new and there are very few dentists that are knowledgable about this form of therapy and even fewer physicians. Some of the latest research is verifying what we in the field already know. That is that oral appliances can meet and beat C-PAP for effectiveness in treating mild and moderate OSA. I am very comfortable with the statement that I can treat a patient with an AHI up to 50 with an oral appliance just as well as C-PAP can. I have all patients utilize overnight oximetry out of my office to titrate their appliance to the needed position for maximum effectiveness. For those patients that get a follow-up polysomnograhy, our office has had our oximetry results confirmed. I like the Thornton Adjustable Positioner for a multitude of reasons, but as a practicing doctor I will discuss these points at a patient consultation only. Of course success with an oral appliance also depends on a number of anatomical factors, patient compliance,etc. for each patient. I have also found that oral appliances work very well with post surgical patients. We have been able to keep the patient out of surgery in most cases. For many physicians this is controversial therapy, but my treatment has been able to manage approximately 85% of the severe apneic cases and over 90% of the mild and moderate cases. Management means a near normal or normal life style with virtually normal oxygen levels while asleep.Of course no therapy is perfect so minor side affects can occur in some cases. Good Luck. Roger Stevens <rogere…@erols.com> wrote in article <6dc949$q1…@winter.news.erols.com>… – Hide quoted text — Show quoted text -> Has anyone had any experience with dental appliances to treat severe sleep > apnea, if so can you comment on the type you use and the results you have > had.
