Steps for Oral Appliance Therapy for OSA

By Lance Timmerman DMD

Often Seattle sleep apnea dentist Lance Timmerman DMD in Tukwila near Starfire is asked by his snoring or sleep apnea patients how EXACTLY the process for oral appliance therapy for OSA goes. While the steps are fairly simple and straightforward, they can be time consuming and unpredictable. Experience is important, as many dentists lack the training and experience to help as many people as possible.

Most patients take advantage of their medical insurance benefits. In order to do this and answer questions about financial investment for oral appliance therapy for OSA at the first visit, we ask for a health history, a copy of the diagnostic sleep study (PSG), a letter of CPAP intolerance and all medical insurance information (including medicare). Having this information in advance allows us to make necessary contacts with doctors and insurances.

After a brief interview, an opportunity to answer any questions and financial arrangements for the estimated investment, a clinical exam is done. This is NOT a dental exam, so if you have a dental home, this exam is not a replacement for the routine exams done every 6 months. This exam is to better understand the airway and how to manage it with an oral appliance, so dental needs taken care of in the dental home may go unreported. This information is included in the claim submitted to insurance. Impressions of the teeth are taken and a bite relationship is taken in a starting position, one that allows adjusting. This is sent to a lab for fabrication.

A MAD (mandibular advancement device) is seated. This appliance, attached to both upper and lower jaws, supports the lower jaw and prevents collapsing backwards. When the jaw goes backwards, the airway is constricted or blocked. Constriction causes hypopneas and blockages cause apnea or apneaic events. When the device is seated (no matter which style; there are around 120 on the market) Dr Timmerman verifies fit and comfort. Dr Timmerman ALSO delivers a morning appliance, something to assist the jaws to return to the normal relationship. Advancing the jaw can cause the jaw to have difficulty biting like normal. This device can help along with exercises. If a TMJ condition is revealed, more therapy may be indicated.

A MAD (mandibular advancement device) is seated. This appliance, attached to both upper and lower jaws, supports the lower jaw and prevents collapsing backwards. When the jaw goes backwards, the airway is constricted or blocked. Constriction causes hypopneas and blockages cause apnea or apneaic events. When the device is seated (no matter which style; there are around 120 on the market) Dr Timmerman verifies fit and comfort. Dr Timmerman ALSO delivers a morning appliance, something to assist the jaws to return to the normal relationship. Advancing the jaw can cause the jaw to have difficulty biting like normal. This device can help along with exercises. If a TMJ condition is revealed, more therapy may be indicated.

Use of CPAP or oral appliance therapy for OSA is a lifelong commitment. Discontinuing use will return health to the original state, perhaps life threatening. Continuing use also may lead to adaptation. The effective position of the MAD may become less effective and require occasional fine tuning.