Oral Appliance Therapy for Sleep Apnea

One of the treatments for obstructive sleep apnea can be performed in our office. Dr. Schell and Dr. Noble have helped hundreds of patients breathe easier at night by fitting them with an oral appliance.

sleep-apnea-device-upper-valley-nh-schellnoble-dentistryAn oral appliance is a small, custom fabricated device that fits in your mouth to create more space and prevent the collapse of the tongue and soft tissue in the back of the throat. This helps to keep the airway open by repositioning and stabilizing the tongue and lower jaw. The mandibular advancement device is adjusted (titrated) over several weeks to obtain the correct setting for each individual patient to maximize air flow and create uninterrupted sleep.

Oral appliance therapy is most often used when:

• Patients have mild to moderate OSA

• Patients with moderate to severe OSA are unable or unwilling to tolerate CPAP therapy

• CPAP therapy alone does not alleviate the OSA symptoms; combination therapy is the use of an oral device and CPAP at the same time

For more detailed information regarding oral appliance therapy, please see below:

  • What is an Oral Appliance?

    oral-appliance-for-sleep-apnea-schellnoble-dentistryAn oral appliance is a small, custom fabricated device that fits in your mouth to create more space and prevent the collapse of the tongue and soft tissue in the back of the throat. This helps to keep the airway open by repositioning and stabilizing the tongue and lower jaw. The mandibular advancement device is adjusted (titrated) over several weeks to obtain the correct setting for each individual patient to maximize air flow and create uninterrupted sleep.

    Will Oral Appliance Therapy Work for Me?

    Oral appliance therapy is effective 60% to 80% of the time depending upon the severity of the obstructive sleep apnea. It is very important that you discuss all options with your sleep physician and/or primary care physician to determine the best treatment for you. We work in conjunction with your physicians and general dentist throughout your oral appliance therapy.

    Oral appliance therapy is most often used when:

    • Patients have mild to moderate OSA
    • Patients with moderate to severe OSA are unable or unwilling to tolerate CPAP therapy
    • CPAP therapy alone does not alleviate the OSA symptoms; combination therapy is the use of an  oral device and CPAP at the same time

    After titration of your oral appliance is complete and you are feeling the benefits of this therapy, an overnight sleep study is required to determine the clinical effectiveness of this treatment.

    What are the Side Effects of Oral Appliance Therapy?

    It does take time to adjust to having the appliance in your mouth each night. Most patients acclimatize to the device in five to ten days. Some patients do experience dry mouth, excessive salivation, or joint soreness during this period. Each patient also receives a positioner to wear each morning after removing the oral appliance. In some people Oral Appliance therapy can cause some changes in your bite; these are usually minor but may continue over time.  We encourage regular visits to watch for these changes and catch them early if they occur. This device reduces the chances of changes in your bite.

    Does my Insurance Cover Oral Appliance Therapy?

    Most medical insurance plans cover oral appliance therapy when treatment is considered medically necessary. Reimbursement is also subject to your plans specific provisions such as deductibles, in and out of network benefits, copayments, and yearly maximums. Our staff will work with you to determine your benefits and make financial arrangements prior to treatment.

  • Obstructive Sleep Apnea is a Serious Medical Condition

    Oral appliance therapy is a very effective treatment and requires coordination and collaboration between your health care providers and a commitment from you to follow the necessary steps to effectively treat the condition. Each appointment is documented and progress letters are sent to your physicians and dentist to ensure consistent treatment and appropriate follow up care.

    Once we have received and reviewed your physician referral, sleep study report, and clinical notes we are able to schedule the first appointment.

    First Appointment: Consultation and Examination

    A thorough history as well as a head, neck, and throat evaluation is completed. Based upon our evaluation and clinical information provided by your physician, we discuss with you the appropriate oral appliance therapy along with the risks, benefits, and reasonable expectations of treatment. If the decision is made to proceed with treatment, impressions are taken of your upper and lower teeth, various measurements are taken, and a record is made of the bite. Your oral appliance is fabricated using the information collected.

    Second Appointment: Delivery of the Oral Appliance

    Two to three weeks after the first appointment, we are ready to deliver your appliance. We test the fit and make any necessary adjustments to ensure the device’s performance and your comfort. Instructions on insertion, titration, and home care are given along with a review of possible side effects. We stay in contact with you by phone over your first few nights of using the appliance and schedule a return follow up visit for 3 weeks.

    Follow up Appointments: Titration and Evaluation

    We work closely with you for the first 90 days following delivery of the appliance to ensure the comfort and effectiveness of the treatment. We do require two face-to-face appointments during this period. We inspect the device, make adjustments as needed, and document your sleep progress. When you and the doctor feel that your titration is complete, a home sleep test is conducted using our monitor. Results are reviewed and discussed with you. 

    Once this phase is complete, it is time to see your sleep physician for an overnight polysomnogram. 

    Patients are seen at least once a year to assess their progress and evaluate the device. An oral appliance can last up to five years but may need periodic replacement.

    This comprehensive approach is critical to success and to achieve it we base our fee on all treatment necessary in the first 6 months of therapy. Recall visits after that time are charged at regular office visit fees. In this way we can devote as much time as needed in the early phase of treatment to achieve a successful outcome.

    • Thoroughly brush and floss your teeth prior to using your oral appliance.
    • Do NOT bite your appliance to place. Use only finger pressure.
    • Inspect the device prior to each use.
    • Engage the hook of the upper tray with the socket of the lower tray before placing the trays in your mouth. Make sure the hook is not dialed too far forward that you cannot comfortably snap the trays from the bottom to snap it over your teeth. Repeat the same process for the lower tray.
    • You may unconsciously remove your appliance at night. This is normal as it may take two weeks to become comfortable with the appliance.
    • You may notice a slight plastic taste while wearing the appliance. This will quickly self-resolve.
    • The oral appliance should only be worn while sleeping.
    • To remove either the upper or lower tray gently open your mouth while the hook is still engaged. At the same time, lift up on the lower tray or pull down on the upper tray to loosen either tray and remove.
    • To advance your lower jaw forward with the appliance in the mouth turn the adjustment key counter clockwise (toward your left ear). One full turn of the key is .25mm. Never attempt to eat with the appliance in place.
    • Both the upper and lower components of the appliance must be worn. Do not wear just one component.
    • Keep the appliance in the storage container when not in your mouth. Pets love to steal oral appliances! There is a fee to replace a broken, damaged or lost appliance.
    • Use the morning positioner each and every morning.
    • Remember potential side effects per the signed informed consent: excessive salivation, difficulty swallowing with appliance in place, sore jaws and or teeth, jaw joint pain, dry mouth, gum pain, loosening of teeth and bite changes.
    • If you are having a problem with your appliance prior to your regularly scheduled appointment, please contact the office at 603-448-3800.
    • Upon awakening remove appliance, wait thirty minutes to use the morning positioner. When you are ready to use the morning positioner, insert the positioner over your upper teeth. Pull your lower teeth into the indentations on the bottom of the tray. Once your lower jaw is in the correct position, squeeze or bite on the tray as if to put your back teeth together. Repeat the process of squeezing the jaw together into the morning positioner until usual bite position is achieved. This may take anywhere from 5 to 10 minutes.  If this takes longer than 10 minutes, take a hot shower or place a warm pack on the joints to warm up the jaw joints and accomplish this process faster. Contact our office at 603-448-3800 if these methods are not successful. To remove the morning positioner, take the tray off your back teeth first and then remove it from your mouth.
    • Rinse appliance with cold water. Brush all surfaces of the appliance with an antibacterial soap. DO NOT USE TOOTHPASTE, HOT WATER OR BLEACH on your appliance.
    • DO NOT soak your appliance in mouth rinse.
    • DO NOT clean in the dishwasher.
    • Rinse thoroughly and dry your appliance completely before storing in the container. It may help to leave the container open to ensure that your appliance dries thoroughly.
    • Wash your storage container as needed.
    • Rinse off your bite exerciser/morning positioner daily with cold water only and dry thoroughly, store with your appliance in storage container, do not leave in the car on a hot day, it will distort.
  • We make treatment recommendations based on your individual needs and help you obtain the maximum insurance reimbursement. It is our practice to require 50% of our fee at the time we take impressions for the oral appliance and the remaining balance at the appliance delivery appointment. 

    Insurance Coverage

    Most medical insurance plans cover oral appliance therapy when treatment is considered medically necessary. Reimbursement is also subject to your plan’s specific provisions such as deductibles, in and out of network benefits, copayments, and yearly maximums. Our staff will work with you to gather the necessary information to submit for preauthorization of treatment, determine your benefits, and out of pocket expenses prior to treatment.

    Dental insurance does not cover the cost of the oral appliance.

    Network Participation

    Dr. Schell and Dr. Noble are not in-network providers for medical insurance plans in their private practice. Patients may be reimbursed for costs under the out-of-network provisions within their policy. Many plans do not allow dentists (DMDs) to become in-network providers. When there is not another qualified in-network provider in the local area, we can request a gap exception. Receiving a gap waiver allows you to be reimbursed at the in-network benefit level. 

    Other Financial Arrangements

    Please check with our Office Manager for details on your insurance plan or to discuss other financial options available through our office prior to your appointment.