Oral Appliance with CPAP

[SevereApnea]

Hi All

I have been searching for threads on the use of Oral Appliances together with xPAP but have found only a limited a number of threads, generally advising against this. Can anyone point me in the right direction to an appropriate thread please?

(Reason for asking: my Sleep Physician suggested I try this: I am seeing him again in December and at least want to say I have tried. It may bring my lower jaw forward a bit, I have an underbite: lower teeth close behind upper teeth.)

[jaswilliams]

Oral appliances are not as effective as a CPAP machine as sleep apnoea is more than just jaw position. any reasons why you are looking at other solutions you see to be well treated with your Autoset for her ?

[SevereApnea]

hi jaswilliams

Three reasons mainly:

1. My Sleep Doc uses them (the pricey ones) and has discussed this with me a few times. 
He suggested I try a cheaper boil and bite to see how I go. I am trialling one of the ones he recommended for 1/2 a day but so far very uncomfortable. Don't know I would cope all night!
When I see him next I will want to let him know that I did pursue this course, hence seen to be compliant.

2. I have an "under bite" where the lower jaw teeth lie behind the top teeth. I am chipping one of the top teeth, maybe just age, maybe tooth grinding from stress, maybe coincidence. I thought if I can equalise the pressure across all teeth then I can protect the teeth and avoid dental problems later.

3. Thirdly, bringing the lower jaw forward and down may help airways open up a bit?

If I could get rid of the neck collar, Alice bands and mouth tape that might be a reasonable trade off.

Probably a misguided idea but I thought I may as well ask the question.

[sawinglogz]

Everybody's lower teeth close slightly behind their uppers, otherwise you'd be chipping your front teeth all the time. It's only an overbite when they're too far behind.

Oral appliances only work on about 50% of patients (according to the apnea dentist that I saw), and they're expensive, and they can cause your teeth to shift. So they're not without their risks. They're also generally adjustable, and it can take some time to find the amount of underbite required to treat your apnea (again, assuming you fall into the lucky 50%), and it may be that the amount of underbite required is too uncomfortable for you to tolerate.

So they're not a silver bullet, but if you've got the $ (or can convince your insurance to cover it), you can always try.

They're mostly only used with CPAP (1) initially if you're already on CPAP to get used to it for the first week, or (2) if you're on a very high CPAP pressure and your goal with an oral appliance is simply to lower the required pressure.

[SevereApnea]

Hi sawinglogz

Thanks for the reply and the correction.

Yes, overbite as you correctly say and not underbite as I posted earlier.

In the last few weeks/2 months maybe, I have noticed tooth pain during the day, my occlusion has changed, lately I can only occlude the molars towards the end of the day. My overbite has changed somehow in the last month. .

So something has changed since the time I started PAP therapy. 
I won't pursue the oral appliance route: I tried the boil and bite jobby as recommended by my sleep Doc, for 1/2 hour daily for 3 days,  and find it very uncomfortable: I can really feel the stress on the teeth; it also takes up room in mouth that pushes the tongue further back so that is no good.

I am now trying to decide what else is causing my altered bite and tooth sensitivity.
Chin collar?
Mouth tape?
Bruxism? 
Stress?
...non-PAP related issues. (TMJ, Vitamin D)


The journey continues!

[Deborah K.]

I have had many dental issues all my life. Your dentist can do some easy correction to your bite so that one tooth is not harming another by hitting against it in a way it should not. This is a painless one visit issue, and should not cost a lot either. Talk to your dentist about it. This correction can make your bite much better, relieving pain and grinding.

[SevereApnea]

Thanks Deborah

I will chat to him about it when I see him next: glad to hear it can be a quick fix: I had visions of Orthodontics and braces for months.....?