Questions & Answers

We have been asked the following questions many times so we decided to put them and their answers into writing. This is for information only. This is NOT medical advice.

How do I know I have Sleep Apnea?
A: Sleep apnea is a medical diagnosis that is made by a sleep physician. However, if you have one or more of the following symptoms, you may want to consult your physician:
· Excessive daytime sleepiness (EDS).
· Daytime fatigue even having “slept” for many hours.
· You wake up choking and gasping for breath.
· Your bed partner tells you that you stopped breathing for brief periods of time while asleep.
· You or your bed partner is aware that you snore.
· You kick your legs or move your arms unconsciously while
sleeping.
· You wake up many times a night to urinate.
· Your sleep is generally not restful or restorative.

How do I start the process of getting treated with oral appliances?
A:The patient will have to present for an evaluation in our office which includes an oral exam (for decay, loose teeth, bite issues, periodontal health, and other determinants) and a consultation. This visit typically takes one hour or more. The purposes of this evaluation are:
· To determine if patient is suitable for oral appliances.
· If he is suitable, which oral appliance would be best for him.
· If he is unsuitable, what would be his next course of action.
Dr Choi will personally consult with the patient to answer their questions and concerns.

What if I am determined to be suitable for oral appliance therapy (OAT) for obstructive sleep apnea (OSA)?
We will first put him on a trial appliance which is solely for the purpose of determining whether he can tolerate having an appliance in the mouth. This appliance does NOT treat OSA or SDB (sleep disordered breathing).

This appliance is to be used for a maximum of two weeks after which the patient will return to our office to decide whether he wants to proceed or NOT to proceed with the treatment appliance. The actual kind of appliance to be used will be determined during this visit.

Do I have to pay for the trial appliance?
Yes. The fee paid for the trial appliance will be applied towards the treatment appliance if patient decides to go on to the treatment appliance. Otherwise, the trail appliance fee is deemed to be paid for services consumed.

What do the trail appliances feel like?
If you have worn dentures or braces before, you will know how that feels. The closest analogy is that it feels like you have a hard candy in your mouth. (Except that this appliance is not sweet and it does not melt!)

How would I look with the trial appliances?
They are largely non-visible although the give-away is usually the thicker lips and the change in the way you speak. BUT, given that these appliances are to be used when you sleep, the esthetics may not be so important.

What is done during the visit to start the treatment appliance?
Some records will be taken: impressions, bite registrations, Xrays, and other records. This takes about 30 minutes.

How many different kinds of appliances are there?
Too many to count. Some of them are for snoring and some for snoring and sleep apnea. We use 3 main kinds regularly. (See next page for pictures.)

When do I get the treatment appliance?
Usually 3 weeks later. During that visit, the appliance will be fitted and trimmed if necessary. Instructions on care and use will be given at that time together with a special box to keep the appliance while not in use.

How often do I return for adjustments?
Usually about once a week for the first 4 weeks. After that, we follow up for 3 months. After the 3 months, patients will be seen on a half-yearly, yearly or ‘as-required’ basis.

Is there pain in using the appliances?
There should not be pain unless they are not fitting right. Patients have to inform us if there is any pain during the process of seating the appliances or anytime after that.

Are the appliances unsightly?
As mentioned before, the appliances are almost not visible and the changes are mainly in pronunciation of words and fatter lips. Other than that, since most people sleep with their lights out, appearance while using the appliances is not an issue. It beats the appearance of the CPAP masks and hoses!

What if I lose or break my appliance?
We have a reduced fee for replacement appliances provided for in our treatment plan.

Are there reasons why OAT would fail?
Yes. There are 5 main reasons:

1. Tolerance – something that we can eliminate during the initial process with the trial appliances.

2. Adjustment. The process of adjusting to the new appliance takes time and patience is required here. Every time the dentist adjusts the appliance, the patient will also have to get use to a new position of the mouth. This usually is not difficult.

3. Changes to teeth and oral structures that may require the appliance to be
adjusted or to be changed completely. We cannot control changes to teeth
caused by decay or periodontal disease, etc. That is why patients have to be
seen by their own DDS periodically for optimum care.

4. Compliance. Usually the devices are so small to handle that even when
they travel, patients can bring them along in their luggage. However, we
cannot control whether our patients use or NOT use their devices at home.
Compliance depends completely on the patient himself.

5. Loss or breakage of appliances. These can be due to a number of reasons: a pet may chew up an appliance that was not kept in its box; somebody might sit on and break an appliance that was left sitting on the sofa (just like people would leave glasses on the sofa); appliances left in hotel rooms or seat pockets of airplanes; appliances that were accidentally tossed out.