PATIENT EDUCATION

• Introduction & Treatment Timing
• Teeth and Face Classifications
• Impacted and Missing Teeth
• Crowding and Spacing of Teeth
• Orthodontic Problems
• Snoring & Sleep Apnea

Snoring and Sleep Apnea

Introduction

Snoring is the sound of partially obstructed breathing during sleep. While snoring can be
harmless, it can also be the sign of a more serious medical condition known as Obstructive Sleep Apnea (OSA).  When Obstructive Sleep Apnea occurs, the tongue and soft palate collapse onto the back of the throat and completely block the airway which restricts the flow of oxygen. 

Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. A recent study  reported that severe sleep apnea raises the risk of early death by 46 percent.  Fortunately, sleep apnea can be diagnosed and treated. Several treatment options exist, and research into additional options continues.

Not sure if you have obstructive sleep apnea?  Click the following link for a Self Test.

Obstructive Sleep Apnea Video Presentation.

Treatment Options

In addition to lifestyle changes, such as regular exercise and weight loss, there are three primary ways to treat snoring and sleep apnea: CPAP, Oral Appliance Therapy and Surgery.

Who is a Candidate for Oral Appliance Therapy?

Oral appliance therapy is indicated for:

• Patients with primary snoring or mild OSA who do not respond to, or are not appropriate candidates for treatment with behavioral measures such as weight loss or sleep position change.
  

• Patients with moderate to severe OSA should have an initial trial of nasal CPAP, due to greater effectiveness than with the use of oral appliances.
  

• Patients with moderate to severe OSA who are intolerant of or refuse treatment with nasal CPAP. Oral appliances are also indicated for patients who refuse treatment or are not candidates for tonsillectomy and adenoidectomy, craniofacial operations or tracheostomy.

Types of Oral Appliances

With so many different oral appliances available, selection of a specific appliance may appear somewhat overwhelming.  Nearly all appliances fall into one of two categories. The
diverse variety is simply a variation of a few major themes.  Oral appliances can be classified by mode of action or design variation.

Tongue Retaining Appliances

Tongue retaining appliances function by holding the tongue in a forward position by
means of a suction bulb.  When the tongue is in a forward position it serves to keep the
back of the tongue from collapsing during sleep and obstructing the airway in the throat.

Mandibular Repositioning Appliances

Mandibular Repositioning Appliances function to reposition and maintain the lower jaw (mandible) in a protruded position during sleep.  This serves to open the airway by indirectly pulling the tongue forward, stimulating activity of the muscles in the tongue and making it more rigid.  It also holds the lower jaw and other structures in a stable position to prevent opening of the mouth.

                                                                    

After consulting with your physician, Dr. Gosalia can determine which appliance is best suited for your specific needs.  We will work with your physician as part of the medical team in your diagnosis, treatment and on-going care.

How do Oral Appliances Work?

Oral Appliance Therapy involves the selection, fitting, and use of a specially designed oral
appliance worn during sleep that maintains an opened unobstructed airway in the throat.

Oral appliances work in several ways:

• Repositioning the lower jaw, tongue, soft palate and uvula

• Stabilizing the lower jaw and tongue

• Increasing the muscle tone of the tongue

On-going Care

On-going care, including short and long term follow-up is an essential step in the treatment of snoring and Obstructive Sleep Apnea with Oral Appliance Therapy. Follow-up care serves to assess the treatment of your sleep disorder, the condition of your appliance, your physical response to your appliance and to ensure that it is comfortable and effective.

Advantages of Oral Appliance Therapy

Oral Appliance Therapy has several advantages over other forms of therapy:

• Oral appliances are comfortable and easy to wear. Most people find that it only takes a couple of weeks to become acclimated to wearing the appliance.
• Oral appliances are small and convenient making them easy to carry when traveling.
• Treatment with oral appliances is reversible and non-invasive.

Is the Appliance Covered by Insurance?

Very few, if any, dental insurance companies will cover oral appliance therapy.  If you are going to file for insurance to cover the costs of the appliance, file for medical insurance not dental insurance. Usually oral appliances fall under the same category as durable medical equipment and prostheses. If this is not the case, ask if oral appliances are covered by the insurance benefits. 

The insurance companies will likely require:

• Copy of Polysomnogram (PSG or sleep study)
• Diagnosis code(s) used by physician
• Copy of prescription for oral appliance from physician
• Letter of medical necessity from physician
• Treatment code(s) used by orthodontist

Be sure to tell the claims personnel that you have a CPT code. This will speed up the approval process.  We can provide the following codes that have all had successful prior approval:

Diagnostic Code	Description
327.23	Obstructive Sleep Apnea
E0486	Oral Appliance to Treat Sleep Apnea
70355	Panoramic X-Ray of Jaws
95806	Sleep Study Unattended
99205	New Comprehensive Exam/Evaluation

FAQ

For more information, click the following link to the American Academy of Dental Sleep Medicine.