Julie’s Question:
I have obstructive sleep apnea and I wear a Somnomed appliance at night. As a result, my bottom teeth and top teeth are meeting on top of each other and the bottom teeth are off to the side. I would to be able to straighten my bite and wear the sleep appliance at night. Is this possible? Please let me know if you have additional questions. I have consulted a prosthodontist who told me he needs to confer with my dentist and sleep appliance doctor. But they are busy and I want to know if my situation is something I must accept.

Dr Shapira’s Response:
Dear Julie

There are many ways to “make you whole” and possibly offer long term cure to sleep apnea. A side effect of wearing a Somnomed Appliance or other sleep appliance is bite changes. These are usually mild but can be more severe. These are discussed at the start of treatment. The bite changes can be favorable or unfavorable. The are he result of the jaw heling to a position with a better airway.

I have been utilizing sleep appliances since 1982 and bite changes are common. Ideally aggressive morning exercise prevents most changes but after they occur they are hard to reverse. I have followed some patients for approximately 30 years and many never have issues.

Sometimes the bite changes can be reversed if you use CPAP instead of an oral appliance to treat your sleep apnea. The changes actually are healing of the retrodiscal ligaments and muscles. They improve your daytime and night-time breathing, posture and actually make your face look younger and healthier but when everything is healed your bite looks wrong.

I teach all my patients how to prevent changes before giving them an appliance. I often have patients who want permanent orthopedic change and this is accomplished with a plan rather than as an accident.

The changes you see in essence explain why you originally had seep apnea. It is possible to orthodontically or prosthetically correct the bite but my preferred method is the RNA version of the DNA Appliance that orthopedically grows your maxilla to a proper size. Additional work may be required to finish case after the DNA Appliance.

I frequently see long distance patients with difficult problems and the DNA Appliance lends itself to long distance treatment.

The beauty of the DNA Appliance is that it has been shown in clinical studies to cure sleep apnea in some patients. Long term prospective studies are underway.

The first video is a physician who is using DNA Appliance to grow larger airway.

This patient is a young girl whose DNA Appliance is growing a larger airway after orthodontics constricted her airway

This is a month by month explanation of a long term patient utilizing DNA Appliance.
http://sleepandhealth.websiteexpert.ca/category/blog-keywords/highland-park-epigenetic-orthodontics/

It is also possible to do a full mouth reconstruction to a neuromuscular position.

Julie’s response:
I currently wear the Summoned sleep appliance which I believe the only appliance my doctor makes. I would like to continue to wear this appliance because it helps my OSA without tearing up the inside of my mouth. I would like to correct my bite as my jaw pops and it is difficult to chew. Is my situation futile or can I do the bite correction and keep my current appliance?

Dr Shapira’s response:
Dear Julie,
I see many patients who we treat for both TMJ and bite issues who also wear sleep appliances. I will usually make a daytime orthotic to treat the jaw issues that is worn when the sleep appliance is out.

Treatment is usually divided into phases, the first phase is a diagnostic that can be adjusted over time during initial treatment. A second phase of long term stabilization is then done. This can be done with long term removable orthotic that would allow you to use your current Somnomed appliance.

There are other options for long time stabilization but they would require replacement of Somnomed appliance.

Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
Chair, Alliance of TMD Organizations
Diplomat, American Academy of Pain Management
Diplomat, American Board of Dental Sleep Medicine
Regent & Fellow, International College of CranioMandibular Orthopedics
Board Eligible, American Academy of CranioFacial Pain
Dental Section Editor, Sleep & Health Journal
Member, American Equilibration Society
Member, Academy of Applied Myofunctional Sciences
www.ThinkBetterLife.com
www.DelanyDentalCare.com
www.IHateCPAP.com
www.iHateHeadaches.org