About.com, Snoring, Dentists

I don't know how many of you read About.com but last month they published an article entitled "Is Snoring a Problem? See your Dentist." We at Snoring Isn't Sexy(tm) and Quietsleep(r) would like to applaud their efforts and thank them for mentioning dentistry as an option in the field of sleep medicine.

But at the same time we'd like to correct a few inaccuracies in the article.

First a pet peeve of mine personally. About.com refers to doctors and dentists. While this is in common usage, it's blatantly incorrect. Dentists ARE Doctors. We received our degrees after four years of intensive education and training, many of us went on to receive post-doctoral degrees and many had internships and residencies. We encourage the proper usage of physician and dentist. Please...

The article stated that

However, if the sleep study rules out obstructive sleep apnea, or if the apnea is still very mild, then you might consider a visit to your dentist. A dentist can supply you with a dental appliance that can help you control your snoring. A dental appliance is a small plastic device that fits in the mouth. You wear it at night and it prevents the collapse of throat tissues that cause the snoring. These devices are easy to use and inexpensive. They are fitted to the individual patient and require no surgery.

While this is partially true, oral appliances have been approved for snoring and sleep apnea and as an alternative to CPAP when patients cannot tolerate the CPAP device. The statement issued in a parameters report from the American Academy of Sleep Medicine states

Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering OAs. Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the over- all care of oral health, the temporomandibular joint, dental occlusion and associated oral structures.

Practice Parameters for the Treatment of Snoring and Obstructive
Sleep Apnea with Oral Appliances: An Update for 2005
SLEEP, Vol. 29, No. 2, 2006

Secondly, as far as appliances are concerned, the article in About.com mentions only two:

One such device is the Snore Guard. Snore Guard looks like an athletic mouthpiece. You wear it while you're sleeping and it prevents the jaw and tongue from dropping back to obstruct the air passages. It allows you to breathe easier, and keep breathing so you get a more restful sleep.

Another such appliance is called Silent Nite. These devices are flexible, small, thin, and quite comfortable to wear. Your dentist will determine from a questionnaire and from impressions of your upper and lower arch just what shape your Silent Nite should take. Snore prevention devices have proved successful in more than 85% of cases, while other treatment, such as surgery or drugs have a success rate of less than 50%.

While both appliances are still available to dentists, neither, in my opinion, is an adequate choice to treat a disease as serious as obstructive sleep apnea.

Better choices for treatment of snoring and sleep apnea are the TAP, Somnomed MAS, Adjustable PM Positioner, Klearway, and many others. Full description of many oral appliances are available at Quietsleep.com. Your dentist who is trained in dental sleep medicine will be able to guide you in which appliance is best for your problem and your mouth. But remember, it's really not about which appliance, treatment of both snoring and sleep apnea is about the therapy.

Dr. Barsh