Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Thursday, July 15, 2010


I have been using somnomed dental appliance for several years. I love it, but it has moved my lower teeth forward and to the left so that I can't close my teeth together -- the top teeth go behind the bottom ones. Do you have suggestion for an appliane that might keep this from happening or maybe allow my teeth to go back to normal positioning? Thanks so much.

Dr Shapira Response
I have written a lot about tooth movement and bite changes with appliance use. It is important to do the exercises daily to prevent this type of problem. I frequently find that patients have stopped doing their exercises because their chronic headaches or neck pain went away as the bite changes.

I strongly advise that patients seek treatment from dentists trained in treating TMJ disorders. The American Academy of Sleep Medicine also Rx that Dental Sleep Medicine and Oral Appliances for Sleep Apnea be provided by dentists with extensive training in treating TMJ disorders. The AADSM does a very poor job of stessing this to new mwmbers, I stress it to doctors who take my Sleep Apnea treatment course. Personally, I Rx seeing a dentist specifically trained in Neuromuscular Dentitry. See my sister site www.ihateheadaches.org

I have seen many patients in whom we uoptimizee the bite changes by combining Neuromuscular treatment utilizing a daytime diagnostic orthotic with the sleep appliance. The NHLBI (http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf) considers sleep apnea to be a TMJ disorder and we combine treatment. Reconstruction via crown and bridge or orthodontics lead to a long term stable position. This frequently also corrects forward head position, chronic headaches, migraines and/or neck pain.

Oral appliances can have problems but they are minimal to the problems from untreated sleep apnea. An interesting fact is that CPAP also can move teeth but the movement is different than that caused by dental appliances.

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posted by Dr Shapira at 5:31 PM