Allergic reaction to somnodent by somnomed cofirmed by clifford test.

Thank you for your assistance regarding my negative reaction to the SomoDent MAS Acrylic. I followed your advise and had a Clifford Test. Unfortunately, the results indicated the Somnodent is not suitable for me. This makes me very unhappy because I am very satified with the results of the device assisting me in terms of sleep. With the device I am able to sleep well throughout the night. Unfortunately, I get small blisters mostly in my upper lip and inside my cheek area which disappear after a couple of hours but what is worse is that my gum area around my upper teeth becomes inflamed and has increased over time ( I keep the oral device in water during the day to reduce reaction but this has not atopped the reaction). I consulted with Dr. Stuart and the device was sent to the lab to change the metal wiring although I suspected I was also reacting to the acrylic material as well – I am still awating for them to return the device back to me. Since then, I have received the results of the Cliffor test which indicated I am not well suited for this device due to contraindicating reactions which were seen in my blood test. I am wondering if SomnoDent makes similar devices with different materials. I paid close to $3,000.00 out of my own packet and I cannot afford to spend as much again. Please advice. Thank you very much.

The appliance comes with a soft liner and with hard acrlic and stainless clasps and screws, They do make a version with a titanium screw. If this is not acceptable I would check with somnomed to see if they could make the appliance out of a material you are not sensitive to. There are other options available otherwise that you can discuss with Dr -------

Dr Ira Shapira

I have been using dental implants for many years to replace missing teeth, secure dentures and to secure oral appliances for treating sleep apnea. This publication in Sleep and Breathing discusses the use of orthodontic implants to support oral appliances in patients who do not tolerate CPAP. This article goes a step further and is using elastic bands attatched to the implants to hold the jaw forward. It is an interesting concept of using the implants to connect directly to the bands because of insufficient support by teeth. It would also be possible to use combinations of a single arch appliance that would connect to implants on the opposing arch.

There are many methods to utilize dental implants to improves the lives of patients. In intolerant CPAP patients would be a life saving alternative. Should medical insurance companies be required to cover the costs of dental implants if they are needed to retain a sleep appliance?

It would be possible to create a simple appliance that utilizes two dental implants in the posterior mandible (back part of lower jaw, and use a tongue bumper held by the implants to prevent airway collapse during sleep. It could attatch to the implants and go behind the tongue to prevent collapse. This would create an appliance that works in a similar matter to TRD's or Full Breath appliance. It would have minimal effect on the teeth or jaw position.

As of now I think the best treatment is to use standard implants to hold fixed bridgework ot dentures and then standard appliances for most patients. It is always possible to do custom modifications of FDA approved appliances or one of a kind unique appliances to address unique problems.


PubMed absrtact
Sleep Breath. 2009 Sep 18. [Epub ahead of print]
Orthoimplants: an alternative treatment for SAHS?
de Carlos F, Cobo J, Fernandez Mondragon MP, Alvarez Suarez A, Calvo Blanco J.

Department of Surgery and Medical-Surgical Specialities, Area of Orthodontics, Faculty of Medicine, Universidad de Oviedo, Clinica Universitaria de Odontologia, C/Catedrático José Serrano, s/n 33006, Oviedo, Spain, fcarlos@uniovi.es.
Numerous sleep studies have been published recently regarding the use of intraoral devices (ODs) for the treatment of sleep apnea-hypopnea syndrome (SAHS). The effectiveness of these devices varies, however, according to the series studied (patient characteristics, parameters assessed, type of device, etc.). Two factors should always be assessed: the presence of an appropriate dental support and a possible temporomandibular joint pathology which can, on occasions, contraindicate the use of these devices. OBJECTIVES: To use orthoimplants as orthodontic anchorages for intermaxillary elastic bands which allow a mandibular advancement to be performed as an alternative treatment to ODs in SAHS patients without appropriate dental support. MATERIALS AND METHODS: Four orthoimplants were placed in an edentulous SAHS patient who did not tolerate continuous positive airway pressure (CPAP). The mandible is pushed forward using orthodontic elastic bands anchored to the orthoimplants. RESULTS AND CONCLUSIONS: Although more studies are still required, orthoimplants could be an alternative treatment for reducing snoring and the apnea-hypopnea index and increasing SaO2, which should be considered for patients who do not tolerate CPAP and lack appropriate dental support for attaching intraoral devices.

PMID: 19763651 [PubMed - as supplied by publisher]

Study supports MAD effectiveness and health of TM Joints

A new study in Sleep and Breathing concluded that" long-term usage of an OA does not cause impairment to the temporomandibular joint." The study also concluded that "There was a long-term improvement in the ESS (epworth slepiness scores) values over the years analyzed."

PubMed abstract is included for reference
Sleep Breath. 2009 Nov;13(4):375-81. Epub 2009 May 1.

Systematic assessment of the impact of oral appliance therapy on the temporomandibular joint during treatment of obstructive sleep apnea: long-term evaluation.
Giannasi LC, Almeida FR, Magini M, Costa MS, de Oliveira CS, de Oliveira JC, Kalil Bussadori S, de Oliveira LV.
Institute of Research and Development IP&D, University of Vale do Paraíba, São Paulo, Brazil. odontogiannasi@uol.com.br
OBJECTIVE: The aim of the present study was to evaluate the symptoms of temporomandibular dysfunction (TMD) in patients with obstructive sleep apnea treated with long-term use of an oral appliance (OA) using a questionnaire based on the Helkimo Anamnestic Dysfunction Index. A further aim of the study was to evaluate the presence of daytime sleepiness using the Epworth Sleep Scale (ESS) and otologic symptoms. MATERIALS AND METHODS: Polysomnograms of 34 patients were performed at baseline and after 6 months of OA use. As follow-up, the patients were contacted by telephone interview to answer the same questionnaires after 36.0 +/- 17.0 months. RESULTS AND DISCUSSION: The intensity of TMD symptoms decreased significantly throughout treatment (p < 0.01). ESS values improved from 12.2 +/- 5.0 to 6.9 +/- 2.6 (p < or = 0.05). Tinnitus was present in nine patients at baseline and decreased in intensity in seven patients by the final assessment while remaining at the same level in two patients. CONCLUSIONS: We conclude that long-term usage of an OA does not cause impairment to the temporomandibular joint. The Helkimo and otologic indexes are simple and useful in long-term patient follow-up. There was a long-term improvement in the ESS values over the years analyzed. A follow-up program could increase compliance by motivating patients to use the device regularly.

Improving Cpap Comfort Mask Appliance Combo

Patient Inquiry

You can take steps to make using a CPAP mask a more pleasant experience. Here's what I do: I’ve been a snorer for a long time. As I got older, my snoring has gotten more frequent and louder. I also noticed I was tired a lot and liked to take naps during the day. I was overweight. People complained about my snoring and I did not want to sleep in the same room with other people for fear of keeping them awake.Finally, I asked my doctor about the problem. He sent me home with a machine to check my breathing and pulse while I slept. The results really shocked me! The doc said my airway was closing off up to 70 times each hour, and that I stopped breathing for as long as one full minute at a time! I had severe apnea. He strongly recommended I start using the CPAP machine, since I was risking damage to my heart due to lack of oxygen.I had read about CPAP machines before and always thought I would never be able to sleep with one, since I am a little claustrophobic. Surprisingly, it only took me a few minutes to get used to, and I was able to start sleeping comfortably right away.The mask part is just a small nose manifold that covers the nostrils to blow in air. That keeps the throat inflated like a balloon, preventing throat closures and snoring. One problem is the straps over the head that keep the nose piece in place. They can be a little annoying at first, and if you change sleeping positions at night, it is possible for these straps to move, causing the nose piece to slip off. I have been using a Dreamhelmet (a combination sleep mask sound-muffling pillow) for years now, to sleep at night and for napping during the day. I always find it hard to sleep without the Dreamhelmet, and was afraid I would not be able to use it with the CPAP mask, but I was wrong about that too. After using the CPAP machine and mask for a short while, I tried wearing the Dreamhelmet over the CPAP mask, covering up the straps – voila, it worked like a charm! I found that the Dreamhelmet actually helps keep the straps in place when I change positions, so now I can sleep all night in comfort, not being bothered by sound, light, or changing positions. The CPAP combined with the Dreamhelmet are the perfect sleeping combo for me. You can see and buy the Dreamhelmet for under 30 bucks at DREAMHELMET.com. Now I don’t snore, I wake up rested, and I have energy that lasts all day long. I’m still overweight, but I don’t feel so run down all the time or feel like I need an afternoon nap, but I still carry an extra Dreamhelmet in the car with me just in case I do need a nap.

I was not familiar with the Dream Helmet and had to Google it. It appears this response may be commercial in nature but I thought it was worth passing it on as it might be helpful for some patients. I recently spent time in Dallas, Texas with Dr Keith Thornton the inventor of the TAP oral appliance for treating sleep apnea and I am please to report the excellent TAP-PAP combinations which include an integrated TAP 3 appliance and a nasal CPAP mask. This will eliminate leaking masks. Airway technologies is also manufacturing custom CPAP masks for appliance connection that use denture technology for a custom mask.

TMJ and Sleep Apnea?

Patient Inquiry:

Dear Dr. Shapira,

I suffer from both TMJ Disorder and Sleep Apnea. Is this common?


Response to Patient:

Dear____,

It is ver common to suffer from headaches and sleep apnea. The National Heart Lung and Blood Institute say that sleep apnea IS a TMJ disorder. Morning headaches, in particular are almost always related to TMJ, Bruxing, Grinding or Sleep Apnea

Sincerly,
Dr. Ira L. Shapira

Patient Inquiry: CPAP Diagnosis

From patient:

Already diagnosed and been on CPAP since march. Dr. told me to stop using it about a month ago since I have mild-moderate apnea and the mask disrupts my sleep.

Response to Patient:

DEAR ____,

STOPPING CPAP WITHOUT OTHER TREATMENT IS VERY DANGEROUS AND COULD LEAD TO DIRE OR EVEN LIFE THREATENING CONSEQUENCES. PATIENTS WITH UNTREATED APNEA ARE MORE LIKELY TO DIE IN THEIR SLEEP THAN WHEN EXERCISING. THERE IS UP TO A SIX-FOLD INCREASE IN HEART ATTACKS, STROKES AND MOTOR VEHICLE ACCIDENTS.

WITH MILD TO MODERATE APNEA YOU NEED TREATMENT. IF CPAP IS NOT ACCEPTABLE SEEK OUT AN ALTERNATIVE: ORAL APPLIANCES OR SURGERY.

Sleep Apnea Increases Chance of Stroke

If you have sleep apnea or someone you know suffers from this condition, you may know the dangers associated with this common, but very dangerous, sleep and breathing disorder. Sleep apnea is a serious, potentially life-threatening condition in which the sufferer stops breathing while he sleeps. The cessation of breathing can go on for several seconds and can occur several hundred times each night. Each sleep apnea patient Dr. Ira Shapira sees in his Gurnee, Illinois dental office presents with a unique combination of symptoms. The most common symptoms sleep apneics suffer are:

Daytime sleepiness
Fatigue
Gastric reflux
Memory problems
Concentration problems
Sore throat
Dry mouth
Depression
Anxiety

One of the most serious problems sleep apnea can lead to is stroke. A study conducted by the American Thoracic Society International Conference showed that people with moderate to severe sleep apnea were 3 to 4 times more likely to have a stroke than people without sleep apnea. The study did not follow those with mild sleep apnea. Moderate to severe sleep apnea, for purposes of this study, was defined as breathing stopping or slowing at least twenty times per hour of sleep.

One reason why sleep apnea may increase your chance of a stroke is that this condition increases your blood pressure; hypertension is the most common risk factor for stroke. For this reason, it is very important to have your sleep apnea treated.

If you live in the Chicago, Illinois area and suffer from sleep apnea (or your partner does), please contact Dr. Ira Shapira today to schedule a thorough evaluation.