Snoring Appliances in Miami

A snoring appliance, or mandibular advancement device, is a custom, adjustable appliance worn on the teeth at night that holds the lower jaw slightly forward. That pulls the tongue and soft tissues forward and widens the airway, so less air squeezes through a narrowed throat. For the right patient it reduces snoring substantially. Before we make one, a sleep physician has to rule out sleep apnea, because the two sound the same from the next pillow and apnea is a medical condition.

Signs it may be apnea, not just snoring

• Pauses in breathing during sleep, or gasping and choking sounds, noticed by a partner
• Waking unrefreshed, or falling asleep during the day: at a desk, watching television, at the wheel
• Morning headaches or a dry mouth and sore throat on waking
• High blood pressure, particularly if it is hard to control
• Waking often during the night, including to urinate

Any of these means a sleep evaluation before anything else. A sleep study, ordered by a physician, records your breathing, oxygen levels and sleep through the night, either at home with a small portable monitor or in a sleep laboratory. The physician interprets it and tells you whether you have apnea, how severe it is, and what treatment is appropriate. Only with that answer do we know whether a snoring appliance is the right thing to make.

Who the appliance suits

Once apnea has been ruled out, a mandibular advancement device is an option for adults who still snore. The dental requirements:

• Healthy, stable teeth and gums in both arches, because the appliance holds onto the teeth and moves the jaw through them.
• Decay and gum disease are treated first.
• Patients with full dentures have nothing for the appliance to hold, and other approaches are discussed with the sleep physician.
• The devices we use are intended for adults and have their own contraindications, including some jaw joint conditions, which we screen for.

How it is made

1. 1
   Step 1 of 4 Assessment

   We confirm the sleep physician's evaluation, examine the teeth, gums and jaw joints, and talk through what the appliance can and cannot do.

2. 2
   Step 2 of 4 Scans and bite records

   Digital scans of both arches, a record of your normal bite, and a special record with the jaw held forward, which tells the laboratory the starting position for the appliance.

3. 3
   Step 3 of 4 Fitting

   The custom appliance is tried in, adjusted for comfort and fit, and you are shown how to insert, remove and clean it.

4. 4
   Step 4 of 4 Adjustment over the following weeks

   The appliance is adjustable. If snoring persists we advance the jaw a little further; if the position is hard to tolerate we ease it back. The right amount is different for each patient and is found gradually.

The designs we use

We work mainly with SomnoDent appliances, which come in a few designs that differ in how the advancement is set. One uses small screws for fine adjustment; another uses interchangeable straps at the sides; a third, the Herbst type, uses metal hinged arms and is also very adjustable. All are custom-made for your teeth and all are comfortable for most patients. Which suits you depends on your teeth, your bite and your preference, and we go through the choice at the assessment.

Living with it

• The appliance is worn every night and comes out in the morning.
• The usual morning experience is that the bite feels slightly off for a few minutes, because the jaw muscles have held a forward position all night. It settles as the muscles relax, and the manufacturer provides a short morning routine to help.
• A bite that still feels different later in the day, or any new jaw pain, is a reason to come in rather than push through, because persistent bite changes need review.
• Clean the appliance each morning with a soft toothbrush and liquid soap, rinse it, and store it as the instructions for your model say.
• Do not put it in an ultrasonic cleaner, which can damage the adjustment parts.
• The small components that set the advancement wear with use and are replaced as needed. We check the appliance and the health of your teeth at your regular visits.

How well does it work?

For simple snoring, many patients and their partners report a large reduction once the advancement has been adjusted, and some find the snoring stops altogether. The result depends on anatomy, on how consistently the appliance is worn, and on the other contributors to snoring: body weight, alcohol in the evening, sleeping on the back and nasal congestion all make it worse, and improving any of them helps the appliance do its job.

Follow-up

The adjustment phase takes a few weeks: you wear the appliance nightly, report on snoring and comfort, and the advancement is changed in small steps until the balance is right. After that we see you at your regular visits to check the appliance for wear and the teeth and bite for any changes, and more often if anything feels different. If a physician is managing sleep apnea alongside the appliance, they follow up on the breathing side and may repeat a sleep study with the appliance in place; we coordinate with them.

Two things it is not

It is not a night guard. A standard night guard protects the teeth from grinding and does nothing for the airway. An advancement device opens the airway and is not designed to absorb heavy grinding. Occasionally a patient has both problems, and we work out which appliance comes first.

It is not a cure. The appliance works while it is in your mouth. For many patients with simple snoring it reduces the noise substantially; for some it does not do enough.

Frequently asked questions

What is the difference between snoring and sleep apnea?

Snoring is noise from a narrowed airway. Sleep apnea is repeated pauses in breathing during sleep, with falling oxygen levels, and it is linked to heart disease and a shortened life. The two overlap and you cannot tell them apart by the sound. That is why a sleep physician, a medical doctor, assesses you before we make an appliance for snoring.

Will the appliance stop my snoring?

For many patients with simple snoring it reduces it substantially; for some it does not do enough. We adjust the amount of advancement to find what works for you, and we are honest if it is not the right tool.

Can I have one if I wear dentures?

A conventional advancement appliance holds onto natural teeth, so it needs enough healthy, stable teeth in both arches. Full dentures do not give it anything to hold. If that is your situation, the sleep physician can discuss other approaches.

Is it uncomfortable?

Most patients wear it comfortably. The common experience is that the bite feels odd for a few minutes in the morning because the jaw muscles have held a forward position all night; it settles as they relax. Bite changes that persist into the day are a reason to come in.

Does insurance cover it?

Dental insurance generally does not. When a physician prescribes an oral appliance for sleep apnea, medical insurance sometimes contributes; for simple snoring it usually does not. We tell you the fee before scanning.

How long does it last?

Several years with care, though the adjustment parts wear and are replaced along the way. We check the appliance and your teeth at your regular visits.

Sources

Professional guidelines and peer-reviewed reviews this page draws on.

1. Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. Journal of Clinical Sleep Medicine. 2015;11(7):773-827. DOI