woman with obstructive sleep apnea

Are Sleep Apnea Appliances and Invisalign Compatible?

I Fixed my Obstructive Sleep Apnea, but My Teeth Are a Mess!

On my schedule was a short description of this patient’s needs which mentioned sleep apnea and Invisalign.
She was new to the practice, and I didn’t know where I was headed regarding her problem.
She told me about her Obstructive Sleep Apnea, which abbreviates to OSA. Before we get to her problem, let’s spend a little time learning about sleep apnea. There has been a lot of press in the past decade or so discussing this sleep disorder. Our society has created so many impediments to getting a good night’s sleep that patients seek help to solve this frustrating problem.

Understanding OSA

Before the words “sleep apnea” is the word “obstructive.” That word describes the cause of the apnea, which means stopping breathing. If our airway is blocked, we do not get sufficient air into our lungs.
In mild cases, snoring can occur as air tries to move through the airway. In more severe cases, we stop breathing for a moment, waking up.
Once we wake up, we get a good gulp of air, and all is good. Well, not exactly. We have air in our lungs, but now we are up in the middle of the night.
In severe cases, this can happen many times resulting in poor-quality sleep.

Sleep Apnea Treatments

CPAP Machines

For many years the gold standard to correct this problem is a device called a CPAP machine. CPAP stands for Continuous Positive Airway Pressure. This apparatus involves a mask that fits over the patient’s face. The mask is connected to a machine which ensures that the air pressure helps keep the airway or breathing path unobstructed.
Many, if not most, people who treat sleep disorders go to this device first, as the results are typically excellent. However, there is one large problem with a CPAP machine. Many patients find the device uncomfortable to wear and can not sleep with it. They try their best to use the machine, but it becomes impossible.

Oral Appliances

An alternative approach to managing sleep apnea involves an oral appliance. Using something you put into your mouth allows the airway to stay open. The usual airway obstruction involves the tongue falling backward and blocking airflow. An oral device moves the lower jaw forward and creates an open airflow path. When the CPAP approach fails, doctors will refer the patient to a dentist to make such a device.

If one does not have a dentist or decides to do their own care for whatever reason, one can purchase a plastic mouthpiece that you boil and adapt to your mouth. These devices will also hold your jaw forward just as a professionally made device does and keep the airway open.

Solving One Problem But Creating Another

As I have written on many occasions, there are consequences to all oral treatments, whether performed by a professional or self-administered.

Our patient bought such a device and solved her sleeping issues. However, she moved many of her teeth with it, so now her smile is less than ideal. She is not happy with the way she looks.  She told me that she used to have a more attractive smile. Now both her upper and lower teeth were crowded onto each other. Her lower jaw juts forward, and the lower teeth are prominent. In an ideal world, the prominent esthetic position goes to the upper teeth.

She came to me for a solution to her sleeping problems and her esthetic dilemma.

Let me explain why helping her is not straightforward. To fix her cosmetic issue or tooth position, orthodontics is indicated. Orthodontics is a dental discipline that focuses on moving teeth for a specific reason. To move teeth, forces must be applied by some type of device. How can she wear her sleep apnea appliance if she wears an orthodontic device like Invisalign?

Clear Aligner Therapy

When we were younger, the only way to move teeth involved braces. Over the past twenty years, clear aligner therapy, like Invisalign, uses plastic devices that the patient wears that opens tooth movement to a world without braces. Most adults would not wear braces, but clear aligners are different. The majority of my aligner patients are adults with no upper age limit. A desire to improve cosmetics or place the teeth in a better position for filling or crowns drive this exciting new field.

Moving and correcting crooked and crowded teeth is not difficult.
Aligner therapy does that well; in many cases, the time is measured in months, not years. There are two aspects of her therapy that are challenging. The first revolves around the position of her lower teeth. As I mentioned above, what we normally see and define, as usual, the lower teeth are behind the upper teeth when the jaws close. Her lower teeth are in front of her upper teeth. Moving them behind the upper teeth is not straightforward. There are various approaches to fixing the situation, and we hope to improve or even correct the problem.

We Found a Solution That Allows Wearing Sleep Apnea Appliance Over Aligners

The real challenge is how a patient wears her sleep apnea appliance while doing aligner therapy. We tried to see if we could wean her off the device but were unsuccessful.

After some serious research, I found a technique that addresses this very problem.

There is an approach that allows a patient to wear a sleep apnea appliance over her aligners!
Both she and I were elated at this discovery.

I don’t anticipate her case being a walk in the park, as many things are going on in her treatment.

I am confident that together with the staff and consultants that I use, we can help this patient solve her problem.

If you are looking for a fresh set of eyes for your dilemma, please call me at 440.951.7856 and schedule a meeting. Nicole will answer the phone and arrange for us to get together, and as always, I look forward to hearing from you.

Jeffrey Gross, DDSFAGD, is an Ohio-licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

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