Q: Is there a Fee for the consult?
A: Yes, Dr. Viviano will be spending approximately 60 minutes with you at the consultation. He will conduct a thorough intra and extra oral examination to establish that you are a candidate for oral appliance therapy and he will review with you his exam findings, the results of your baseline sleep study findings, exactly what is happening in your airway to create the problem and all of the treatment options available for you as per the american academy of dental sleep medicine and the american academy of sleep medicine guidelines. This examination/consult appointment is typically covered by your dental insurance plan.
Q: How much does the appliance cost?
A: Fees for the appliance vary depending on the type of appliance; trial, Over-the-counter temporary or custom made. These fees range from approximately $500 to $3,000.
Q: How many appointments will it take?
A:Should you decide to proceed with an Oral Appliance we will require a Physician direction (prescription) to do so. At the first appointment we take impressions (analogue or digital) and a bite registration. Approximately 2-3 weeks later, Dr. Viviano will deliver the appliance and provide you with instructions on use and care of the appliance.The first milestone is to become accustomed to wearing the appliance throughout your sleep period (usually a couple of weeks). The appliance is then adjusted over several appointments to establish which jaw position optimally manages your sleep symptoms as evaluated by questionnaire. Once we deam the appliance to be optimally calibrated we conduct a Home Sleep Study to Objectively evaluate appliance effectiveness.Once we are pleased with the results or we establish the results are as good as is currently achievable we send a report along with a copy of the Home Sleep Test to the referring physician. This entire process usually takes 6 to 12 weeks
Q: Why do I have to go for a Sleep Study to get an appliance?
A: Sleep Apnea is a serious medical disorder with the potential for severe consequences when mismanaged. Currently, the only method we have for a physician to establish an accurate diagnosis involves an overnight sleep study.
Q: Why can’t I just get an appliance to deal with my snoring?
A:Before making a snoring appliance, we must first ensure there is no underlying sleep apnea. Many snoring patients have sleep apnea but are not aware of this fact because they do not necessarily exhibit other symptoms such as daytime sleepiness. making a snoring appliance without considering the presence of sleep apnea could result in creating a “silent apneic”, leaving the patient “snore free” but medically compromised due to the unresolved sleep apnea.
Q: Why doesn’t OHIP cover sleep apnea appliances?
A: Unfortunately, this is purely a fiscal decision. there are many other countries that have socialized medicine such as France and Swedan that do cover oral appliance therapy. In fact, even the USA Medicare system covers Oral Appliance Therapy for the management of sleep apnea.
Q: Will Dental Insurance cover them?
A: Snoring and sleep apnea are medical disorders, and as such, dental insurance does not cover them.
Q: How do I find out if my Medical Insurance will cover them?
A:Our office can send a pre-determination request to your medical insurance. to do so we will need a copy of your baseline sleep study and a Physician Direction (prescription) to fabricate an oral appliance for your sleep apnea. This is usually done after the initial consultation so we can establish which appliance you would be proceeding with.
Q: I only snore on my back!
A:for some patients, the problem is purely positional and resolves when you avoid sleeping on your back. inexpensive Positional aides are available to help you avoid back sleep. However, an overnight sleep study is necessary in order to confirm this issue.
Q: My insurance won’t pay for an Oral Appliance!
A:Insurance policies vary greatly and are dependant on decisions made by your plan administration. Coverage, or lack of coverage in no way speaks to whether or not an appliance is appropriate for you.
Q: My Physician said Oral Appliances don’t work!
A: According to the most current American academy of sleep medicine Guidelines, oral appliances are considered “first line therapy” for snoring, and a “Standard of care” for any severity of sleep apnea should the patient not tolerate cpap, or if they simply prefer an orAl appliance over cpap. download guidelines
Q: My Physician said Oral Appliances will ruin my jaw!
A: nothing is free of side effects. however, over 30 years of literature evidence does not support this statement. Side effects associated with wearing an oral appliance are mostly short lived and upfront while you are first becoming accustomed to wearing your appliance. Over the long term, the only meaningful side effect is changes in the bite, which interestingly, is also associated with wearing a CPAP mask.
Q: I heard that Oral Appliances cause TMJ!
A: over 30 years of literature evidence does not support this statement.
Q: I heard that Oral Appliances will ruin your teeth!
A:The oral appliance engages the teeth and repositions the jaw in a slightly forward position. a proper dental examination to determine health of the teeth and restorations is necessary prior to placing an oral appliance. If the dentition and supporting bone and soft tissues are helthy, the appliance will do no harm.
Q: My Physician said he doesn’t believe in them!
A: Although the Medical guidelines are very clear as to the role oral appliances can play in the management of sleep apnea, Unfortunately, there is still a great deal of myth and bias in the medical feild regarding this role. My suggestion is to consider what the medical guidelines state as they would be the most evidence based and free of bias opinion available to you. Download guidelines