Talk to your medical doctor, tell them you will not or cannot tolerate sleeping with the CPAP. Sign an affidavit stating your CPAP intolerance. Ask your medical doctor to provide a diagnosis of your sleep apnea to Dr. Nugent and to write a prescription for an oral sleep apnea appliance. If your medical doctor will work with you and write a prescription then we are good. You will start by getting a CBCT 3D x-ray and then proceed to step 4.
If your medical doctor will not help you out then you can seek out another medical doctor who is willing to work with your CPAP intolerance.
Another option is to have you start the sleep apnea screening process over with Dr. Nugent and his medical doctors who are current with oral appliance therapy protocols. Our office can help you get around your Medical Doctor lack of cooperation. We have set up a work flow that partners with Board Certified Sleep Physicians that understand the important role dentists play in making mandibular advancement devices when appropriate.
1. To move forward with our workflow, a CBCT 3D x-ray taken here at the office. This advanced image will be read by a Radiologist. The report will have detailed information about the airway, sinuses, nasal septum and jaw joints. The CBCT is important to rule out obstructions in the nose, sinus and airway.
2. We will get you set up for a Home Sleep Test. A medical company will send you the easy to use equipment with instructions on how to properly wear the equipment. In your own house, in your own bed, you will sleep with the equipment. You will do this for two days. Then simply put the equipment back in the pre-paid shipping box and send the equipment back. A board-certified sleep physician will analyze your sleep study. A diagnosis and recommendation of treatment will be given by the medical doctor. If oral appliance therapy is appropriate, the medical doctor will give Dr. Nugent all the paperwork necessary.
3. Dr. Nugent will receive the reports from the Radiologist and Sleep Physician. Dr. Nugent will review the reports.
4. You will come in for a consultation and Dr. Nugent will review your results. If you have a diagnosis of Mild to Moderate Sleep Apnea and the Medical Doctor recommends an oral appliance for the treatment of sleep apnea, then we can start the impressions and exam for the oral appliance.
If you are diagnosed with Severe Sleep Apnea and CPAP intolerant your Medical Doctor has written a prescription for an oral appliance then we are good. Oral appliances are best at treating Mild to Moderate Sleep Apnea. But for patients with Severe Apnea who can’t wear a CPAP, getting an oral appliance is recommended. Wearing an an oral appliance and opening up the airway in Severe Apnea patients is better than not wearing a CPAP.
However, before the appliance is made a complete dental exam must be performed.
a) This office can become your dental provider. We will check the health of the gum tissue, teeth, screen for oral cancer and evaluate the jaw joint. Detailed documentation of the teeth position and a head and neck exam is performed. Dental x-rays and gum tissue is checked for periodontal disease. If any dental treatment is needed that must be completed before the fabrication of the oral device. Once your dental health is identified as healthy then impressions for the apnea oral appliance can be made.
b) If you are regularly seeing a dentist, a letter from that dentist stating that you have no active gum disease, decay or pending treatment is necessary. We will provide you with the letter to give to your dentist. This is needed due to the fact that the oral appliance is custom made to your teeth. If the teeth change (decay or new crown) then there is a high chance of your appliance not fitting. Furthermore, Dr. Nugent does not want to place an oral device on compromised teeth if there is gum disease present. Once Dr. Nugent receives the letter from your dentist we can start impressions for the sleep apnea oral appliance. You will continue to see your dentist for all dental care and cleanings. Dr. Nugent will only be involved with your sleep apnea appliance.
5. Take impressions for the mandibular sleep apnea appliance.
6. The sleep apnea oral device is delivered.
7. The oral appliance is titrated. Once a comfortable position is found, you will repeat the Home Sleep Study to verify the sleep apnea oral device is helping.
8. You will be seen for a one month follow up, then a 6 month follow up. Next, yearly follow ups will be scheduled. The apnea appliance is changed every 5 years.
