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Dental Sleep Medicine

Frequently Asked Questions

  1. Why should I choose Dr. Almeida as my doctor?
    Fernanda Almeida, DDS, MSc, PhD, is a well-established Dentist practicing in Vancouver, Canada, who specializes in Dental Sleep Medicine. As a result of treating hundreds of patients over the years, and through her research as a full-time Assistant Professor at the University of British Columbia, Dr. Almeida’s work in the field of Dental Sleep Medicine has become internationally recognized and acclaimed by leading experts in the field.

    Dr. Almeida has been published in numerous Sleep Medicine technical magazines and journals, and has regularly been invited to lecture for such prominent organizations as the World Federation of Sleep Medicine, the American Academy of Dental Sleep Medicine, the World Association of Sleep Medicine, the Australasian Sleep Society, the American Thoracic Society and the Canadian Sleep Society. Through her ongoing research and practice, combined with her continued learning and networking with some of the top minds in Sleep Medicine today, Dr. Almeida is able to offer her patients a variety of treatment options, using state of the art technologies, to develop the most innovative solutions for her patients’ individual sleep needs. By having such diverse knowledge of not only the oral appliances available, such as Klearway, tongue retaining devices, Silencer and Somnomed, but also the therapies best suited for each unique situation, Dr. Almeida can tailor the best all-round solution for you to ensure that you finally get a better night’s sleep.
  2. How do I care for my oral appliance?
    For the recommended treatment plan to be successful, the oral appliance must be worn in the mouth every night. It is also important that you take a good care of your appliance; that includes daily cleaning before and after each night-time use. In fact, to extend their lifespan, most oral appliances require the same type of care you would give your own teeth.

    Brush the appliance with a toothbrush or denture brush and toothpaste for approximately 2 minutes before and after each night-time use, paying extra attention to the nooks and crannies that can trap unwanted material and retain dental plaque. Rinse thoroughly under cool water.

    When you receive your appliance, Dr. Almeida and her staff will show you techniques and provide you with step-by-step instructions to take home on how to care for your appliance. At any time during the adaptation period, if you have any questions or concerns, please contact Dr. Almeida’s office and we will gladly help resolve any issues.
  3. If I wake up with jaw and/or facial muscle discomfort, what should I do?
    Some patients do experience jaw and/or facial muscle discomfort in the first few days of using oral appliances but the effects will dissipate over the course of a few weeks as your body adjusts to the appliance. With some basic stretching exercises, the immediate discomfort can be alleviated. Dr. Almeida has done considerable research in this area so she can confidently suggest a variety of techniques to restore movement and function to the jaw, and control and reduce any discomfort to the facial muscles.

    While some patients do experience further discomfort beyond the adaptation period, this may be due to external life influences such as stress or worry. By faithfully continuing to perform the exercises, however, the discomfort can be reduced to a manageable level. If you find that despite your best efforts you are unable to reduce the discomfort even with these exercises, please contact Dr. Almeida’s office and schedule a follow-up appointment.

    These exercises should be done in the morning after taking the appliance out of your mouth and in the evening before inserting the appliance into your mouth for the night. It is recommended that the sequence of exercises be done in 3 sets of 5 repetitions for each movement.

    A
    • Begin your sequence of exercises by controlling your mouth opening:
      Open your mouth (as in Image A) touching your tongue to your upper palate and keep contact there firmly.
      B
    • Keeping your mouth slightly open :
      Place your right palm against your right jaw and cheek.
      Move your mandible (lower jaw) to the right while applying light hand resistance (as in Image B).
             
    C Repeat the same movement but reverse the side of your jaw:
    Place your left palm against your left jaw and cheek.
    Move your mandible (lower jaw) to the left while applying light hand resistance (as in Image C).
      D Next, stretch the jaw and muscles vertically:
    Place your fist under your chin (as in Image D).
    Provide light resistance while opening your mouth.
             
    E Finally, stretch your mouth open as wide as possible using your fingers
    (as in Image E).
         


    Rest briefly before repeating the sequence of exercises.
  4. Will I start snoring again in the future?
    Some patients do experience the return of snoring despite the use of oral appliances. There are several well documented explanations for this problem.

    Older Appliances: After a number of years of regular use, older appliances may lose their retention to the teeth and pop off during the night. In this situation, the appliance may need to be adjusted or possibly replaced. Please contact Dr. Almeida’s office to have your appliance checked.

    Weight Gain: With time and age, some patients may gain weight and this may increase the amount of snoring. In this situation, the appliance may need to be adjusted. Please contact Dr. Almeida’s office to have your appliance checked.

    Alcohol Consumption: An increase in snoring and sleep apnea has been closely linked to alcohol consumption, including beer and wine. Dr. Almeida recommends that you avoid the consumption of any alcoholic beverages at least 4 to 6 hours before bed time.

    Disease Progression: With time and age, the severity of the disease may increase. In this situation, advancement and/or new appliances may be required to control snoring in the future. Dr. Almeida requires regular follow-up visits to ensure that your oral appliance is maintaining its proper fit and to asses that your mouth and teeth are in a healthy condition.

    If none of these situations are related to your increased snoring, Dr. Almeida will work together with you to find the exact cause and formulate a new solution for you.
  5. What should I do if my oral appliance breaks?
    Please contact Dr. Almeida’s office to advise us of the breakage and try to set up an appointment as soon as possible. Our qualified team of technicians can fix your appliance or assess the extent of damage over the phone if you cannot schedule an appointment immediately.

    Please do not use your appliance if you know or suspect that it may be broken. You may accidentally swallow some of the material or smaller parts, or cause damage to your mouth.
  6. Do I have to use my appliance every night?
    Yes. Compliance to the treatment plan is essential for a better night’s sleep and it requires that the oral appliance be used every night.

    In some cases, when prescribed by Dr. Almeida, the oral appliance may be used for traveling and interchangeable with CPAP (Continuous Positive Airway Pressure). Dr. Almeida may recommend the patient to use the oral appliance 1 to 2 nights per week even if not traveling since it is important to accustomize the jaw to the correct position.
  7. Are there any side-effects associated with continued use of the oral appliances?
    Short Term Effects: Dr. Almeida has performed extensive research and published numerous studies on the short term effects of oral appliances, including excessive salivation, difficulty swallowing with the appliance in place, or some kind of discomfort. Many of these side effects are minor and resolve quickly on their own or with minor adjustment of the appliance.

    Long Term Effects:
    There are reports of bite changes that may be permanent, resulting from tooth movement . This may or may not be fully reversible even if appliance therapy is discontinued.

    Despite the above described side effects, however, obstructive sleep apnea may pose serious health risks and should be treated. It disrupts normal sleep patterns, can reduce normal blood oxygen levels, and may result in excessive daytime sleepiness, irregular heartbeat, high blood pressure, heart attack or stroke. Although some changes might be undesirable in certain patients, the effective treatment of a life-threatening disease such as sleep apnea supersedes the maintenance of regular bite. Even if major tooth movements are seen, the discontinuation of oral appliance treatment should occur only if the patient accepts another treatment form, such as a CPAP (Continuous Positive Airway Pressure) device, as directed by Dr. Almeida or your sleep professional.