When Sally came to her first Julian Center appointment, she brought with her a bag of four different oral appliances —treatments she had been given by multiple providers for her headaches and TMJ pain. Each appliance was based on that particular practitioner’s experiences, none of which included looking for an airway obstruction or sleep apnea as the source of her problems.
At the Julian Center, we discovered that her headaches and jaw pain were stemming from a habit of clenching and grinding while she slept. And that was stemming from sleep-disordered breathing caused by an airway obstruction. We fitted her with an appliance customized to resolve her problems, and within a few weeks her headaches and TMJ pain were gone.
Sally’s case is a perfect example of how treatment often addresses only the symptoms, not the cause, and how many patients receive the “standard” instead of a customized solution when it comes to resolving their needs. But every patient is different; everyone needs a different fix. In appliances alone—the first part of treatment for many patients to remodel and reshape the mouth as the foundation for subsequent work on the teeth—there are a number of options.
Daytime Nightime Appliance (DNA). One of my first go-to appliances for a sleep apnea patient is the DNA because it expands the arches to address crowding of the teeth while making room for the tongue and getting it out of the back of the throat. Just as exercise stimulates muscle and bone in your body, the DNA stimulates bone growth and development around each tooth as well as the cranial sutures. It works by applying forces to the teeth and bones and muscles and the face and jaw. The DNA appliance is removable, so it’s for people who are more likely to use it as prescribed. This appliance was designed by Dr. Dave Singh and based on the concepts of Pneumopedics and Craniofacial Epigenetics.
Alternative Lightwire Functional (ALF) Appliance. The ALF is designed to correct cranial imbalances such as facial asymmetry—one ear or eyebrow is higher than the other or the mouth is crooked. The ALF works by stimulating cranial sutures. Once the cranial imbalance is corrected, then the arches are expanded to make more room for the tongue. That is followed by a mandibular advancement appliance to bring the jaw forward. Unlike the DNA, the ALF cannot be removed for up to 18 months, so it is ideal for children and adults who are less likely to be compliant. The ALF appliance was designed by Dr Derrick Nordstom in order to coordinate cranial balancing with correcting orthodontic/orthopedic problems.
Oral Systemic Balance (OSB) Appliance. The OSB is a first-phase appliance that can retrain the tongue, helping to correct swallowing issues and poor tongue posture before using the DNA or ALF. The OSB is for people that have a normal arch with enough room for the tongue, but that lack the proper swallowing ability. The OSB is for someone who just wants to get some relief for their problems—they don’t want or need their teeth moved or their jaws expanded. The OSB is also for patients who have mild sleep apnea or mild bruxism issues. OSB appliances are removable and, for the first three months of treatment, require weekly adjustments while monitoring heart rate, pulse, and heart-rate variability.
Appliances are just part of a holistic treatment plan to resolve problems like Sally was experiencing. That’s why it’s important to find the right provider, one that has multiple solutions that are customizable to your specific needs, preventing you from the time, frustration, and expense of collecting a bagful of appliances that never really solve your problems. There are currently over 100 FDA approved appliances to treat bruxism, sleep disordered breathing, snoring or sleep apnea.