Dear Dr Kent, i was thinking about an oral appliance and i put my thoughts in one of the topics, maybe you have some opinions about it, or it might interest you the following ideas; i was saying that it would be a good idea for people with obstructive sleep apnea due to the tongue rolling back into the airways and therefore blocking them, to have something like a mesh that could be attached to the last molars, creating like a barrier against the tongue; well, that was one, then somebody said, like a mouse trap, and it came into my mind the following: what about having something like a denture, or two dentures, one up and one down, with a horizontal bar that would keep the tongue in place; what do you think of that? Best regards and very grateful that you are in this forum.

That's sort of the idea behind the Full Breath Apppliance, but the inhibition is from the top of the mouth instead.

Bringing the mandible forward (or simply holding it where it does not drop back) has even more advantages. When you bring the mandible forward, it "increases the baseline activity of the genioglossus". All that means is that when the lower jaw is brought forward, the tongue says "HEY! Wait for me!" and comes forward with it.

Additionally, you get an "external splint" of the pharyngeal musculature, so it reshapes (for the better) the airway from the oral cavity down.


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Kent Smith DDS

But i have read a lot of not so pleasant comments about moving the jaw forward, like pain or that the jaw gets stucked or something like that, that is the reason why that treatment does not seem very appealing to me;talking about that pharyngeal splint, that one sounds very interesting indeed; i thought of something like that before; can you tell me where i can look for more information about it? what is your opinion about this pharyngeal splint? I was in such a hurry to answer your post that i forgot to thank you for all your good and well based advices Dr. Kent. Best regards and wishing you a happy day.

and it is so sad Dr. Kent because if the TONGUE is the main problem, if you could just hold the tongue forward and let a person breath while sleeping, we must find a real solution for that problem; to use a cpap machine has a lot of side effects, sometimes when i read the posts, i do get scared just thinking that i am also prone to all these side effects that people mention here; i do not agree really about having all this blast of air going into my lungs. But my case of severe sleep apnea, seems not to be corrected by oral appliances; what do you think about it, Dr. Kent? Have you heard recently about comments of people using full breath solution? best regards.

sorry Dr. Kent for making my answers in three parts, but, it comes to my mind what about that mesh located at the last molars, that could be adjusted to make it higher or lower according to the oropharynx size, wouldn't that be a good idea to search for, to give some thoughts about it? you are in that field, what do you think about it? does it sounds good to you?just looking for something less agressive, more comfortable, less damaging.

melhajj wrote:

But i have read a lot of not so pleasant comments about moving the jaw forward, like pain or that the jaw gets stucked or something like that, that is the reason why that treatment does not seem very appealing to me;talking about that pharyngeal splint, that one sounds very interesting indeed; i thought of something like that before; can you tell me where i can look for more information about it? what is your opinion about this pharyngeal splint? I was in such a hurry to answer your post that i forgot to thank you for all your good and well based advices Dr. Kent. Best regards and wishing you a happy day.

I'm sorry I was not more clear. By moving the jaw forward, this automatically reshapes the pharynx to a degree. I just wanted you to know that moving the jaw forward had more benefits than actually moving the tongue forward. 30-35% of patients have a bit change when using an appliance that moves the jaw forward. This can be very minimal, or it could be obvious. The vast majority just don't care. They like breathing. The pain you hear of is usually within the TMJ, and a properly fitted and advanced appliance will almost always solve this problem.


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Kent Smith DDS

melhajj wrote:

and it is so sad Dr. Kent because if the TONGUE is the main problem, if you could just hold the tongue forward and let a person breath while sleeping, we must find a real solution for that problem; to use a cpap machine has a lot of side effects, sometimes when i read the posts, i do get scared just thinking that i am also prone to all these side effects that people mention here; i do not agree really about having all this blast of air going into my lungs. But my case of severe sleep apnea, seems not to be corrected by oral appliances; what do you think about it, Dr. Kent? Have you heard recently about comments of people using full breath solution? best regards.

I have taken many severe apneics to non-apneics, but the literature says that appliances are less successful with severe apnea. About 65% of the time can you cut the AHI or RDI in half (the measure of success) with appliances, while PAP machines arem 95% successful. I have no experience with the full breath solution, but know that the inventor uses some amazing statistics when talking about it.


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Kent Smith DDS

melhajj wrote:

sorry Dr. Kent for making my answers in three parts, but, it comes to my mind what about that mesh located at the last molars, that could be adjusted to make it higher or lower according to the oropharynx size, wouldn't that be a good idea to search for, to give some thoughts about it? you are in that field, what do you think about it? does it sounds good to you?just looking for something less agressive, more comfortable, less damaging.

If you really want to move the tongue forward or keep it from dropping back, I would suggest the AVEO TSD or the TRD. You can even do a search and order the Aveo online if you try hard enough. You would have to draw me a photo of what the mesh idea - I can't quite picture it.


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Kent Smith DDS

Dear Dr. Dent, this appliance called AVEO ST, i have read in this forum that it hurt the frenulum, that what it does is to push the tongue forward and that due to that pain it is like impossible even to think about getting........  talking about the mesh, i was thinking about something like a fish net, not to pliable that could blocked the throat, the problem is, where to attach it? till now i have just thought about the last molars or it can be like a denture attach to the last molars  all the way to the front, to have more support; another idea that comes to my mind is like using two somehow dentures, i don't really know how in your field call this kind of appliances, and have like an inverted S shape attached from the back of the molars and putting pressure on the tongue to hold the tongue down; i wonder about all this, because the tongue is slippery and i don't know if that could help; if you put two dentures together, maintaining the tongue down, would that be enough for not letting the tongue rolls back? i need some time to fix my thoughts; but, for the time being, you, that you know more about the mouth and all the anatomical parts of it, tell me about if my ideas are possible or tell me why they might be not possible. take care Dr. Kent, i will check for your answer.  

sorry Dr. Kent, i am not explaining myself well, but, i am trying; talking about dentures, i think the best word to describe would be like a night guard, the one that they use for TMJ; both guards covering the hard palate and the inferior guard covering the tongue, and in the posterior part of the guards to put like a bar or mesh that would help the tongue from rolling back to the throat; do you believe that making something like this would keep the tongue from rolling back?  

This gets a bit complicated, and I am headed for a dive trip, so I will be brief. First, I am not a fan of the aveo..I was just giving you an option. About the anatomy, what is important is that the tongue nees the freedom to push against the palate when swallowing. This is impossible when forced to stay down in the lower part of the mouth.

There are 2 muscles that are in a battle to keep the upper teeth where they are, and in the correct position. The masseters in your cheek are constantly putting a light force against the teeth from the outside. As you swallow about 2,000 times a day, the tongue (when swallowing against the hard palate) is putting pressure on the teeth from the inside. If these are in balance, your upper teeth are in a good position (slightly overlapping the lower teeth). If there is no inside pressure from the tongue (with mouth breathers, for example), the teeth move in, the palate rises towards the nose and you develop a "crossbite".

So, no, I do not think your design would work, but keep thinking!

See you in a week...


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Kent Smith DDS

so, the tongue must be up in order to swallow, at least, saliva at night; well, if we think about that net place it at the end of the molars, that is the solution, isn't it? but, where to attach it? what about a mesh that has an upper and lower ring and that kind be adjusted according to the size of the mandibules?

melhajj wrote:

so, the tongue must be up in order to swallow, at least, saliva at night; well, if we think about that net place it at the end of the molars, that is the solution, isn't it? but, where to attach it? what about a mesh that has an upper and lower ring and that kind be adjusted according to the size of the mandibules?

You might send your ideas to one of the appliance manufacturers. That's just not my field - sorry!


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Kent Smith DDS