Effective Treatment for Snoring and Obstructive Sleep Apnea

Effective Treatment for Snoring and Obstructive Sleep Apnea

By Dr. Jeff Shnall

(Please see the free 15 minute consultation offer at the end of this article)

Note:  If you have already been told you have obstructive sleep apnea or use a CPAP machine and are unhappy with it, you may prefer to read the following article on my website by clicking this link: http://www.beachdentistry.com/unhappy-with-cpap

Do you snore or does someone you know snore?  Is your partner’s snoring preventing you from getting a good night’s sleep?  Does your sleeping partner complain about your snoring?  Have you been sent to sleep in a separate bedroom because the person you normally sleep with can’t stand to share a bed with you at night because of your snoring?

If you answered yes to any of these questions this article may improve not only your health but  also your marriage and/or relationship.

People who snore loudly often also suffer from a condition known as obstructive sleep apnea (OSA).    This article will  talk about how your dentist can eliminate problem snoring and also help cure or improve OSA by providing you with a device that you wear in the mouth while you sleep.

I know first hand that dental appliances can eliminate snoring and also treat obstructive sleep apnea for three reasons:  one, medical research has shown that these appliances work, two:   for many years I have been making dental  appliances for my patients with these conditions with good results, and three:   I wear a dental appliance for problem snoring. 

A dental appliance can be a great solution for people who snore,  however if you snore and also have obstructive  sleep apnea there is another option that may be more appropriate for you than a dental appliance, and that is to sleep while using  a machine called a CPAP, which we will discuss as well in this article.

What causes snoring?

When we fall asleep our muscles tend to relax.  This includes your tongue which is also a muscle.  When the tongue relaxes during sleep it can fall to the back of your throat and cause your airway to narrow.  If you breathe in air in through a narrowed airway this can cause the soft tissues in the back of your mouth to vibrate causing the annoying noise that we call snoring.

Why do some people snore and not others?

There are several factors that can lead one to snore:  first, the relaxation of the tongue already mentioned being a big factor.

If you have any of the following you are more likely to have problem snoring as all of the following can limit the size of the airway in the back of your mouth and throat:

•   A receded lower jaw

•   Fat deposits in the tissues that line your throat (more common in overweight and obese people)

•   If you consume alcohol or certain drugs such as sleeping pills: these can cause your throat muscles and tongue to relax more than they normally would

• sleeping on your back:  gravity causes the tongue to fall back into the airway more than if you sleep on your side or stomach

Snoring affects a significant percentage of the population.  The percentage of adults that snore depends on age and sex.  It appears that the older you are, the more likely you are to snore and men are more likely than women to have problem snoring.

Before we can talk about how to eliminate troublesome snoring it is important to know if you are simply someone who snores or whether you also have a condition common in loud snorers known as obstructive sleep apnea…

What is obstructive sleep apnea? (OSA)

If, while you sleep your airway becomes partially closed (i.e. if your tongue falls to the back of your throat) your lungs receive a reduced amount of oxygen.

 However if your airway becomes completely closed off (by your relaxed tongue or other factors as can occur in loud snorers) your lungs will not be getting a fresh supply of oxygen.

 This will lead to lower levels of oxygen in your blood stream.  When your blood oxygen levels go down and your blood carbon dioxide levels go up your brain gets into action and awakens you just enough to take a quick breath or two.

 This is why snorers sometimes wake up with a sudden gasp for air.  You then promptly fall back to sleep.

Obstructive Sleep Apnea is the complete stoppage of air entering the lungs during sleep for at least ten seconds at a time in adults (less time in children).

If the amount of air entering your lungs during sleep does not entirely stop but instead is reduced to the point where it is not enough to allow for proper oxygenation of our blood  this event is called a Hypopnea.  This low level of incoming air and oxygen will also lead to awakenings during sleep to allow  some proper breathes of air to enter the lungs.

People who suffer from sleep apneas or hypopneas can “wake-up” briefly anywhere from several times an hour in mild cases to several hundreds of times a night in patients who have severe sleep apnea.

During these brief awakenings the patient may gasp for air, however they are only partially awake and do not have any awareness or memory of the awakenings in the morning.

 As you can imagine, if you are waking up several hundred times a night to breathe this is a serious disturbance of your regular sleep cycle. This can have potentially serious effects on our daytime functioning and health.

Symptoms of Sleep Apnea:

•  Sleepiness during the day
•   difficultly concentrating

•  sexual dysfunction
•  depression  and/or  irritability
•  decreased ability to  learn new tasks / memory problems
•   falling asleep while at work, on the phone or while driving
•  higher risk of high blood pressure, heart attack and stroke as sleep apnea is a strain  on the heart and the circulatory system)

When should Obstructive Sleep Apnea be suspected?

• If you snore loudly

• If you have breathing interruptions during sleep

• If you awaken from sleep gasping and choking

• if you struggle to breath during sleep
• if you fall asleep during the day at inappropriate times i.e. while driving a car, working or talking
• very often the spouse or co-workers of sleep apnea sufferers notice there is a problem and the person with sleep apnea won’t believe it when told

Do you have sleep apnea or do you simply snore?

In order to treat problem snoring we need to know whether you snore or whether you also suffer from obstructive sleep apnea(OSA).  Why is this important? 

This is in order to provide you with the most appropriate treatment.

People who simply snore can be treated with a simple dental appliance or in some cases other simple methods.

However, if you snore and also have  OSA, even though  you could benefit from a dental appliance, this may not be the first treatment option you should consider.  To be discussed below.

How do you know if you have obstructive sleep apnea or if you simply snore?

This is best done in consultation with your family doctor.  As a dentist, before we treat a patient who snores we do recommend you see your family doctor to determine if you also have obstructive sleep apnea.

A simple screening tool can be used to determine whether  you simply snore or if you are more likely to have OSA.  This tool is called the Epworth Sleepiness Scale, which was developed by Dr. Murray Johns of Epworth Hospital in Melbourne Australia.

The Epworth scale is a short questionnaire, asking you to rate how likely you are to doze off or fall asleep in eight situations, such as while reading, watching TV, while riding in a car and the like.  For each question you score yourself between 0 and 3, with 0 being not at all and 3 being a high chance of dozing. 

Depending on how you score on the test, you are either more likely or unlikely to have a sleep disorder that requires medical attention.

Take a moment to complete this test:

Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations, in contrast to just feeling tired? This questionnaire refers to your chance of falling asleep, according to your usual way of life, for about the last week or two. Even if you have not done some of these things recently, try to estimate how they would have affected you during the last two weeks.

Use the following scale to choose the most appropriate number for each situation:

Scale: 
0 = No chance of dozing
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing

Scoring: 
7 or less = you have a normal amount of sleepiness
8 to 9 = you have a average amount of sleepiness
10 to 15 = you may be excessively sleepy depending on the situation and you may want to seek medic al attention
16 + up = you are excessively sleepy and should seek medical attention

If you complete the Epworth Sleepiness Scale and score in the normal category, have no symptoms of OSA and simply want relief from snoring, then we will consider you in the “snoring” category.                                                                                               If you have some symptoms of OSA  that we mentioned earlier, or if your spouse or sleeping partner has told you that you struggle to breath while you sleep,  or if you wake up choking or gasping  and you also snore, then it is important that you see your family doctor for  problem snoring before seeking treatment from a dentist.  Your doctor will determine whether you may be at risk or suffer from obstructive sleep apnea or whether you a simply a snorer.  If you are at risk for OSA your doctor should refer you to a physician who specialises in sleep.  

     The sleep specialist will determine if you have OSA,  and if so, whether it’s mild, moderate or severe (depending on the number of times you stop breathing each hour during sleep, or for what period of time each night your blood oxygen levels are below normal).  This is done by conducting a sleep study where your breathing is monitored while you sleep.

The sleep study will measure the number of times per hour that you have “obstructive events”, meaning the number of times per hour during sleep that  your airway is either completely blocked or partially but significantly blocked each hour.

The degree of Obstructive Sleep Apnea is classified as follows:

How is Snoring and Obstructive Sleep Apnea Treated?

Whether you simply snore or also have OSA, changes in certain behaviours or habits can reduce the amount that you snore and also can reduce the severity of your OSA

Alcohol, tobacco or sleeping pills all make the airway more likely to collapse during sleep, and also increase the length of time that people with sleep apnea stop breathing. Eliminating the use of alcohol, tobacco and sleeping pills can help reduce snoring and the severity of OSA

Overweight people are more likely to have obstructive sleep apnea. This is because they will often have fat deposited in their airway causing it to narrow. If a patient is able to reduce their weight by ten percent or more this can reduce the severity of sleep apnea.

Some patients only experience OSA when they sleep on their backs. These patients may simply choose to use pillows or other devices to help keep them on their sides or more upright during sleep.

In my own personal experience, sleeping on my side stopped me from snoring, however I am more comfortable sleeping on my back, and despite my best efforts to sleep on my side I would usually wind up on my back during the night and resume my snoring.

 I tried sewing a tennis ball into the back of my pyjamas to prevent me from sleeping on my back.  This would allow my wife to sleep soundly as I would not have the opportunity to sleep on my back and snore.   The trouble was when I tried the tennis ball method I had probably the worst night of sleep ever,  as I woke up  at least a dozen times that night each time I  rolled onto the tennis ball.  I knew that I would have to try another method to help me stop snoring.

The fact is that for some, sleeping on there side can be helpful in preventing snoring but is not easy to accomplish due to the tendency for some us of to roll onto our backs during sleep.

The other fact is that losing weight, drinking less alcohol and the like, for most, won’t be sufficient to stop snoring and won’t be all that is required to eliminate even mild OSA.

 If you snore or have Mild to Moderate Obstructive Sleep Apnea:

There are several dental appliances on the market that can effectively eliminate snoring and can be helpful in treating mild to moderate OSA.   A dental appliance may not completely eliminate mild to moderate sleep apnea but it can reduce it and help relieve the symptoms of mild to moderate OSA.

How do dental appliances eliminate snoring or improve mild to moderate OSA?

There are two basic types of dental appliances that are used to eliminate snoring and to help treat OSA.  These two types of appliances both work by helping to maintain an open airway during sleep.

Remember, the main cause of snoring and mild to moderate OSA is the tongue relaxing and falling back during sleep.  So, one type of appliance is called a Tongue Retaining Appliance.  Appliances of this type use a suction cup or similar features to retain the tongue in a forward position during sleep, preventing the tongue from falling back during sleep and obstructing the airway.

     A more commonly used appliance to treat snoring and mild to moderate  OSA is what is termed a mandibular repositioning appliance, which, in simpler terms is a dental appliance that brings the lower jaw into a more forward position during sleep. 

The base of our tongue is attached to our lower jaw (mandible), so if the lower jaw is brought forward by the appliance the back of our tongue is also brought forward during sleep, opening the airway, eliminating snoring and improving airflow into the lungs.

     As a dentist, the type of appliance that I provide my patients and the one that I wear to stop my snoring is the latter group, the lower jaw repositioning appliance.

    I have never worn or made a tongue retaining appliance.  When I received my training in sleep dentistry the sleep physician teaching the program said the consensus is that the tongue retaining appliances were not as comfortable as the jaw advancement appliances and for that reason, I just never got involved with them. 

As well, in a August 2008 article that appeared in the medical  “Journal of Family Practise”, an article entitled “Management of Patients with OSA “ the author of the article, sleep physician Dr.Robert Ballard  states re: dental appliances: “mandibular advancement devices are the best studied type of (dental) appliance (to treat OSA) are likely the most effective.”

So let’s talk more about the lower jaw repositioning appliance.  There are several such appliances on the market.  The appliance that I personally wear and make for my patients is called the SUAD Appliance, made by Strong Dental based in Leamington, Ontario, Canada. 

There are many   dental sleep appliances on the market.  I have had good experiences with the SUAD appliance and so have my patients so, in dentistry, if I find a product or a technique that I am happy and works well with I tend to stick with it.

Here are some thoughts on the jaw repositioning dental  appliances that treat snoring and mild to moderate obstructive sleep apnea:

What does the SUAD  Appliance look like?:

The SUAD appliance is made up of two horseshoe shape  pieces of moulded material that each look  somewhat like a sports mouth guard.  There is a moulded piece   that fits snugly over your upper teeth and a one that fits over your lower teeth and an expandable bar that joins the two.  The bar is attached to the lower section while a hollow metal tube is attached to the upper section.  The bar can slide in and out of the metal tube which means that the upper and lower sections are not rigidly fixed to one another, but instead, your lower jaw can open and close and move side to side while you wear the appliance.

The SUAD appliance  brings your lower jaw into a more forward position, opening the airway during sleep.

The SUAD appliance, like other jaw repositioning appliances,  are generally very effective in eliminating snoring and have been proven to improve air flow to the lungs in patients with OSA, and are an accepted treatment for Obstructive sleep apnea.

However, if you have been diagnosed  with Obstructive sleep apnea the first   method of treatment should be the use of a CPAP machine, and not a dental appliance.

A CPAP machine consists of a motor, hose and a nose or mouth piece that the patient wears during sleep.  The machine blows air through the mask or nose piece.  This stream of air prevents the tissue at the back of our mouth and throat from collapsing during sleep, which eliminates snoring, and also cures all forms of obstructive sleep apnea. CPAP machines have been shown to be the most effective way to treat OSA.

Patients get the CPAP machine from their sleep physician.

The problem with the CPAP machine is that not everyone likes using it.  Some patients won’t use it at all while others may use it for a few months or a few years and then stop.

Some people get claustrophobic having to wear a mask or nose piece.  Some people find the air flowing through their nasal passages dries their throat, so it is these patients who will seek out dentists for relief of their symptoms.  There are other problems that pts have with CPAP units which can be discussed in a future podcast.

Many problems that patients experience with CPAP can be overcome with some work and patience, however for some patients  the CPAP is just not acceptable to them.

Having said that, dental appliances have been proven to improve sleep apnea symptoms.  They  are the next best alternative to patients with mild to moderate OSA that won’t tolerate a CPAP unit.

What are the advantages of a dental appliance in the treatment of snoring and/or sleep apnea?

• you don’t have to be connected to a machine while you sleep
• Unfortunately some people are embarrassed that they need to be connected to a machine while they sleep and prefer dental sleep appliances for this reason.
• dental appliances are portable (can fit in a pocket/can be slipped in the mouth while on an overnight plane flight)
• no power source required

So, if you snore or have Obstructive Sleep Apnea what is your next step?

1.  If you snore or suspect you have sleep apnea call your family doctor.  Your doctor will refer you to a physician who specializes in sleep disordered breathing.  This specialist will determine if you have sleep apnea and if so, whether it is mild, moderate or severe.

2.  Once diagnosed, if you have mild or moderates sleep apnea or if you simply snore, you are a candidate for a dental sleep appliance, however note the following:

1. CPAP is considered to be the first choice to treat mild, moderate and severe sleep apnea, as it will work for all patients.
2. However, some patients do not like the thought of wearing a CPAP mask while they sleep or have tried it but can’t tolerate it.  If you have worked together with your sleep doctor, have tried CPAP but have given up on it, then a dental appliance such as the SUAD is the next option
3. Appliances like the SUAD are effective in the treatment of mild to moderate sleep apnea and snoring but as stated at the beginning of the article it may only be partially effective for some patients.  Again, this is due to the fact that everyone’s airway anatomy is different.  In some patients, bringing the tongue into a more forward position will open up the airway nicely and provide relief to the symptoms, whereas in some patients, this won’t be enough.
4. Patients who may not get relief from a dental sleep appliance are those with:

• • Large thick tongues that fill up the back of their mouth.  In these patients, if you ask them to ayah” you cannot see the back of their throat.
  • Patients with receded say “ah” lower jaws:  their lower jaw is positioned far back compared to their upper jaw which means the tongue will also be positioned further back in the mouth/throat.  The sleep appliances may not be able to bring the tongue far enough forward to open the airway.
  • Patients who are obese:  these patients may have fat deposits in the walls of their airway which narrows the airway to such an extent that even if the tongue is brought forward by a dental appliance, the narrowed airway still interferes with oxygen delivery to the lungs.
  • Other anatomical problems which may make all dental  sleep appliances ineffective, no matter which type you chooses, and it is impossible  to predict who the appliance will and won’t help.  This is why patients should at least try the CPAP first as it can overcome anatomical problems that dental appliances can’t.
  • Patients with severe obstructive sleep apnea generally won’t get enough benefit from a dental sleep appliance and should use the CPAP.  They may get some improvement in their sleep apnea symptoms, however, the only time a patient with severe sleep apnea should consider a dental appliance is if they absolutely can’t tolerate the CPAP.  Even then, these patients would consult their sleep physician to examine other ways to treat severe sleep apnea in addition to a dental appliance, i.e. weight loss, surgery, etc.

3.    Wearing a jaw repositioning appliance to treat snoring and OSA has been  found to be  safe if chosen for appropriate pts.

4.  You should wear an appliance that has a good safety rating.  Check that the appliance you are considering to use appliances that have been approved by Health Canada (in the United States, the FDA).  The SUAD has been approved by both agencies.

5.  Call our office for an appointment.  I will  examine your jaw, jaw joints, gums and teeth to ensure that you are a suitable candidate for the appliance. 

6.  Patients with  chronic pain in the joints of their jaw (known as the temporomandibular joint or TMJ) likely won’t be suitable candidates for a jaw repositioning appliances.

7.  If you have loose teeth or broken down or decayed teeth you will need to get you’re  your mouth into better health before having an appliance made or else the appliance won’t fit well and won’t be long lasting.  I do see patients who already have their own family dentist and simply wish to have an appliance made.  I will simply make the appliance and will refer you back to your own dentist for regular dental care.

8.  An x-ray of your teeth and jaws will be necessary to ensure they are in good health before proceeding with the appliance.  I usually will take only one simple x- ray, called  a panorex, which gives us an overall view of your jaws and teeth.

8.  Once you are deemed to be a good candidate for a dental appliance models will be made of your teeth and a record will be made of your bite as well.  This is a simple procedure, even for patients who are normally nervous in the dental chair.  We send the models and bite to the lab.

10.  The lab makes the SUAD appliance from these models and bite. 

11.  You return to receive your appliance and to learn about the use, care and maintenance of the appliance.

What are some  features of the SUAD appliance?

•  The SUAD is comfortable.

•  It fits your teeth snugly

 •  It allows you to open and close your mouth as well as drink liquids while you wear the appliance

•  The appliance is adjustable;   the key feature of any appliance of this type is the amount that it brings your jaw forward.  With the SUAD appliance the distance that your jaw is set forward can be easily adjusted by the patient or the dentist in a minute or so, without any tools.

 • The SUAD  appliance  is very durable and special modifications can be made to the appliance for use with patients that are chronic tooth grinders;  this can help relieve the jaw pain and headaches that can plague chronic tooth grinders.

  • The appliance should be expected to last for several years and should be modifiable to be refitted to your teeth if you have dental treatment done

  • In fact the SUAD  appliance comes with a two year warranty to repair the appliance at no cost to the patient.

 •  I you have few or no teeth you can still be a candidate for an oral appliance you do need something to hold the appliance in your mouth.  Placing  regular or mini implants in your upper and/or lower jaw could give a dental appliance the support that the appliance needs.

What about do-it-yourself  appliances for snoring that are advertised on television or the internet?

If you are considering the purchase of a do-it-yourself appliance you should research whether it has the features of the jaw repositioning appliances such as the SUAD mentioned in this article.

  I suspect that most D-I-Y appliances  do not allow movement of your upper and lower jaws during use, and do not have the durability and comfort of a custom made appliance.

They also may not be adjustable by the patient if it is determined that your lower jaw needs to be brought more forward or less forward to get resolution of your symptoms of snoring and/or apnea.

If you are using a D-I-Y appliance can you be sure that the condition of your teeth gums and jaw joints make you a suitable candidate for a dental appliance?

There are two types of SUAD Appliances:

There is the  regular SUAD appliance I have discussed up until now.  However if you are unsure whether you can benefit from a dental sleep appliance you can have a tempororary SUAD appliance made for about half the cost of a permanent appliance.

The temporary SUAD appliance. which is a similar dental device to the SUAD  appliance but with one difference:   it is made of plastic components and will only likely last only weeks versus years as compared to the permanent SUAD appliance.  

     The temporary appliance is simply meant to allow you to know if you would benefit from a dental sleep appliance with a lower initial financial commitment.

If you decide you like the temporary appliance and would like to go on to have a permanent appliance made we do reduce our permanent fee.

  The temporary SUAD  Appliance  is good for patients who are afraid to commit to the permanent appliance without a trial run.  The temporary appliance  works the same as the permanent but is made with less costly material and as a result, less durable material. The temporary appliance  may only last weeks rather than years .  The patient can keep the temporary appliance as a spare if they decide to have the permanent appliance made.    

Are there  complications that patients experience if they wear jaw advancing appliances?

 When pts awake in the morning  their bite will likely feel somewhat different for 10-15 minutes as it was in a forward position all night while they slept;  but the muscles and ligaments of our jaw have memory, and the jaw will settle back into its normal position.

Strong dental includes with every SUAD appliance that they make at no additional cost an appliance called the morning repositioner. 

 They recommend that the patient use the morning repositioner in the morning when they first wake up for a short period of time while you shower or get dressed to help the jaw settle back into its normal position. 

Jaw advancing appliances have been shown to be safe for jaw joints although on awaking  your jaw could be a little sore when you first take out the appliance.  You should contact your dentist if the jaw soreness persists, as this could mean that your lower jaw has been advanced too far.  If you have an adjustable appliance this can be corrected very simply.

I find that when I make SUAD appliances for my patients I do get good reports from patients saying that their spouse tells them they are no longer snoring.  This is always welcomed feedback but if you have obstructive sleep apnea it is recommended that you return to your sleep physician for follow-up, which likely could involve having another sleep study done while you wear your appliance to determine how well the appliance is treating your sleep apnea.  This is regardless of what type of sleep appliance you use.

The research has shown that pts with severe OSA are not helped very much with dental appliances although some will say that if you are not going to use a CPAP machine a dental appliance is better than no treatment at all.

Even with mild to moderate sleep apnea one cannot guarantee the success of a dental appliance  for every pt.  Everyone has different  anatomy  and  bringing the lower jaw forward during sleep may not open the airway enough to relieve the apnea symptoms, if other factors are causing a more severe obstruction of your airway.

Are there any other effective ways to eliminate snoring or obstructive sleep apnea besides using dental appliances or the CPAP unit?

Surgery is an option for some patients who snore and/or have sleep apnea. These surgeries have the goal of increasing the size of the airway. None of these surgeries are completely successful or without risk.

(i) Young patients may benefit from the removal of adenoids, tonsils, nasal polyps and the correction of deformities of the airway.
(ii) A surgical procedure known as Uvulopalatopharyngoplasty (UPPP) is the surgical removal of excess tissue at the back of the throat (tonsils, uvula, and part of the soft palate) This technique only has a 30-50% success rate and is not necessary as less invasive methods are available.

     It is widely agreed that surgery is not as effective as CPAP for OSA.

A Personal Testimonial regarding the wearing of a Dental (SUAD Appliance) to Eliminate Snoring:

I have personally worn the SUAD Appliance every night for the past several. It has completely eliminated my snoring, according to my wife.

 I have had also had good success with the vast majority of patients that we have made the SUAD Appliance for .

The appliance is well built, very durable and is repairable if it should break. But please, if you do have me make you one, keep it away from your family dog.  My dog mistook my dental appliance for a chew toy.

My appliance has been problem free after several  years of nightly use and I was even able to reshape and continue to use my SUAD appliance it after our dog gnawed on it. Yes, I was incredibly lucky to be able to salvage it and yes, I sterilized it before reusing it (the appliance, not the dog).

If you would like to have a snoring/OSA  appliance made in our office:

 Please ask your MD or sleep specialist for a letter outlying your diagnosis, i.e. mild/moderate or severe obstructive sleep apnea(they can give you the letter or mail/fax/e-mail it to me with your permission).

Please contact our office for a sleep appliance consultation.

The procedure to make your appliance is simple: models will be made of your upper and lower teeth and as well and a few brief measurements will be made of your particular bite

The lab then requires between 1 to 3 weeks to construct your appliance

You will return for a brief appointment where we will give you your appliance and instructions on its proper use and maintenance.

Patients with sleep apnea may be asked by their sleep specialist to return for a sleep study to ensure that the appliance has been effective in treating the apnea.

Usually patients will provide us feedback that their snoring has stopped; in case where it hasn’t the appliance can be briefly adjusted while you sit in my chair and this should do the trick.

     A good night's  sleep for you and your partner is well worth the money spent.  Medical research has shown that a good night's sleep is crucial for optimum alertness, mental functioning and overall health.  Our sleep appliance can provide many years of sound restful sleep. 

Snoring and obstructive sleep apnea are manageable  conditions. You owe it to yourself, your partner and other family members to get properly diagnosed and treated.

If you would like to book a free 15 minute consultation to view the SUAD Appliance or to discuss your options please contact our office by phone or e-mail, or visit the contact section of our web site.

Best regards,

Dr. Jeff Shnall B Sc., DDS
tel:  416-691-2886  fax:  416-691-6847
e-mail:   dr.shnall@gmail.com    website: www.beachdentistry.com

LINKS

www.strongdental.com   (makers of the SUAD appliance)