At Norcal Snore and Sleep Solutions, we offer Oral Appliance therapy for  patients who have been diagnosed with sleep apnea and/or snoring. If you have tried and failed with CPAP therapy, Dr. Krishnamurthy will present you with more options. With our In-office or Virtual consultation, we can certainly help you find a solution.

CONSULTATION VISIT

The first step of our treatment protocol is always a consultation either through a Virtual video Consult or In-office visit during which Dr. Krishnamurthy provides the patient with information about Oral Appliance Therapy . If the patient wishes to proceed with treatment, we start with a diagnostic workup in a Comprehensive Clinical Exam and records visit scheduled for the next appointment.

COMPREHENSIVE CLINICAL EXAM AND RECORDS VISIT

• Extraoral digital radiographs: Panoramic view to see the jaw, a cephalometric view to see the airway and presence of obstructions such as hypertrophic adenoids, a Para nasal sinus view to check for nasal obstructions such as enlarged turbinates or soft tissue, and open/closed views of the temporomandibular joint to check for any predisposition to TMD such as pre-existing damage or excessive wear and tear of TMJ.
• Clinical exam: oral cancer screening, dental and periodontal exam, airway evaluation (checking any potential pharyngeal obstructions such as enlarged tongue, hypertrophic palatine tonsils, excess lateral pharyngeal tissue, enlarged uvula or soft palate, retro gnathic mandible, etc.), maxillomandibular evaluation (size, vaulting of palate, tori, etc.), TMJ exam (joint sounds, check for evidence of Para functional habits affecting TMJ health, muscle palpation), range of motion recording, and occlusal evaluation.
• Taking dental impressions and pouring up stone models to send to top-notch sleep labs for fabrication of FDA approved custom Oral Appliances.
• Bite registration in the appropriate position of the mandible as dictated by dental anatomy, range of motion, TMJ health, and patient comfort.
• Appropriate referrals are made to PCPs, patient’s Family dentist and dental specialists such as Oral and Maxillofacial surgeons, ENT surgeons or board-certified sleep physicians.

ORAL APPLIANCE DELIVERY APPOINTMENT

The patient comes in for the Oral Appliance fitting appointment, during which we check the appliance intraorally for proper fit, alignment, and occlusion. Any necessary adjustments are made during that appointment. The patient is also educated about how to take care of the appliance, what new morning routines are needed to avoid TMJ problems, and oral hygiene instructions are reviewed. We also fabricate a custom morning repositioner device to prevent occlusal changes in the patient’s dentition.

2 WEEK FOLLOW-UP VISIT

After that the patient comes in 2 weeks for in-office titration treatment. This time is necessary for the muscles and TMJ to adjust to each new position.

1 MONTH FOLLOW-UP VISIT

After 1 month post-delivery and titration the patient may be tested with a pulse oximeter overnight to check if blood oxygen saturation is improving.

3 MONTH HST TITRATION EFFICACY FOLLOW-UP VISIT

When titration is completed, the patient is sent back to either PCP or Sleep Physician for a follow up sleep study with the oral appliance to check its efficacy.

6 MONTH FOLLOW-UP VISIT

Very often our patients have Para functional oral habits (such as bruxism) that predispose them to having TMJ problems, so we have to provide even more care to those patients during the treatment phase (more frequent visits, working with them to address the Para functional habits, educating them about maintaining TMJ health, etc).

This visit may be scheduled if patients need a follow-up for addressing any questions or concerns either Virtually or In-office as needed.

ANNUAL RECALL VISIT

After treatment is completed, our patients usually come in annually per AASM protocol for recall/maintenance visits, which may include overnight oximetry. During these visits, Dr. Krishnamurthy checks fit, alignment, and wear of oral appliance, addresses any relapse (if pulse oximeter results are worse than previously or if patient reports that their symptoms are worse), and checks the patient’s oral/TMJ health. Patients are also encouraged to see their sleep physician for regular follow-ups to make sure their sleep apnea is under control.