Frequently Asked Questions
Q: I'd like to buy the Silent Sleep™ tray and use my own VPS.
A: Before launching the Silent Sleep™ oral appliance, several VPS materials were tested. Regular VPS sets very firm and becomes somewhat brittle. We discovered that chunks of the VPS would break off the appliance while patients slept. This not only makes the appliance not very reliable but poses a very serious health risk. Silent Sleep ONLY recommends using the GC Reline™ material, as this has been proven to be extremely durable, comfortable, and long lasting vs. regular VPS type materials.
Silent Sleep has found that thermoplastic beads are an acceptable alternative to GC Reline™ material if you choose to not use the GC Reline. The thermal plastic beads are a good choice for lining the Silent Sleep if the Silent Sleep must be used for long term. The thermal plastic bonds very well to the Silent Sleep tray and will not break down over time like the VPS materials. The thermal plastic will discolor over time and usually will take on an odor. The thermal plastic tends to be the best choice for patients who report significant “chewing” of the GC Reline material and in patients who have poor dental retention. The thermal plastic shrinks slightly as it sets (which may be enhanced by snap setting it using cold water) which allows for excellent retention in most cases. Due to the thermal sensitive nature of the material it is also easy to vary the amount of retention. However, since the material does shrink on setting it is important to monitor the patient for movement of the teeth as the material can place pressure interproximally and open up contacts.
We have found Temp Span, a clear VPS material, to be a very good material for use in the Silent Sleep. Temp Span is a more firm than GC Reline and is therefore better for patients who tend to “chew” on the GC Reline material while sleeping. The material is colorless and transparent which is positive for many patients. The Temp Span material is easier to rip and tear than the GC Reline material, and therefore does not tend to hold up as well. However, this is completely dependent on how the patient treats the appliance and what if any parafunctional activity there is at night. We have patients using the Temp Span material as the liner in their Silent Sleep for 3 or more months without problems.
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Q: Can you adjust the Silent Sleep™ once fit to the patient?
A: Yes, to adjust the Silent Sleep™ you need to remove the reline material and refit the appliance to a different position.
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Q: Is the Silent Sleep™ FDA approved for apnea as well?
A: The Silent Sleep™ is FDA approved for the temporary and trial treatment of snoring and mild to moderate obstructive sleep apnea.
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Q: How long does a Silent Sleep™ appliance last?
A: While no long term clinical data currently exists, we have patients reporting using the Silent Sleep™ daily for 10 months now without significant wear that would make the Silent Sleep unsafe to use. Long term clinical data is being collected and will be published when complete.
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Q: How do I help patients avoid side effects of tooth movement and jaw position changes?
A: The key to avoiding problems is performing a thorough evaluation before treating the patient and being aware of any underlying problems that they may have. Please watch my video “Avoiding and treating jaw problems in the OSA patient” for more details. Two simple things that you can do include asking the patient to floss everyday and report if they ever notice a change in the tightness of their interproximal contacts, and having the patient tap their teeth together every night before bed and report if they ever notice a change in their occlusion (for example noticing that they are having troubles getting their posterior teeth to occlude). If your patient begins to have side effects that you don’t understand it is important to have the patient see someone with more training in TMJ disorders and dental sleep medicine. Both the American Academy of Craniofacial Pain (www.aacfp.org) and the American Academy of Dental Sleep Medicine teach courses on oral appliance therapy and have members (fellows and or diplomates) who have dedicated a major portion of their professional career to the treatment of these patients. Seek out a mentor in your area who is a credentialed member of one (or preferably both) of these organizations.
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Q: How do I warm up the thermal plastic beads?
A: The thermal plastic beads may be warmed up in a microwave safe (“Pyrex”) bowl. In most small microwaves it takes about 1 minute to melt the beads. HOWEVER, be careful as this will vary based on the power of the microwave and the beads can become super heated, basically boiling, and if you handle the molten plastic you can receive a serious burn. ALWAYS WEAR TREATMENT GLOVES (LATEX OR NON-LATEX) WHENEVER HANDLING THE MOLTEN THERMAL PLASTIC SO THAT YOU MAY RIP OFF YOUR GLOVE IF THE MATERIAL STICKS TO YOUR FINGERS AND BEGINS TO BURN YOU.
A more predictable and safe method for warming up the beads is by pouring boiling water over the beads in a bowl or other suitable container. The boiling water will melt the beads quickly and they will coalesce. At this temperature the molten beads are easy to handle and the water helps keep the material from sticking to your gloves. Shake off the excess water before placing the thermal plastic in to the Silent Sleep tray.
REMEMBER, when using thermal plastic as a liner for the Silent Sleep you must treat it exactly like you would acrylic. Thermal plastic CAN AND WILL lock in to undercuts. Use with caution and expertise.
