Insertion and Removal

To Insert the Appliance:

  1. Place the appliance in your mouth.

  2. Position the upper arch onto your upper front teeth and gently push it into place.

  3. Use your fingers to move to the back molar region and push the arch up firmly to fully seat it.

  4. You may hear an audible “snap” as it engages the undercuts of your teeth. If the appliance loosens, the “snap” may not be heard, but it should still fit snugly.

  5. Bring your lower jaw forward and repeat the process to place the lower arch (with “wings”).

To Remove the Appliance:

  1. Bring your thumbs together and firmly push up on the edge of the lower arch near the canines.

  2. Use your index fingers on the edge of the upper arch above the molars and pull downwards until the appliance releases from your teeth.

The First Week

  • No adjustments should be made to the clips during the first week after receiving your appliance. This time is crucial for allowing your jaw and teeth to adjust to the appliance.

  • Monitor your symptoms (see the included adjustment journal), including snoring, daytime sleepiness, and sleep quality.

  • You may experience increased salivation, drooling, and mild tenderness in your teeth and jaw as you acclimate. If you have concerns, contact our Clinical Treatment Department at 815-599-3082.

After the First Week

  • Change the adjustment clips every 3-4 days, unless you experience discomfort or pain in the jaw joint or teeth.

    1. Detach the existing adjustment clip and place it in plastic bag labeled #1.

    2. Take the adjustment clips from plastic bag #2 and snap them into place on the left and right sides.

    3. Continue switching clips every 3-4 days until you reach bag # _______, clip # __________.

Some patients advance through these changes faster than others. If you feel significant tenderness, pause the advancement or revert to the previous clip. When you resume changing clips, do so more gradually by increasing the days between adjustments. Always monitor your symptoms as you progress.

Note: A bag labeled -1 is included, allowing you to return to an earlier setting if you experience excessive jaw discomfort.

Keep track of rod changes and record them in your adjustment journal.

IMPORTANT: We hope you notice immediate improvement in your symptoms. However, advancing the jaw slowly over time is usually necessary for the appliance's effectiveness while maintaining comfort. You have a set number of adjustment rods to use over the next six weeks. Even if you notice improvement early, continue advancing the appliance (unless you experience pain) and document your observations for discussion at your follow-up visit.

WARNING

  • Keep the appliance away from all animals. It tends to attract them, and the lab does not cover damages from animal interference.

  • Avoid extreme temperatures: Do not use water that is too hot or too cold when cleaning.

  • Do not store the appliance in extremely hot or cold environments.

  • Avoid abrasive or chemical cleaners that are not specifically suggested by our office.

Warranty

For 36 months from the shipping date, the lab will replace any device free of charge for in-mouth material breakage not resulting from modifications that alter normal use. The warranty is void if new models or impressions are needed due to dental work.

Patients Using CPAP

  • If you tolerate CPAP, always start by using it simultaneously with the oral appliance.

  • You have been advised to wear the oral appliance alone only during observed naps.

Problems

  • Retention Problems: Contact us if you experience retention issues. This may require adjustments or sending the appliance back to the lab. There’s a fine line between too tight and too loose. If the appliance is overly rigid or retentive, adjustments may be needed at your next visit. The appliance may loosen with wear during the first month.

  • Jaw Joint Pain: Mild tenderness in the jaw joint, similar to overworked muscles, is normal initially but should not last more than 1-2 hours in the morning. If pain persists into the afternoon, causing headaches or earaches, consult the jaw tenderness handout and contact our office if necessary.

  • Tooth Tenderness: Initial tooth tenderness is normal and should not last more than 1-2 hours in the morning. If it extends into the afternoon or lasts all day, contact our office for possible adjustments.

  • Increased Saliva Flow: A bit of extra saliva flow is typical at first and will diminish after a few days.

  • Dry Mouth: Using rubber bands may help. If dryness persists, consider OraCoat XyliMelts, OraCoat XyliGel, or Biotène Oralbalance Moisturizing Gel. Please call us if the problem continues.

Cleaning Instructions & Infection Control

Hand Hygiene: Hand washing is crucial for reducing infection risk. Follow these steps:

  1. Wet hands with warm running water.
  2. Apply soap and distribute it thoroughly.
  3. Rub hands together for 10-15 seconds, covering all surfaces.
  4. Rinse thoroughly to remove soap and dry with a clean towel.

Daily Cleaning: Clean your appliance daily for optimal benefit and longevity:

  1. Clean your appliance immediately after removing it.
  2. Use a soft toothbrush and antibacterial soap (not toothpaste) to brush the appliance, then rinse.
  3. Dry all parts and the storage case with a clean towel, leaving the lid off to air dry.
  4. Store the appliance in its case, away from children and pets, and out of direct sunlight.

Weekly Deep Cleaning: Recommended 1-2 times weekly:

  1. Rinse and lightly brush the appliance.
  2. Fill your sonic cleaner halfway with lukewarm water.
  3. Add the cleaning solution and place the appliance in the container. Follow the specific cleaning instructions for your solution.
  4. After cleaning, rinse the appliance again with cool to lukewarm water, dry it, and store it in the container.

Allergen Note: Some cleaners may contain allergens. Follow the instructions and warnings for the cleaner used. DentaSoak cleaning solution may be preferable if you suspect an allergy.

Morning Repositioner

30 minutes after removing the appliance, complete the morning repositioner exercises for a total of 3-5 minutes.

Instructions:

  1. Insert the repositioner onto the upper teeth.
  2. Bite into the grooves on the lower portion, squeezing your back molars together and holding for 5-10 seconds, then release.
  3. Repeat this squeezing and releasing for approximately 3-5 minutes, or until the original bite position is achieved.

Cleaning: Always use cool water for cleaning the repositioner, as it is thermally sensitive and will deform in hot water. You can follow the same cleaning instructions as for the oral appliance.

Important Reminders

  • Your 90 days of included visits and adjustments begin on the date you receive your appliance. Visits outside this period will be billed to your medical insurance.

Return Visit

Your first follow-up will be scheduled 6 weeks from your delivery to check settings and order your follow-up sleep study.

Sleep Study

An order will be sent to the sleep center for an overnight study with the oral appliance. The order will include the settings to be tested during the study. If adjustments are made to the appliance before the study, please inform our office. The order is valid for 90 days; if the study isn’t completed, an office visit may be required for a new order and to verify appliance settings.

Results

Please ensure that Midwest Dental Sleep Center is included on any release of information from the sleep center to guarantee we receive the results. Our office will contact you to review them. If you have not heard from us within 3 weeks after the sleep study, please call our office. Remember, we cannot assess the appliance's effectiveness until we receive the results; caution is advised when operating vehicles or machinery until then.