Informed Consent
For the Treatment of Sleep Disordered Breathing with
Oral Appliances
Snoring and obstructive sleep apnea are both breathing disorders that occur during sleep due to narrowing or total
closure of the airway, Snoring is a noise created by the partial closure of the airway and may often be no more
problematic than the noise itself. However, consistent, loud, heavy snoring has been linked to medical disorders such
as high blood pressure. Obstructive sleep apnea is a serious condition; the airway totally closes many times during the
night and can significantly reduce oxygen levels in the body and disrupt sleep. In varying degrees, this can result in
excessive daytime sleepiness, irregular heartbeat, high blood pressure, reflux, depression, occasionally heart attack and stroke.
Because any sleep disordered breathing may potentially represent a health risk, all individuals will be tested by an
overnight sleep recorder in their home or by a polysomnogram in a sleep laboratory.
Oral appliances may be helpful in the treatment of snoring, upper airway resistance syndrome (UARS) and sleep
apnea. Oral appliances are designed to assist breathing by keeping the jaw and tongue forward, thereby opening the
airway space in the throat. While documented evidence exists that oral appliances have substantially reduced snoring
and sleep apnea for many people, there are no guarantees this therapy will be successful for every individual. Several
factors contribute to the snoring/apnea condition including nasal obstruction, narrow airway space in the throat and
excess weight, Because each person is different and presents with unique circumstances, oral appliances will not
reduce snoring and/or apnea for everyone. Post testing will be done to assure effective treatment.
Possible Complications
Some people may not be able to tolerate the appliances in their mouths. Also, some individuals will develop temporary
adverse side effects such as excessive salivation, sore jaw joints, sore teeth and a slight change in their "bite",
However, these usually diminish within an hour after appliance removal in the morning. On a rare occasion, a
permanent "bite" change may occur due to jaw joint changes and/or tooth movement. Generally, this can be prevented
with modifications to the appliance. These complications may or may not be fully reversible once appliance therapy is
discontinued. If not, restorative, orthodontic, and/or surgical treatment may be required, for which you are responsible.
Oral appliances can wear and break. The rare possibility that these or broken parts from them may be swallowed or
aspirated exists. For patients with sleep apnea, the device must be worn nightly. Discontinuation of use is a hazard to
your health and can lead to a heart attack, or stroke, and even death. See your prescriber before discontinuing use and
for recommendations of alternative therapy such as CPAP and/or surgery.
Length ofTreatment
The oral appliance is strictly a mechanical device to maintain an open airway during sleep. It does not cure snoring or
sleep apnea. Therefore, over time, the device must be worn nightly for a lifetime to be effective. Over time, simple
snoring may develop into sleep apnea. Sleep apnea also may become worse. Therefore, the appliance may not
maintain its effectiveness. The oral appliance needs to be checked at least twice a year to ensure proper fit and the
mouth examined at that time to assure a healthy condition. If any unusual symptoms occur, you are advised to
schedule an office visit to evaluate the situation.
Individuals who have been diagnosed as having sleep apnea may notice that after sleeping with an oral appliance they
feel more refreshed and alert during the day. This is only subjective evidence of improvement and may be misleading.
The only way to accurately measure whether the appliance is keeping the oxygen level sufficiently high to prevent
abnormal heart rhythms and other problems is to be retested with a sleep recorder or polysomnogram.
Alternative Treatments
Other accepted treatments for sleep-disordered breathing include behavior modification, weight loss, constant positive
airway pressure, and surgery. You have chosen oral appliance therapy to treat your particular problem and are aware
that it may not be completely effective for you.
Unusual Occurrences
As with any form of medical or dental treatment, unusual occurrences can and do happen. Broken or loosened teeth,
dislodged dental restorations, mouth sores, periodontal problems, root resorption, non-vital teeth, muscle spasms, and
ear problems are all possible occurrences.
Most of these complications and unusual occurrences are infrequent. Additional medical and dental risks that have
not been mentioned may occur. Good communication is essential for the best treatment results. Please call or come
to the office if you have any questions or problems regarding treatment. I consent to the taking of photographs and x-rays before, during and after treatment, and their use in scientific papers and demonstrations.
Follow Up Visits
Patients will be seen twice a year for the lifetime of the appliance. There will be no charge for the first two months of
evaluation. Then dollar charge will be applied for the next follow-up visits.
I certify that I have read, or had read to me, the contents of this form. I realize and accept any risks and limitations
involved, and do consent to treatment