To Soak or Not to Soak: That is the Question, Among Others

If you treat obstructive sleep apnea with mandibular advancement devices and you use more than one type of device, there may be some confusion regarding the best method of caring for the appliance. Should you soak the appliance in water? Should you use toothpaste or mild soap or nothing at all to clean it? Is it safe to use a denture cleaner? If yes, how often and for how long?
It would seem that the purpose of cleaning the appliance is two fold. Compliance in wearing the device is always important when it comes to oral appliance therapy. Odor and cleanliness would influence this greatly. Cleanliness is also important with the devices that require access to small parts to assist with titration. A cleaner that is both a deodorizer and a germicide is vital in having a positive impact on patient usage and compliance.
But what about the appliance itself? Some appliances are made of a polymer material; others are made of hard acrylic. Some appliances have metal parts, while others do not. As you may have guessed, the cleaning instructions differ based upon the material from which the appliance is fabricated. A quick overview of four commonly used appliances will further illustrate how the materials impact the prescribed cleaning methods.

The SomnoDent Fusion is comprised of a soft polymer molecularly bonded to an acrylic. The care instructions for this appliance include using a soft toothbrush with mild soap to clean it after use. After thoroughly rinsing the appliance, it is recommended to soak the appliance in clean water ensuring it is fully submerged. This is done to keep the microbial count down and so that the soft liner material will not become desiccated. Soaking will also help to prevent crack corrosion and possible discoloration to the metal components caused by a build up of salts and saliva. Once a week, it is recommended to soak your SomnoDent in a partial denture cleaner for five minutes, then rinse and store in water. Some denture cleaning tablets containing active oxygen may damage the SomnoDent. Ensure that you use a partial denture cleaner.
A Narval appliance is made up of a biocompatible polymer material and is metal free and flexible. The most important care instruction regarding this appliance is to use a soft toothbrush whose only designated use is to clean the Narval appliance. Each morning, use the designated toothbrush to clean and remove the saliva film using warm water. This device is stored dry. Do not use toothpaste or liquid soap as the Narval appliance is fabricated from an extremely porous material that will trap cleaning materials with in the appliance and may cause an allergic reaction. Two times per week, use the sonic cleaner that comes with the appliance. You may also use denture tablets that have an effervescent quality to soak the Narval in for 10 minutes at a time.
The TAP appliance is made of a polycarbonate material with a soft liner. Because of the bilaminate nature of this appliance, you must be careful using certain harsh cleaners because they may destroy the soft liner with extended use. When cleaning the TAP appliance daily, it is recommended to use hand soap or regular toothpaste with a soft toothbrush to clean the appliance. It is strongly recommended to avoid whitening or tartar control toothpastes as they are too abrasive for use on the soft liner. After cleaning, simply rinse off the appliance and store in an open, dry container to avoid an increase in microbial growth.

The Herbst Sleep Appliance is comprised of hard acrylic with two metal telescopic mechanisms on each side. For this appliance, it is consistently and strongly recommended to use DentaSOAK due to the diverse nature of the two materials- acrylic and metal. DentaSOAK is mixed up once a week in a sealed container. After waking, it is recommended to soak the Herbst Sleep Appliance in the solution for 15 minutes. A soft bristled toothbrush may also be used to remove debris or build up. After a thorough rinse, this appliance is also stored in a dry container.
Regarding the different types of cleaners, there are some items of which to be aware. Some cleaners may damage or weaken acrylic. Other cleaners may harm the metal components. The cleaners used for sleep apnea appliances need to be both germicidal and deodorizing in nature. It is important to consider that a segment of your patient population may be sensitive to the chemicals within the cleaning product that you recommend. It is best practice to recommend that patients try a small sample first to make certain they do not experience any adverse reactions. For example, some cleaners contain persulfates, a known allergen. This process may also include your dental team. For example, at subsequent follow up appointments, we place their appliances in the ultrasonic cleaner with a tartar-removal cleaner. Because patients do not have access to this equipment, it’s a nice service to compliment their home care routine.
So that your patients will have the highest possible levels of satisfaction with their appliances, the dentist, dental team and the patient must be committed to keeping their devices clean and fresh. Knowing your appliance and the cleaners you recommend will allow you to match the right chemicals to the device, ensuring optimum outcomes!