Side Effects & Contraindications
By way of full disclosure, please be advised that occlusal changes and temporomandibular joint symptoms occur in a percentage of patients who wear oral appliances for the treatment of snoring and sleep apnea.
In a recent study, Robertson found that overall, 26% of patients in this study exhibited some form of occlusal changes which were radiographically detectable. Only 10% of the sample however, showed changes that were clinically detectable. Nearly all patients with occlusal changes exhibited a degree of tipping of the upper and lower front teeth. An open bite of the back teeth also occurred in some patients.
Occlusal changes can occur with mandibular repositioning appliances. Most changes appear to be of a minor nature, and of little concern to the patients, however some patients can exhibit changes that are detrimental to their occlusion.
It is strongly advised that informed consent be given to all patients prior to treatment with mandibular repositioning appliances, this should be combined with routine regular dental reviews with ongoing treatment.
Courtesy of Christopher Robertson, BDS MDS
Occlusal changes may be for the better or worse.
Almeida FR, Lowe AA, Jung OS, Tsuiki S, Otsuka R. Long-term sequelae of oral appliance therapy in obstructive sleep apnea patients: Part1. Cephalometric Analysis. Am J Othod Dentofacial Orthop 2006; 129: 195-204
Introduction: Oral appliances (OAs) have been widely used to treat snoring and sleep apnea, but their effects on craniofacial structures in patients after 5 years or more of wear have not yet been quantified.
Methods: Seventy-one patients who had worn adjustable mandibular repositioners to treat snoring or sleep apnea were evaluated. Upright lateral cephalometric radiographs in centric occlusion taken before treatment and after a mean of 7.3 ± 2.1 years of OA use were compared. Baseline sleep studies and patient demographic data were included in the analysis.
Results: Cephalometric analyses after long term OA use showed significant (P < .01) changes in many variables, including increases in mandibular plane and ANB angles; decreases in overbite and overjet; retroclined maxillary incisors; proclined mandibular incisors; increased lower facial height; and distally tipped maxillary molars with mesially tipped and erupted mandibular molars. The initial deep overbite group had a significantly greater decrease in overbite. Duration of OA use correlated positively with variables such as decreased overbite and increased mandibular plane angle; changes in the dentition appeared to be progressive over time.
Conclusions: After long-term use, OAs appear to cause changes in tooth positions that also might affect mandibular posture.
Almeida FR, Lowe AA, Jung OS, Tsuiki S, Otsuka R. Long-term sequelae of oral appliance therapy in obstructive sleep apnea patients: Part 2. Study Model Analysis. Am J Othod Dentofacial Orthop 2006; 129: 205-13
Introduction: Side effects observed in the occlusion and dental arches of patients using an oral appliance (OA) to treat snoring or sleep apnea for more than 5 years have not been investigated.
Methods: Stone casts trimmed in centric occlusion before appliance placement and after a mean of 7.4 ± 2.2 years of OA use in 70 patients were compared visually by 5 orthodontists.
Results: Of these patients, 14.3% had no occlusal changes, 41.4% had favorable changes, and 44.3% had unfavorable changes. Significant changes in many variables were found. Patients with greater initial overbites and Class