ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Oral Appliances for Obstructive Sleep Apnea May Cause Transitory Symptoms of Temporomandibular Disorder
Clinical Question Can oral OSA appliances cause TMD symptoms?
Clinical Bottom Line Oral OSA appliances may cause TMD symptoms. These symptoms generally occur in the first few months of therapy and generally resolve within a year or two.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21538074 Doff/201251 patients used oral OSA appliances and 52 used Continuous Positive Airway Pressure (CPAP).Randomized Controlled Trial
Key resultsMeasurements of pain intensity, disability and mandibular function impairment were recorded for all patients at baseline, 2 months, 1 year and 2 years after providing an oral OSA appliance or a CPAP. Patients with TMD pain at baseline, 2 months, 1 year and 2 years among the oral OSA appliance group was 8%, 24%, 8%, and 3% respectively, while among the CPAP group was 4%, 6%, 10% and 8% respectively.
#2) 23270383Gong/201394 patients with OSA using oral OSA appliances for 24 months completed a questionnaire.Survey
Key resultsThe most prevalent side-effect of the oral OSA appliances was single sore tooth (37%) followed by dry mouth (33%) and odd bite feeling (32%). Other symptoms reported by the patients were excessive salivation (31%), buccal soreness (29%) and dental discomfort (9%), while only 17% of patients did not experience any side-effects. The majority of the side-effects resolved after a few months of use. Only a few patients still experienced side-effects after 24 months of appliance usage.
Evidence Search (“Sleep Apnea Syndromes” [Mesh]) AND “Facial Pain” [Mesh]
Comments on
The Evidence
Patients in both studies experienced TMD and other dento-orofacial symptoms. The symptoms appear to be related to the oral OSA appliance holding the mandible in a protruded position. For the various observation periods, the highest incidence of TMD pain was observed at 2 months after therapy began (Doff MH et. al.). The Gong et. al. study unfortunately had only a 23% returned response from the 412 patients who were treated with an oral OSA appliance and received the questionnaire. The evidence presented by both studies suggest that these symptoms are generally temporary and resolve without intervention. The studies conclude that the benefits in treating OSA with an oral OSA appliance greatly outweigh the side-effect of self-resolving TMD symptoms.
Applicability According to American Sleep Apnea Association, OSA affects over 18 million Americans. With obesity being a risk factor for OSA, one may suspect that OSA will become more prevalent as obesity continues to increase among the population. The general public is becoming more aware of OSA and is taking appropriate measures to treat it. Oral OSA appliances are a common therapy for OSA. These studies suggest that there is an association between oral OSA appliances and TMD symptoms. However, the effects are generally short term and self-limiting. The most common long lasting effect is a change in occlusion, but this change is not accompanied with persistent TMD pain. Dentists should educate their patients about the TMD and occlusal effects of oral OSA appliances and closely monitor their patients. Evidence shows that dentists generally do not need to intervene for TMD symptoms due to oral OSA appliances.
Specialty/Discipline (Public Health) (General Dentistry) (Oral Surgery)
Keywords TMD; Temporomandibular Disorder; Obstructive Sleep Apnea; OSA; Sleep apnea; Oral OSA appliance; TMD pain
ID# 2746
Date of submission: 09/08/2014spacer
E-mail thusu@livemail.uthscsa.edu
Author Akshay Thusu
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Edward F. Wright, DDS, MS
Faculty mentor/Co-author e-mail WrightE2@uthscsa.edu
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