ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title The Cardiovascular Health Benefits of Using Oral Appliance Therapy for Obstructive Sleep Apnea Typically Outweigh the Risks of Tooth Movement and Malocclusion
Clinical Question Do the cardiovascular health benefits of using oral appliance therapy typically outweigh the risk of tooth movement and malocclusion in an overweight, elderly male with moderate obstructive sleep apnea?
Clinical Bottom Line The cardiovascular health benefits of using oral appliance therapy (OAT) typically outweigh the risk of tooth movement and malocclusion in an overweight, elderly male with moderate obstructive sleep apnea (OSA). This is supported by a systematic review and a medical records review. The systematic review reported an improvement in blood pressure (BP), endothelial function (EF), and left ventricular (LV) function in patients who were treated using oral appliance therapy. The medical records review reported a variety of tooth movement and occlusal changes in patients using OAT, both of which progressed throughout therapy. When combining the evidence from both studies, it is concluded that the dental side effects of treating OSA with OAT are secondary to the cardiovascular benefits experienced when using an oral appliance.
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) No ID Available YetVan Haesendonck/2015674 patients in 11 included studiesSystematic Review
Key resultsThere was an improvement in BP (mean decrease of 4.2 mm Hg), EF, and LV function in OSA patients who used oral appliance therapy. EF was shown to correlate with apnea-hypopnea index and OSA severity. Reductions in BP values were reported to be of the same magnitude for both the oral appliance and CPAP therapy.
#2) 25325593Pliska/201477 patients with an average MAD treatment length of 11.1 yearsMedical Records Review
Key resultsPatients treated with mandibular advancement splints (MAS) experienced reduction in overbite (2.3 ± 1.6 mm), overjet (1.9 ± 1.9 mm), and mandibular crowding (1.3 ± 1.8 mm); as well as increases of mandibular intercanine (0.7 ± 1.5 mm) and intermolar (1.1 ± 1.4 mm) widths. These changes were significant (P < 0.001) and progressed with continued MAS use.
Evidence Search Obstructive sleep apnea adverse side effects AND removable orthodontic appliance
Comments on
The Evidence
Validity: The first article is a systematic review, but not all of the included studies were randomized control trials. There were a total of 674 patients in 11 included studies. The second study is medical records review. 77 patients were observed for an average of 11.1 years and were required to have either their initial or most recent set of dental study casts. Most patients reported using the MAS nightly, and ranged in disease severity from primary snoring to severe OSA. Perspective: Although the second study is a medical records review, it is the most current evidence and provides the longest observation period of this topic to date. Taken together, the two studies imply that the cardiovascular benefits outweigh the negative effects of tooth movement. Further studies should evaluate the two outcomes within one study.
Applicability Patients in the first article had varying degrees of OSA. Studies that assessed BP had majority male patients. Studies that assessed LV function included patients without cardiovascular disease. Participants in the second article were majority males (62 of 77) with an average age of 47.5, average BMI of 29.1, and AHI score of 29.8. Because both studies had a majority male patients, this evidence may not be as applicable to female patients. Patients should be thoroughly informed of the risks of OAT, with the alternative therapies being the use of continuous positive airway pressure (CPAP) or surgery. This is a patient-by-patient issue due to a variety of possible co-factors. Ultimately, the final decision on OAT use should be left to the patient.
Specialty/Discipline (General Dentistry) (Orthodontics)
Keywords Obstructive Sleep Apnea, Adverse Side Effects, Cardiovascular Disease, Malocclusion, Tooth Movement
ID# 2808
Date of submission: 02/26/2015spacer
E-mail cliftonc@livemail.uthscsa.edu
Author Corbin Clifton
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Clarence C. Bryk , DDS, MS & James Andry, MD
Faculty mentor/Co-author e-mail BRYKC@uthscsa.edu; andry.james@sleeptrc.com
Basic Science Rationale
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Comments on the CAT
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