Longterm oral appliance therapy in obstructive sl

Authors: M H J Doff K J Finnema A Hoekema P J Wijkstra L G M de Bont B Stegenga

Publish Date: 2012/05/06

Volume: 17, Issue: 2, Pages: 475-482

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Abstract

This study aimed to assess possible dental side effects associated with longterm use of an adjustable oral appliance compared with continuous positive airway pressure CPAP in patients with the obstructive sleep apnea syndrome and to study the relationship between these possible side effects and the degree of mandibular protrusion associated with oral appliance therapyAs part of a previously conducted RCT 51 patients were randomized to oral appliance therapy and 52 patients to CPAP therapy At baseline and after a 2year followup dental plaster study models in full occlusion were obtained which were thereupon analyzed with respect to relevant variablesLongterm use of an oral appliance resulted in small but significant dental changes compared with CPAP In the oral appliance group overbite and overjet decreased 12 ±11 mm and 15 ±15 mm respectively Furthermore we found a significantly larger anterior–posterior change in the occlusion −13 ± 15 mm in the oral appliance group compared to the CPAP group −01 ± 06 mm Moreover both groups showed a significant decrease in number of occlusal contact points in the premolar region Linear regression analysis revealed that the decrease in overbite was associated with the mean mandibular protrusion during followup regression coefficient β = −002 95  confidence interval −004 to −000Obstructive sleep apnea syndrome OSAS is characterized by repetitive episodes of pharyngeal collapse with increased airflow resistance during sleep 1 and is often accompanied by extensive snoring OSAS is associated with excessive daytime sleepiness sexual dysfunction neurocognitive deficits and higher rates of cardiovascular and cerebrovascular morbidity and mortality 2 3 4 5 In the North American population OSAS affects approximately 4  of the male and 2  of the female adults 4 The severity of the disorder is usually expressed by the apnea–hypopnea index AHI ie the mean number of apneas and hypopneas per hour of sleep and is classified as mild AHI 5–15 moderate AHI 15–30 or severe AHI 30 6 Standard treatment with continuous positive airway pressure CPAP is highly efficacious for OSAS but adherence to the treatment limits its overall effectiveness 7 Oral appliance therapy is a viable alternative in the treatment of OSAS especially in the mild and moderate cases and in patients unwilling or unable to tolerate CPAP 8 Generally oral appliances aim at enlarging the upper airway during sleep by holding the mandible in a forward and downward position 9Mild and “transient” side effects are commonly reported in the initial period of oral appliance therapy and include tooth pain temporomandibular joint pain myofascial pain dry mouth excessive salivation and gum irritation 10 11 12 13 14 15 16 17 18 In several studies dental side effects related to longterm use of an oral appliance have been studied with study model analysis 16 19 20 21 22 However most of these studies were retrospective comprised small study samples did not include a control group or only included snorers or mild and moderate OSAS patients Furthermore all studies except for two 21 22 evaluated the effects of an oral appliance that was nonadjustable and fixed the mandible in a predefined position at 50–75  of the maximum mandibular protrusion Therefore the relationship between the amount of mandibular protrusion during followup and the extent of dental side effects is an aspect that needs further study

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