Pay attention to dental side effects during long-term oral appliance therapy

We understand how successful treatment of obstructive sleep apnea (OSA) can be. However, we need to pay attention to the potential side effects from long-term oral appliance use. If we are aware of these side effects, we can help educate our patients and prevent them from occurring and interrupting care.

What do we do as dentists to help?

I have read several studies that looked at the predictors of dental changes associated with long-term treatment with oral appliances in patients with OSA. From these studies I have found that yes, long-term use can lead to dental complications if we do not educate our patients.

Before you fit your patient for an oral appliance, ask them if they are willing to take at least two-minutes out of their morning to perform exercises. That’s all it takes. Just two minutes (maybe even less) a day to prevent further complications. And, of course, if they do notice any shifts in their teeth, it is important for them to keep you up-to-date. You can provide an adjustment to their treatment or offer other solutions to improve this change.

When you are fitting your patients for their oral appliance, let them know that it is important to perform daily exercises after removal of the device. By performing jaw exercises, it can help prevent the patient’s mouth from becoming stiff or sore. It can also help to prevent lock-jaw and other complications.

It is our duty as dentists to take care of our patients and that means proper education for daily exercises after removing the oral appliance each morning.

What are you doing to help your patients through the oral appliance process? Are you having them perform exercises? If so, what kind? I am interested in learning what everyone is doing to help their patients each step of this journey.

Minimizing mandibular advancement in oral appliance therapy

In a recent study from the journal Sleep Medicine researchers looked at the treatment of obstructive sleep apnea (OSA) with an oral appliance (OA). There is currently no gold standard method to fine-tune the mandibular advancement. This study was created to analyze the effect of gradual increment of mandibular advancement on the evolution of the apnea.

What were the results?

The researchers proposed the use of a multiparametric titration protocol to optimize the mandibular advancement. Thirty percent of the sample population exhibited the best results without any mandibular advancement and low frequency of side effects were observed. There were 36 patients involved in this study (22 were men) with a mean age of 57 years.

The mean mandibular advancement was between 1.7 and 1.5 mm achieving about 50 percent reduction in AHI in 72 percent of the patients. There were also 27 patients with an AHI of 10. Of the 21 patients with moderate to severe OSA, 17 had the highest decrease in the AHI in a mandibular advancement of about three millimeters.

Researchers found that monitoring the subjective symptoms of the patient and objective evolution in the AHI could minimize the mandibular advancement needed for proper treatment of OSA. What are some other ways to help improve oral appliance therapy results with our patients?

Why don’t more sleep physicians recommend oral appliances for OSA?

It’s an important question that many of us continue to wonder about – why aren’t more sleep physicians recommending oral appliances for sleep apnea? Well, to begin with, there appears to be a lack of data on the subject. While most dentists understand the importance of using oral appliances for the treatment of sleep apnea, physicians are still not in the know. So let’s get them some data.

What information is out there?

After doing a quick search through Google Scholar I found the following studies that showcase how effective oral appliances are for the treatment of sleep apnea in our patients:

Another reason is because they may not be comfortable with the process. If that is the case, then we must help them get more acquainted. This can be done by contacting their offices and educating them on the services we provide. Through proper education and understanding, you can help sleep physicians become better acquainted with oral appliance therapy as a successful alternative to the CPAP machine.

They are ignorant about topics they know little about, which is why it is important to educate them on oral appliances. Look up studies, attend classes and do what you can to provide the information they need to better understand this treatment alternative so we can all continue to help patients get a better night’s sleep.

Embrace Alternative Therapies Besides CPAP

This is important to think about: We are lying to ourselves if we don’t embrace alternative therapies other than continuous positive airway pressure (CPAP) for patients with sleep apnea. While CPAP therapy has been proven to be a successful form of treatment for patients with sleep apnea, it isn’t the only or best way for all patients.

As an alternative to CPAP therapy, oral appliance therapy is important to bring to the attention of your patients. By emphasizing how this alternative therapy option works, you can provide better treatment options for your patients. But, in order to successfully treat patients with oral appliances, I have a few things to point out.

Re-emphasize Bite Change

With your patients, it is important to re-emphasize the bite change that might occur. To help with this, ask the following questions:

  • Are you willing to give two minutes every morning?
  • Are you ok with your back molars not touching?

By asking these questions, you are setting your patients up for success. Oral appliances work, but many patients are hesitant or impatient. Asking if they are willing to give two minutes every morning to perform exercises after wearing the appliance at night will allow you to help them to ensure no bite changes occur.

The exercises work to keep their teeth aligned and bite unchanged. This is also important for the back molars. Use of the oral appliance can keep the back molars from touching if exercises are not completed. Treatment requires dedication from the patient and dentist.

Disruption in Veneers and Crowns

It is also important to note that if a patient has veneers or crowns and they pop off, that has nothing to do with the oral appliance. In fact, it has everything to do with how the treatment was conducted. Veneers or crowns that fall off or crack are typically due to not being cemented in place properly. This has nothing to do with the oral appliance.

Document Everything

This might be the most important part about treatment for your patients–not only because it helps the patient, but because it can protect your office down the road. I cannot emphasize this enough, but you must:

Document everything you say and that it did take place.

I have made this sentence bold while standing on its own because it needs to be said and engrained in your mind for every patient that walks through your office doors. Document everything. And I do mean everything. By including every detail, you can ensure proper treatment is conducted and your patients are made aware of what you said.