Original Article

Sleep and Breathing

, Volume 13, Issue 4, pp 375-381

Systematic assessment of the impact of oral appliance therapy on the temporomandibular joint during treatment of obstructive sleep apnea: long-term evaluation

  • Lílian C. GiannasiAffiliated withInstitute of Research and Development IP&D, University of Vale do ParaíbaSleep Laboratory, Rehabilitation Sciences Master’s Program, Nove de Julho University Email author 
  • , Fernanda R. AlmeidaAffiliated withUniversity of Vancouver
  • , Márcio MaginiAffiliated withInstitute of Research and Development IP&D, University of Vale do Paraíba
  • , Maricília S. CostaAffiliated withInstitute of Research and Development IP&D, University of Vale do Paraíba
  • , Cláudia S. de OliveiraAffiliated withSleep Laboratory, Rehabilitation Sciences Master’s Program, Nove de Julho University
  • , Júlio César Mendes de OliveiraAffiliated withSleep Laboratory, Rehabilitation Sciences Master’s Program, Nove de Julho University
  • , Sandra Kalil BussadoriAffiliated withSleep Laboratory, Rehabilitation Sciences Master’s Program, Nove de Julho University
  • , Luis Vicente F. de OliveiraAffiliated withSleep Laboratory, Rehabilitation Sciences Master’s Program, Nove de Julho University

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Abstract

Objective

The aim of the present study was to evaluate the symptoms of temporomandibular dysfunction (TMD) in patients with obstructive sleep apnea treated with long-term use of an oral appliance (OA) using a questionnaire based on the Helkimo Anamnestic Dysfunction Index. A further aim of the study was to evaluate the presence of daytime sleepiness using the Epworth Sleep Scale (ESS) and otologic symptoms.

Materials and methods

Polysomnograms of 34 patients were performed at baseline and after 6 months of OA use. As follow-up, the patients were contacted by telephone interview to answer the same questionnaires after 36.0 ± 17.0 months.

Results and discussion

The intensity of TMD symptoms decreased significantly throughout treatment (p < 0.01). ESS values improved from 12.2 ± 5.0 to 6.9 ± 2.6 (p ≤ 0.05). Tinnitus was present in nine patients at baseline and decreased in intensity in seven patients by the final assessment while remaining at the same level in two patients.

Conclusions

We conclude that long-term usage of an OA does not cause impairment to the temporomandibular joint. The Helkimo and otologic indexes are simple and useful in long-term patient follow-up. There was a long-term improvement in the ESS values over the years analyzed. A follow-up program could increase compliance by motivating patients to use the device regularly.

Keywords

Oral appliance Temporomandibular joint Temporomandibular disorder Sleepiness Quality of life