The incidence and prevalence of temporomandibular disorders and posterior open bite in patients receiving mandibular advancement device therapy for obstructive sleep apnea
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This study aims to evaluate the incidence and prevalence of temporomandibular disorders (TMD) in patients receiving a mandibular advancement device (MAD) to treat obstructive sleep apnea using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). In addition, it also aims to assess the development of posterior open bite (POB).
Materials and methods
Data from 167 patients were evaluated at baseline, from 159 patients after 118 days (visit II), from 129 patients after 208 days (visit III), and from 85 patients after 413 days (visit IV). The presence of TMD symptoms was evaluated through a questionnaire. TMD signs were assessed using the RDC/TMD. Clinical evaluation assessed for the presence of POB.
The prevalence of TMD was 33/167 (19.8 %) at baseline. After an initial decrease to 14.5 % on visit II, the prevalence increased to 19.4 % on visit III and finally demonstrated a decrease to 8.2 % on visit IV. The incidence of TMD was 10.6 % on visit II. This decreased on further visits and only two (1.9 %) patients developed TMD from visit III to visit IV. POB was found to develop with an average incidence of 6.1 % per visit. The prevalence of POB was 5.8 % on visit II, 9.4 % on visit III, and 17.9 % on visit IV.
The use of MADs may lead to the development of TMD in a small number of patients. Nevertheless, these signs are most likely transient. Patients with pre-existing signs and symptoms of TMD do not experience significant exacerbation of those signs and symptoms with MAD use. Furthermore, these may actually decrease over time. POB was found to develop in 17.9 % of patients; however, only 28.6 % of these patients were aware of any bite changes.
KeywordsMandibular advancement device Oral appliance Temporomandibular disorders Obstructive sleep apnea Side effects
We would like to thank those who contributed to this publication: Felipe Porto, Tory Eisenlohr-Moul, Jessica Burris, Isabel Moreno H, and Po Chin Lin.
- 6.Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, Boehlecke B, Brown TM, Coleman J Jr, Friedman L, Kapen S, Kapur VK, Kramer M, Lee-Chiong T, Owens J, Pancer JP, Swick TJ, Wise MS (2006) Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 29(3):375–380PubMedGoogle Scholar
- 9.Kushida CA, Morgenthaler TI, Littner MR, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Owens J, Pancer JP (2006) Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep 29(2):240–243PubMedGoogle Scholar
- 24.De Leeuw R, American Academy of Orofacial P (2008) Orofacial pain: guidelines for assessment, diagnosis, and management. Quintessence, ChicagoGoogle Scholar
- 27.Giannasi LC, Almeida FR, Magini M, Costa MS, de Oliveira CS, de Oliveira JC, Kalil Bussadori S, de Oliveira LV (2009) Systematic assessment of the impact of oral appliance therapy on the temporomandibular joint during treatment of obstructive sleep apnea: long-term evaluation. Sleep Breath 13(4):375–381PubMedCrossRefGoogle Scholar
- 32.Chen H, Lowe AA, de Almeida FR, Fleetham JA, Wang B (2008) Three-dimensional computer-assisted study model analysis of long-term oral-appliance wear. Part 2. Side effects of oral appliances in obstructive sleep apnea patients. Am J Orthod Dentofacial Orthop 134(3):408–417PubMedCrossRefGoogle Scholar
- 42.Ueda H, Almeida FR, Chen H, Lowe AA (2009) Effect of 2 jaw exercises on occlusal function in patients with obstructive sleep apnea during oral appliance therapy: a randomized controlled trial. Am J Orthod Dentofacial Orthop 135 (4):430 e431-437; discussion 430-431Google Scholar
- 45.Doff MH, Veldhuis SK, Hoekema A, Slater JJ, Wijkstra PJ, de Bont LG, Stegenga B (2011) Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side effects. Clin Oral Investig. doi: 10.1007/s00784-011-0555-6
- 47.Al-Ani MZ, Davies SJ, Gray RJ, Sloan P, Glenny AM (2004) Stabilisation splint therapy for temporomandibular pain dysfunction syndrome. Cochrane Database Syst Rev (1):CD002778Google Scholar
- 50.Okeson JP (2008) Management of temporomandibular disorders and occlusion. Mosby, St. LouisGoogle Scholar
- 58.Sari E, Menillo S (2011) Comparison of titratable oral appliance and mandibular advancement splint in the treatment of patients with obstructive sleep apnea. doi: 10.5402/2011/581692
- 59.Ahrens A, McGrath C, Hagg U (2011) A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnoea. Eur J Orthod. 33(3):318–324Google Scholar
- 60.Mehta A, Qian J, Petocz P, Darendeliler MA, Cistulli PA (2001) A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med 163(6):1457–1461Google Scholar