Sleep and Breathing

, Volume 17, Issue 1, pp 323–332 | Cite as

The incidence and prevalence of temporomandibular disorders and posterior open bite in patients receiving mandibular advancement device therapy for obstructive sleep apnea

  • Cristina V. PerezEmail author
  • Reny de Leeuw
  • Jeffrey P. Okeson
  • Charles R. Carlson
  • Hsin-Fang Li
  • Heather M. Bush
  • Donald A. Falace
Original Article



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.


Mandibular 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.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Cristina V. Perez
    • 1
    Email author
  • Reny de Leeuw
    • 1
  • Jeffrey P. Okeson
    • 1
  • Charles R. Carlson
    • 2
  • Hsin-Fang Li
    • 3
  • Heather M. Bush
    • 3
  • Donald A. Falace
    • 4
  1. 1.Orofacial Pain CenterUniversity of KentuckyLexingtonUSA
  2. 2.Orofacial Pain Center, Department of PsychologyUniversity of KentuckyLexingtonUSA
  3. 3.BiostatisticsUniversity of KentuckyLexingtonUSA
  4. 4.Orofacial Pain CenterUniversity of Kentucky, RetiredLexingtonUSA

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