Oral appliances are a viable and promising treatment option for the management of obstructive sleep apnea (OSA) that have shown good patient adherence and acceptance. However, one of the main limitations of oral appliances is their long-term side-effects.
Research has shown dentoalveolar changes leading to changes in occlusion with oral appliance use. Mainly, the changes are in the form of a reduction in overbite and overjet, maxillary incisor retrusion and mandibular incisor protrusion, mesialization of the mandibular molars, and distalization of the maxillary molars, as well as changes in dental arch crowding.
These dental changes develop as a result of the forces exerted on the upper and lower arches due to both the mandibular protrusion and the counteracting forces trying to return the mandible to its resting position. However, it is not yet clear whether these changes are progressive in nature or if they stop progressing after a certain number of years of oral appliance use. Additionally, it is unclear if there are irreversible skeletal changes associated with oral appliance treatment.
The objectives of my research, “Long-Term Side Effects of Sleep Apnea Treatment with Oral Appliances,” were to determine the nature of the changes associated with long-term oral appliance treatment (ie, dental and/or skeletal), to evaluate the magnitude and progression of these changes, and to determine if initial patient and dental characteristics are possible predictors of the observed long-term side effects of treatment.
By employing cephalometric analysis (using radiographs of the facial, dental, and skeletal structures to assess relationships), we were able to characterize the nature, magnitude, and progression of the oral appliance side effects, which is an important step toward mitigation.
Our study analyzed baseline and follow-up lateral cephalograms of 62 patients treated with oral appliance therapy for OSA. The average followup period was 12.6 years (range: 8 to 21 years), making this the longest evaluation to date of oral appliance therapy side effects. Results show that there were significant and progressive dental changes with prolonged oral appliance use, mainly in the form of upper incisor retroclination and lower incisor proclination, but there were no clinically significant skeletal changes.
While these dental changes are mostly considered negative, they could not and should not be corrected by an orthodontist as long as these patients are using the oral appliance, as they are ongoing changes. These changes will return if they are corrected as long as the patient is still using the oral appliance. They can only be corrected by an orthodontist if the patient chooses not to use the oral appliance anymore and uses another OSA treatment instead.
In particular, this research confirms that serious skeletal changes should not be a major concern for long-term oral appliance users. Even though major dental changes may occur, these side effects should not deter patients from continuing oral appliance therapy if it proves to be an effective OSA treatment for them, unless they are willing to adhere to another effective treatment. Conclusively, because oral appliance therapy for OSA is a lifelong treatment, this study confirms the need for careful and extended patient followup by a qualified dentist to evaluate possible dental side effects with prolonged durations of oral appliance use.
Dr. Hamoda is from the University of British Columbia (UBC) and was the recipient of the American Academy of Dental Sleep Medicine (AADSM) Student Excellence Clinical Research Award at the Academy’s 26th Annual Meeting in Boston, Mass. She can be reached at monahamoda@alumni.ubc.ca.
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