Table of Contents
Sleep Apnea; Problems with Anti Snoring Devices
The Side Effects of tooth borne snoring appliances
Because of the very serious consequences of sleep apnea, the following negative consequences of prolonged wearing of a dental appliance to overcome the syndrome are really a small price to pay for the improvement in the quality and the length of life that these appliances provide.
The down side to anti-snoring devices is that constant pull of the muscles of the lower jaw places forces upon the entire dentition, both upper and lower. Over time, some tooth movement tends to take place so that eventually the upper and lower teeth do not seem to “bite” together properly. Most of the time, because the teeth in each arch (upper and lower) are splinted together by the appliance, there is little visible movement of individual teeth relative to their immediate neighbors. However, there may tilt, or even bodily movement over time in each arch. This may cause the upper and lower teeth to feel as though they do not properly come together.
This problem can be reversed to a certain extent by taking a two day break from wearing the appliance every month. In most cases, however, once a patient experiences the improvement in quality of life providec]d by improved breathing during sleep, he or she is generally reluctant to give up the splint even for a single day.
While the problem of tooth movement can be a problem for a patient, most of the time patients are more than willing to adapt to a new bite in exchange for the relief of the symptoms of sleep apnea.
Posterior open bite
A mandibular advancement appliance draws the condyle in the TM joint foreward. Over time, the body adjusts to this by building more soft tissue behind the condyle which tends to keep the lower jaw in a slightly protruded position permanently. This can cause the patient to experience contact of the upper and lower teeth only in the front teeth instead of on the back teeth as is the case in normal occlusion. For a few patients, this can be quite a problem, but in a vast majority of patients, the discrepancy is relatively small, and can even improve the quality of life because if the back teeth can’t contact with force, the patient can no longer brux (Grind) their teeth. Bruxing is a major cause of headaches and other symptoms of TMJ. Keep in mind that in normal circumstances, the back teeth do not contact, even when chewing, unless the patient has a parafunctional habit.
Interestingly, patients who tend to clench and grind their back teeth during the day do not usually suffer the problem of open posterior bite or permanently advanced lower jaw because their habits push the condyle backwards in the joint capsule, and prevent the buildup of th soft retrodiscal tissue in the first place.
As a rule, joint pain happens when protrusive adjustments are made too quickly. If the adjustments to the appliance are done gradually, any joint pain is minor and gradually fades away. There is, however, a limit in how far the TM joints can be be stretched, and the patient will know when that limit has been reached. any overextension can easily be reversed to relieve the pain and maintain the relief of the symptoms of sleep apnea.
Important: Even if the protrusive movement permitted by the patient’s TM joints is limited, substantial breathing relief can still be achieved because in the process of moving the tongue and soft palate forward, the appliance is also creating more LATERAL (side to side rather than front to back) space between these structures and the back of the throat. The increase in the lateral can substantially increase the luminal area (the volume of space available for air to flow) in the windpipe.
Generally pain in any given tooth is due to excessive pressure placed on that tooth by the plastic of the appliance. Most of the time it is an easy adjustment for the dentist to make. Once the pressure is relieved, the pain subsides.
Muscle spasm and pain, like joint pain is generally temporary since the muscles adjust to the new position of the jaws over time. It can be avoided altogether by making the protrusive adjustments gradual.
Changes in salivary flow
Some people experience a dry mouth while wearing an appliance, however a majority experience increased salivary flow. both conditions are best dealt with by an appliance that keeps the jaws together, allowing the lips to remain closed throughout the night.
Crowns and filling dislodged
This is rarely a problem in a properly reconstructed and maintained mouth. Most of the time, whenever a crown or filling is dislodged by a sleep apnea appliance, it is because of recurrent decay under the restoration. This is the reason why dentists recommend that patients have their teeth properly repaired before having impressions taken for such an appliance.
Because healthy teeth are essential for the retention of these appliances, it is imperative that patients understand the incredible importance of good oral hygiene and regular dental care!!!