MANAGEMENT of POTENTIAL SIDE-EFFECTS
of Mandibular Advancement Orthotics

Some dentists may express concern about the potential negative side-effects associated with the use of orthotics to reposition the mandible to dilate the airway. It should be understood that the importance of this therapy to the health, longevity and quality of life of the sleep apnea patient overwhelms any associated risks from the therapy. With good patient education, patient compliance with instructions and regular follow up examinations, risks associated with this therapy are virtually non-existent. Acute discomforts are readily reversible.

1. Dislodged dental restorations - This occurrence is rare. If anything, this is generally an advantage in locating teeth with inadequate restorations, failing cement, or undiagnosed caries.
   
   
2. Hypersalivation - Typically, those susceptible to this may have some excess saliva or even drooling during the two week accommodation period to the appliance. This is generally self-limiting with use.
   
   
3. Sore teeth - Some patients may report mild discomfort of their anterior teeth during the accommodation period. This may be improved with slight adjustments to the appliance, but it should be recognized that some discomfort may be related to the subconscious parafunctional movements of the mandible during sleep in the accommodation period. Often those complaints are self-limiting and absent at the two-week recall visit as the patient learns to relax in the appliance.
   
   
4. Minor tooth movement - Movement of any consequence is a relatively rare occurrence. This should be evaluated on a case by case basis, and looked for at regular dental check ups.
   
   
5. Muscle soreness - The patient should be instructed to follow instructions very closely on the appropriate method of incremental advancement of the mandible seeking the effective treatment position. Too rapid a rate may result in discomfort or muscle spasm. See Appliance Delivery Instructions for Dentists on this CD. Palliative treatment for muscle discomfort is recommended, e.g. soft diet, heat, massage, stretching, NSAIDS prn. When the patient is comfortable, repeat the delivery process with a slower rate of advancement.
   
   
6. Transient occlusal changes - Each morning, virtually every patient will report a transient posterior open bite. This is not likely due to the movement of teeth, but due to the shortened lateral pterygoid muscles. The head of the condyle has simply failed to return fully to its normal position in the joint, being under the influence of the pterygoids. The patient must be informed to be compliant daily with exercises to restore the bite properly. See the Leaf Gauge Exercise for TAP Users on this disk. A copy of these instructions should accompany each case, and the patient should be fully informed on its use. Typically, the bite can be restored within minutes. If discomfort is present or if the patient is having difficulty restoring centric occlusion easily early each day, the dentist should be informed.
   
   
7. Anterior open bite patients - Patients with an anterior open bite may be more susceptible to a permanent anterior repositioning of the mandible with occlusal change. With no anterior overbite to signal the transient morning advancement, proper stretching and bite recovery may be more difficult for the patient to sense. Contact Comfort Acrylics, Inc. to discuss the case. Perhaps a morning retainer to guide to the proper centric occlusion may be prudent.
   
   
8. Permanent Occlusal Change - The occurrence of permanent occlusal change has been dramatically reduced with the use of the leaf gauge and other morning exercises. It is always prudent to scrutinize the occlusion at regular dental visits and to include this relatively uncommon side-effect in the informed consent for care. A well-treated patient understands that the proper recovery of the bite early each morning and frequent observation will decrease the occurrence of bite changes.

The management of sleep disordered breathing patients is enormously rewarding. Proper informed consent, good patient education and regular follow up examinations can provide safe and effective patient care. The improvement in patients’ quality of life will often be surprisingly dramatic.

Questions?

If you have any questions, please feel free to call Comfort Acrylics, Inc. at 800-748-2566 or 360-834-9218. We will be happy to walk you through the process, even while your patient is in the chair. Thank you for using the TAP®!

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