Management of Side Efffects of Oral Appliance Therapy for Sleep-Disordered Breathing

Publication Date: October 1, 2017
Last Updated: March 14, 2022

Recommendations

The management of side effects is essential to maximize treatment adherence and the clinical effectiveness of oral appliances. The guideline further states that although multiple manuscripts refer to side effects, the overall evidence is limited and of low quality.
6731

Transient Morning Jaw Pain

“Watchful waiting, palliative care, isometric contraction and passive jaw exercise, and decreasing the titration rate are considered first-line treatments to manage transient jaw pain.”
6731

Persistent Temporomandibular Joint Pain

“Palliative care, isometric contraction and passive jaw stretching exercises, verifying or correcting midline positions, appliance adjustment, decreasing the titration rate, decreasing advancement, and conducting a temporomandibular disorder work-up and management are considered first-line treatments to manage persistent temporomandibular joint pain. Placing posterior stops or anterior discluding elements, decreasing wearing time and temporarily discontinuing use of oral appliance therapy are considered second-line treatments. If these treatment options are insufficient or inappropriate, using a daytime intraoral orthotic, prescribing a steroid dose pack, recommending a different oral appliance design, referring to a dental specialist or additional health care provider, and permanently discontinuing oral appliance therapy may also be appropriate.”
6731

Tenderness in Muscles of Mastication

“Palliative care, watchful waiting, verifying or correcting midline positions, use of a morning occlusal guide, and isometric contraction and passive jaw stretching exercises are considered first-line treatments to manage tenderness in the muscles of mastication. Decreasing oral appliance advancement, vertical dimension, and the rate of forward titration, modifying the acrylic, and temporarily discontinuing use of oral appliance therapy are considered secondline treatments. If these treatment options are insufficient or inappropriate, recommending a different oral appliance design, referring to a dental specialist or additional health care provider, and permanently discontinuing oral appliance therapy may also be appropriate. In very rare instances, increasing oral appliance advancement may be indicated.”
6731

Joint Sounds

“Watchful waiting is considered first-line treatment to manage joint sounds caused as a result of using an oral appliance. If this treatment option is insufficient or inappropriate, temporary or permanent discontinuation of oral appliance therapy may also be considered.”
6731

Soft Tissue and Tongue Irritation

“Palliative care and appliance modification are considered first-line treatments to manage soft tissue and tongue irritation side effects. Temporarily discontinuing use of the oral appliance is considered second-line treatment. If these treatment options are insufficient or inappropriate, orthodontic wax and switching to a different oral appliance design may also be considered appropriate.”
6731

Gingival Irritation

“Modification of the appliance and palliative care are considered first-line treatments to manage gingival irritation. Discontinuing oral appliance therapy temporarily is considered second-line treatment.”
6731

Excessive Salivation

“Watchful waiting is considered first-line treatment to manage excessive salivation/drooling. Modification to the appliance is considered second-line treatment. If these treatment options are insufficient or inappropriate, prescribing medications to decrease salivary input may also be appropriate.”
6731

Dry Mouth

“Palliative care, watchful waiting, and decreasing vertical dimension of the device to encourage lip seal, are considered first-line treatments to manage dry mouth. Modification of the appliance and techniques for discouraging mouth breathing are considered second-line treatments. If these treatment options are insufficient or inappropriate, avoiding commercial mouth rinses with alcohol or peroxide, mouth-taping, and referring to an additional health care provider may also be considered appropriate.”
6731

Altered Occlusal Contacts/Bite Changes

“Watchful waiting, jaw stretching exercises, and use of a morning occlusal guide are considered first-line treatments to manage altered occlusal contacts or bite changes. Chewing hard gum in the mornings and making modifications to the appliance are considered second-line treatments. If these treatment options are insufficient or inappropriate, discontinuing oral appliance therapy temporarily or permanently may also be appropriate.”
6731

Incisor Changes

“Watchful waiting, use of a morning occlusal guide and modification to the appliance are considered first-line treatments to manage incisor angulation and position changes. If these treatment options are insufficient or inappropriate, recommending a different oral appliance design and discontinuing oral appliance therapy permanently may also be appropriate treatment options.”
6731

Decreased Overjet and Overbite

“Watchful waiting, isometric contraction and passive jaw stretching exercises, and use of a morning occlusal guide are considered first-line treatments to manage decreased overjet and overbite. Chewing hard gum in the morning is considered second-line treatment.”
6731

Alterations in Position of Mandibular Canines and Molars

“Watchful waiting and use of a morning occlusal guide are considered first-line treatments to manage altered positions of mandibular canines and molars.”
6731

Inter-Proximal Gaps

“Watchful waiting, use of a morning occlusal guide, adjusting ball clasps and making modifications to the appliance are considered first-line treatments to manage interproximal gaps. If these treatment options are insufficient or inappropriate, use of a distal wrap-around retainer and restoration of contact areas may be appropriate.”
6731

Tooth Mobility

“Palliative care and modifying the appliance are considered first-line treatments to manage tooth mobility. Decreasing the titration rate is considered second-line treatment. If these treatment options are insufficient or inappropriate, daytime/fixed splinting of teeth may also be appropriate.”
6731

Tooth Fractures or Damage to Dental Restorations

“Modifying the appliance and referral to a general/ restorative dentist are considered first-line treatments to manage tooth fractures or damage to dental restorations. If these treatment options are insufficient or inappropriate, recommending a different oral appliance design may also be appropriate.”
6731

Appliance Breakage

“Repairing or replacing the appliance is considered first-line treatment to manage appliance breakage. If these treatment options are insufficient or inappropriate, recommending a different oral appliance design may also be appropriate.”
6731

Allergies to Appliance Materials

“Removing the allergenic material and temporary discontinuation of oral appliance use are considered first-line treatments to manage allergies to appliance material. If these treatment options are insufficient or inappropriate, referring to another health care provider may also be considered as a treatment option.”
6731

Gagging

“Modification to the appliance is considered first-line treatment to manage gagging. Deprogramming the gag reflex is considered second-line treatment. If these treatment options are insufficient or inappropriate, recommendation of a different oral appliance design may also be appropriate.”
6731

Anxiety

“Watchful waiting and use of desensitization techniques are considered first-line treatments to manage anxiety. If these treatment options are insufficient or inappropriate, recommending a different oral appliance design and referring to a different health care provider may also be appropriate.”
6731

Recommendation Grading

Overview

Title

Management of Side Effects of Oral Appliance Therapy for Sleep-Disordered Breathing

Authoring Organization

Endorsing Organizations

Publication Month/Year

October 1, 2017

Last Updated Month/Year

January 17, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Physician, dentist, nurse, nurse practitioner, physician assistant

Scope

Assessment and screening, Diagnosis, Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D020919 - Sleep Disorders, Intrinsic, D005115 - Extraoral Traction Appliances

Keywords

sleep-disordered breathing, oral appliance therapy, Temporomandibular joint-relatedside effects, Intraoral tissue-related side effects, Occlusal changes, Appliance Issues

Supplemental Methodology Resources

Methodology Supplement