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Supporting Your Practice

What Are the Side Effects Associated with Oral Appliance Therapy?

Dr. Brad Lands
Orthodontist, Toronto

In this edition of CDA Oasis Live, Dr. John O’Keefe, Director of Knowledge Networks CDA, talks to Dr. Brad Lands, an orthodontist from Toronto, about the side effects associated with Oral Appliance Therapy.

Dr. Lands walks through the common side effects and how they can be managed. He also explains that while these side effects are commonplace, it is important to remember that sleep apnea itself is a very serious medical condition that can have some very serious consequences for the patient if left untreated.

“While bite changes are serious, I’d like to say that no one has died from an occlusal change. Whereas living with sleep apnea is a very serious issue.”

Here are the key takeaways from the conversation:

Common Side Effects of Oral Appliance Therapy

  • Temporal mandibular joint related side effects
  • Occlusal changes

Mitigation of Side Effects

  • When it comes to appliance design, it is not a case of “more is better.” 50% protrusion is an effective position for most patients. Starting at 75% or 100% protrusion may be excessive and there are diminishing returns once it goes beyond 50%.
  • Titrate the appliance slowly until the sweet spot is found. Jumping at 5mm intervals will cause a lot of joint discomfort.
  • Ensure that the appliance is advanced evenly on both sides. When the appliance is inserted ensure that the midlines are where they should be when the patient is protruding.
  • Morning positioner – something patients can clench into in the morning to help them find their occlusion more easily.
  • Isometric and passive jaw exercises – exercises designed to encourage the patient to find their occlusion more quickly in the morning and reduce the strain on muscles and joint.
  • Physiotherapist or chiropractor – referring to a physio or a chiropractor to release tension can go a long way to making the patient more comfortable.

Other OAT Management Tips

  • It is important to properly document cases using intra-oral scans, photos, models, protrusion measurements etc.
  • It is important to have an informed consent completed by the patient so that they are aware of potential long-term changes to occlusion.
  • Sleep apnea is a serious medical condition. Asking a patient to stop wearing the appliance is not something we should do without consulting their physician.

We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
CDA Oasis Team

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