Surgery for snoring and sleep apnea has potential risks and side effects. As a surgeon writing this post, I feel like I have to emphasize that I know that these risks and side effects exist. In fact, my previous blog post cited the research I have done showing that the risk of serious medical complication after sleep apnea surgery is 1.6%, mainly in those with major medical problems before surgery. The goal of a surgeon and their team is to minimize those risks and discuss them with patients, who can weigh the benefits and risks of surgery. A key part of that discussion is having quality knowledge of surgical risks so that a discussion can be based on accurate information.
Oral appliances for snoring or sleep apnea have risks too
Oral appliances are a possible treatment for snoring and obstructive sleep apnea that work by holding the lower jaw in a forward position during sleep. Studies have shown that they can work well for some patients. In fact, I refer a number of patients to my dental colleagues, whether based on my office examination or drug-induced sleep endoscopy. Before referring my patients, I discuss the potential risks of oral appliances that are not life-threatening but that can be problematic. The most likely side effects of oral appliances are drooling, temporomandibular disturbances (muscular or related to the joint–also known as the TMJ), tooth pain, and movements of the teeth that can change a person’s bite. Tooth movements occur with oral appliances because the forces applied to the teeth, while not excessive, are applied for long periods of time while patients sleep.
The December 2014 issue of the Journal of Clinical Sleep Medicine included what is now the most thorough study of the long-term risks of tooth movements with oral appliances. Based on limited studies, it has been felt that most of these occur in the first 2 years and then never worsen. This study shows that the tooth movements continue far beyond the first 2 years of use. Alan Lowe, DMD, PhD and Fernanda Almeida, DDS, MSc, PhD at the University of British Columbia in Vancouver, Canada, are some of the world’s true experts in the use of oral appliances to treat snoring and sleep apnea. They have been using them for decades. When their patients wear out their oral appliance and needs a new one, they take impressions of the teeth and have saved them. Because they are such a busy center, they had a group of 77 patients with an average length of followup of 11 years. By making various measurements of the teeth from these casts, including in the same patients over time, they were able to measure the tooth movements that occur over time. They found the following:
- Most patients experience movements of the teeth, with continued movement over time.
- There were many types of tooth movements, ranging from pulling the upper teeth backwards to pushing the lower teeth forward to spreading out the teeth of the lower jaw (widening the arch of the teeth) to opening up spaces between the molars (potentially making chewing less effective).
- These changes were greater than previous studies had suggested, likely because those studies had not followed people over time as closely.
Because oral appliances should be worn throughout the night, every night, this study suggests that these tooth movements will be more likely to occur with greater use.
The Bottom Line: Oral Appliances Have Risks, Just Like All Treatments
Oral appliances for snoring or sleep apnea are still a good treatment option for some patients. However, just as with surgery, it is important to discuss the risks and benefits fully with patients. Many patients will gladly accept these tooth movements for the chance to improve their snoring or sleep apnea. However, for oral appliances to work, they should be worn throughout the night, every night, just like CPAP; this study suggests that these tooth movements will be more likely to occur with more use of the oral appliance.