Long-term side effects on the temporomandibular joints and orofacial function in patients with obstructive sleep apnea treated with a mandibular advancement device

Summary

Patients with obstructive sleep apnea (OSA) in long-term treatment with a mandibular advancement device (MAD) to increase the upper airway space, may develop changes in the temporomandibular joint (TMJ) and the orofacial function due to the protruded jaw position during sleep. The aim was to investigate the influence of long-term MAD treatment on the TMJs, orofacial function and occlusion. This prospective study included 30 men and 13 women (median age 54) with OSA (Apnoea-Hypopnoea Index (AHI): 7-57). They were examined with the Nordic Orofacial Test Screening (NOT-S), the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and cone beam computed tomography (CBCT) of the TMJs. The examination was performed before MAD treatment (T0), and 3-6 months (T1, no CBCT), 1 year (T2) and 3 years (T3) after treatment start. The results were analyzed as long-term (T0-T3, n=14) and short-term (T0-T2, n=24) by t-test, Fisher's exact test, and ANOVA. Both long- and short-term analysis revealed a reduction in AHI (p<0.002). Significant long-term were increased scores in the NOT-S Interview (p<0.045), reduced vertical overbite (p<0.031), and increased jaw protrusive movement (p<0.027). TMJ changes were found as joint sounds in terms of reciprocal clicking and crepitus, short-term as a decrease and subsequently recurrence (p<0.053; p<0.037). No significant radiological changes were found. In conclusion MAD treatment is beneficial to some OSA patients, but might induce changes in the TMJs, the orofacial function and the occlusion. However, these changes seemed to be less harmful than previously reported with careful adaptation, control and follow-ups.

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