Side effects of boil and bite type oral appliance therapy in sleep apnea patients

Tsuda, Hiroko; Almeida, Fernanda R.; Masumi, Shin-ichi; Lowe, Alan A.

doi:10.1007/s11325-009-0304-0

Cited by 30 publications

(25 citation statements)

References 20 publications

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“…84 In this study, 33% of patients cited poor overnight retention as the main reason for compliance failure whereas a later study by Tsuda et al recorded 77.8% of non-users of thermoplastic OAs were non-compliant in the first three months complaining of poor comfort and fit of the device. 85 It is now generally accepted that customfabricated OAs are better tolerated and, in particular, remain in place during sleep and are more efficacious compared to a thermoplastic OA. 84,86 Oral appliance titration Titratable OAs are usually activated by means of a screw, elastomeric chain or hook attachment that incrementally advances the mandible.…”

Section: Oral Appliance Device Typementioning

confidence: 99%

Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea

et al. 2013

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The purpose of this review is to provide guidelines for the use of oral appliances (OAs) for the treatment of snoring and obstructive sleep apnoea (OSA) in Australia. A review of the scientific literature up to June 2012 regarding the clinical use of OAs in the treatment of snoring and OSA was undertaken by a dental and medical sleep specialists team consisting of respiratory sleep physicians, an otolaryngologist, orthodontist, oral and maxillofacial surgeon and an oral medicine specialist. The recommendations are based on the most recent evidence from studies obtained from peer reviewed literature. Oral appliances can be an effective therapeutic option for the treatment of snoring and OSA across a broad range of disease severity. However, the response to therapy is variable. While a significant proportion of subjects have a near complete control of the apnoea and snoring when using an OA, a significant proportion do not respond, and others show a partial response. Measurements of baseline and treatment success should ideally be undertaken. A coordinated team approach between medical practitioner and dentist should be fostered to enhance treatment outcomes. Ongoing patient follow-up to monitor treatment efficacy, OA comfort and side effects are cardinal to long-term treatment success and OA compliance.Keywords: Mandibular advancement splint, obstructive sleep apnoea, oral appliance, review, snoring.Abbreviations and acronyms: AASM = American Academy of Sleep Medicine; ADA = Australian Dental Association; AHI = apnoeahypopnoea index; ASA = Australasian Sleep Association; BMI = body mass index; CBCT = cone beam computed tomography; CT = computed tomography; ESS = Epworth Sleepiness Scale; MAS = mandibular advancement splints; OA = oral appliances; OSA = obstructive sleep apnoea; PSG = polysomnogram; SDB = sleep disordered breathing; TMD = temporomandibular disorder; TMJ = temporomandibular joint; TRD = tongue retaining device; TSD = tongue stabilizing device; UARS = upper airway resistance syndrome; UPPP = uvulopalatopharyngoplasty.

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Section: Oral Appliance Device Typementioning

confidence: 99%

Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea

et al. 2013

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“…OSAS patients often encounter jaw symptoms (pain/discomfort) during an initial period following the commencement of oral appliance use. [12][13][14][15] In addition, longterm use of an oral appliance is associated with dentoskeletal Although it has been proposed that MAS contractions play a supporting role in reinstating the compromised upper airway, 16 physiological understanding of MAS contractions in patients with OSAS is limited. MAS contractions are usually associated with the termination of apnea-hypopnea events, while MAS contractions do not always occur after respiratory events in patients with OSAS.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Responsiveness of Jaw Motor Activation to Arousals during Sleep in Patients with Obstructive Sleep Apnea Syndrome

Kato

Katase

Yamashita

et al. 2013

Journal of Clinical Sleep Medicine

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“…Although many types are available [13–16], all MADs require retention on the teeth to maintain protrusion of the mandible during sleep. Lack of retention causes loosening of the MAD and might result in reduced efficacy of OSA treatment, patient complaints about poor fit and an increased risk of side effects [15, 17, 18]. …”

Section: Introductionmentioning

confidence: 99%

Retention of mandibular advancement devices in the treatment of obstructive sleep apnea: an in vitro pilot study

2013

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PurposeIn order for a mandibular advancement device (MAD) to be efficacious, it must remain seated on the teeth during sleep. Quantitative data on the retentive characteristics of MADs are currently unavailable. The present pilot study is the first to describe an in vitro setup testing the retentive characteristics of different monobloc MADs.MethodsA hydraulic cyclic test machine was used with MADs seated on dental casts to measure retention forces upon removal of the MADs. A custom-made monobloc (CM-mono), a thermoplastic monobloc (TP-mono), and a thermoplastic duobloc (TP-duo) configured as a monobloc were tested. Two protrusions were investigated, representing 25 and 65 % of the maximal protrusion. The effects of the type of MAD, duration of the test, and amount of protrusion on removal forces were measured.ResultsThe measured removal forces of all three MADs tested differed significantly, with the TP-duo showing the highest values (P < 0.0001). The effects of wear due to the repetitive cyclic loading became obvious by the production of wear particles in all MADs tested. However, only the TP-duo showed a significant reduction in time in removal forces for both protrusion positions (P < 0.0001; P = 0.0011). The effect of the amount of protrusion on the removal forces differed significantly between all three MADs tested (P = 0.0074).ConclusionsThis in vitro pilot study reveals significant differences in retention forces for the MADs tested. The findings are consistent with clinical effects of nightly loss of MADs as reported in the literature and are within the range of reported physiological mouth-opening forces. Future research is needed to determine the key design features of MADs that explain these differences.

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Side effects of boil and bite type oral appliance therapy in sleep apnea patients

Cited by 30 publications

References 20 publications

Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea

Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea

Responsiveness of Jaw Motor Activation to Arousals during Sleep in Patients with Obstructive Sleep Apnea Syndrome

Retention of mandibular advancement devices in the treatment of obstructive sleep apnea: an in vitro pilot study

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