Sleep and Breathing Study Shows Oral Appliance Therapy is Effective and Does Not Cause Impairment of TM Joint

A new study has shown that oral appliances are effective in improving daytime sleepiness as measured by ESS (Epworth Sleepiness Score) and does not impair the TM Joints. Bite changes and tooth movement is a frequently reported side effect of appliance wear. It is rarely a serious problem and patients accept the changes and continue to prefer oral appliances to CPAP. This study is important because it shows that these changes do not adversly affect the TM Joints. The changes are actually similar to those seen with long time wear of an orthotic to treat TMJ disorders. The change in bite is partially due to unloading the joint during the night which allows healing. Most TM Joint internal derangements are caused by overloading the joint.

This makes sense because Sleep Apnea is a TMJ or Jaw disorder. The NHLBI has a report on “Cardiovascular and sleep related consequences of TMJ disorders” The fact that some patients experience and seek treatment for pain does not preclude a sleep disorder. Female patients are more prone to TMD (temporomandibular dysfunction) with related pain complaints while male patients are more likely to complain of symptoms related to snoring and apnea. There is a common pathway and many anatomical similarities to both disorders. Information on oral appliance treatment of sleep apnea is available at

PubMED abstract below.
Sleep Breath. 2009 Nov;13(4):375-81. Epub 2009 May 1.
Systematic assessment of the impact of oral appliance therapy on the temporomandibular joint during treatment of obstructive sleep apnea: long-term evaluation.

Giannasi LC, Almeida FR, Magini M, Costa MS, de Oliveira CS, de Oliveira JC, Kalil Bussadori S, de Oliveira LV.
Institute of Research and Development IP&D, University of Vale do Paraíba, São Paulo, Brazil.
OBJECTIVE: The aim of the present study was to evaluate the symptoms of temporomandibular dysfunction (TMD) in patients with obstructive sleep apnea treated with long-term use of an oral appliance (OA) using a questionnaire based on the Helkimo Anamnestic Dysfunction Index. A further aim of the study was to evaluate the presence of daytime sleepiness using the Epworth Sleep Scale (ESS) and otologic symptoms. MATERIALS AND METHODS: Polysomnograms of 34 patients were performed at baseline and after 6 months of OA use. As follow-up, the patients were contacted by telephone interview to answer the same questionnaires after 36.0 +/- 17.0 months. RESULTS AND DISCUSSION: The intensity of TMD symptoms decreased significantly throughout treatment (p < 0.01). ESS values improved from 12.2 +/- 5.0 to 6.9 +/- 2.6 (p < or = 0.05). Tinnitus was present in nine patients at baseline and decreased in intensity in seven patients by the final assessment while remaining at the same level in two patients. CONCLUSIONS: We conclude that long-term usage of an OA does not cause impairment to the temporomandibular joint. The Helkimo and otologic indexes are simple and useful in long-term patient follow-up. There was a long-term improvement in the ESS values over the years analyzed. A follow-up program could increase compliance by motivating patients to use the device regularly.