Sleep bruxism, snoring, and headaches in adolescents: short-term effects of a mandibular advancement appliance

Sleep Med. 2013 Jul;14(7):656-61. doi: 10.1016/j.sleep.2013.03.009. Epub 2013 May 2.


Objectives: Sleep bruxism (SB) frequently is associated with other sleep disorders and pain concerns. Our study assesses the efficacy of a mandibular advancement appliance (MAA) for SB management in adolescents reporting snoring and headache (HA).

Methods: Sixteen adolescents (mean age, 14.9±0.5) reporting SB, HA (>1d/wk), or snoring underwent four ambulatory polysomnographies for baseline (BSL) and while wearing MAA during sleep. MAA was worn in three positions (free splints [FS], neutral position [NP], and advanced to 50% of maximum protrusion [A50]) for 1 week each in random order (FS-NP-A50 or NP-A50-FS; titration order, NP-A50). Reports of HA were assessed with pain questionnaires.

Results: Overall, sleep variables did not differ across the four nights. SB index decreased up to 60% with MAA in A50 (P=.004; analysis of variance). Snoring was measured as the percentage of sleep time spent snoring. The subgroup of snorers (n=8) showed significant improvement with MAA (-93%; P=.002). Initial HA intensity was reported at 42.7±5/100 mm, showing a decreasing trend with MAA (-21% to -51%; P=.07).

Conclusion: Short-term use of an MAA appears to reduce SB, snoring, and reports of HA. However, interactions between SB, breathing during sleep, and HA as well as the long-term effectiveness and safety of MAA in adolescents need further investigation.

Keywords: Headache; Mandibular advancement appliance; Pediatrics; Polysomnography; Sleep; Sleep bruxism; Snoring.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Cross-Over Studies
  • Female
  • Headache / etiology
  • Headache / therapy*
  • Humans
  • Male
  • Mandibular Advancement / instrumentation*
  • Occlusal Splints*
  • Polysomnography
  • Sleep
  • Sleep Bruxism / complications
  • Sleep Bruxism / diagnosis
  • Sleep Bruxism / therapy*
  • Snoring / etiology
  • Snoring / therapy*
  • Treatment Outcome