Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: A randomized, placebo-controlled trial on temporomandibular side-effects

Clin Exp Dent Res. 2020 Aug;6(4):400-406. doi: 10.1002/cre2.288. Epub 2020 Apr 4.

Abstract

Purpose: To assess the differences in the frequency of clinical signs of temporomandibular disorder (TMD) pain and mandibular function impairment between mandibular advancement device (MAD) and nasal continuous positive airway pressure (nCPAP) therapies in obstructive sleep apnea (OSA) patients at baseline and after 6 month of treatment.

Methods: This study concerns a secondary analysis of a randomized placebo-controlled trial in which different treatment effects of an objectively titrated MAD were compared with those of nCPAP and an intra-oral placebo appliance in a parallel design. Sixty-four mild to severe OSA patients (52.0 ± 9.6 years) were randomly assigned to these three groups. All patients underwent a shortened functional examination of their masticatory system at baseline and after 6 months to establish the presence of clinical signs of TMD pain. Mandibular function impairment was assessed with a questionnaire.

Results: Clinical signs of TMD pain were only rarely present at baseline and therapy evaluation. No significant differences were found between the three groups in the (low) frequency of clinical signs of TMD pain at both time points (p = .401-.176). In addition, the (low) scores of mandibular function impairment did not differ between the three groups either, neither at baseline (p = .744) nor after 6 months (p = .359).

Conclusions: A low frequency of clinical signs of TMD pain in mild to severe OSA patients was found after 6 months, regardless of treatment with MAD or nCPAP. In addition, no difference in mandibular function impairment was observed between the different treatment modalities.

Keywords: continuous positive airway pressure; oral appliance; side-effects; sleep apnea; temporomandibular disorders.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Continuous Positive Airway Pressure / adverse effects*
  • Humans
  • Mandibular Advancement / instrumentation*
  • Occlusal Splints / adverse effects*
  • Placebo Effect
  • Sleep Apnea, Obstructive / pathology
  • Sleep Apnea, Obstructive / therapy*
  • Surveys and Questionnaires
  • Temporomandibular Joint Disorders / etiology
  • Temporomandibular Joint Disorders / pathology*
  • Treatment Outcome