Oral appliances are widely used to treat disruptive snoring and mild to moderate forms of obstructive sleep apnea (OSA), a common and life-threatening sleep disorder.

As the use of these appliances, which are sometimes referred to as mandibular advancement devices, has grown in recent years so has concern about potential effects on the temporomandibular joints. These joints, one on each side of the face, help connect the jaw to the skull; they also work with a complex network of nerves, muscles and other components to provide functionality for eating and speaking. In addition, they lend their name to temporomandibular joint disorder (TMJ), another common condition that can inhibit jaw performance and result in severe headaches, facial pain and other uncomfortable symptoms.

woman suffering from a migraine headache

Oral Appliances and Sleep Apnea

Mandibular advancement devices come in many forms. The versions offered by neuromuscular dentists to treat snoring and OSA offer a high level of customization to fit each patient’s unique bite structure and jaw position.

These oral appliances are designed to help the wearer maintain an open air passage by holding the jaw in a natural, forward resting position. They fit similarly to sports mouthguards, and most sleep apnea sufferers find them a comfortable alternative to continuous positive airway pressure (CPAP) machines.

In fact, many patients are unable to tolerate CPAP air-delivery masks and discontinue treatment, thus putting their health at risk. Oral appliances are highly recommended for sufferers of severe OSA who can’t maintain CPAP therapy.

Oral Devices and TMJ

Though oral appliances are effective in treating snoring and sleep apnea, doctors and researchers picked up on some patient complaints of jaw discomfort. Over the years, numerous patients with OSA have also been diagnosed with TMJ; research published in 2009 indicated that more than 50 percent of OSA patients had symptoms of TMJ.

A 2012 study examined whether there may be a link between mandibular advancement devices and signs and symptoms of TMJ. The research noted that long-term oral appliance use can strengthen the jaw muscles and foster slight bite corrections that may augment the benefits of oral devices. However, there was some concern that these changes may also stress the temporomandibular joints and contribute to the onset of TMJ.

Prior research demonstrated both increases and reductions in TMJ indicators related to the long-term use of oral appliances. This particular study focused on 15 patients (nine men and six women) undergoing mandibular advancement therapy for OSA, and followed up at 1 month, 3 months, 6 months and 2 years after beginning treatment. Of those who reported TMJ symptoms, the severity remained unchanged over the study period; most symptoms were described as minor and were well tolerated. Some symptoms, including jaw clicking and popping, were reported more frequently among patients who discontinued oral appliance treatment. A more limited study published in 2002 focused on seven male patients over a one-year treatment span and found no significant changes to or displacement of the temporomandibular joints.

Oral Appliances and TMJ: A New Review

Researchers in Spain recently completed a new review of data related to the impacts of mandibular advancement devices on the temporomandibular joints. They focused on 21 studies published between 2000 and 2015.

Scientists found that long-term treatment with an oral appliance often advanced the mandible’s condyles, the round protrusions atop each side of the jaw bone where it connects to the skull via the temporomandibular joints. The review found no adverse effects on the joints themselves, and indicated that oral devices may actually improve or prevent harm to joints that were initially at risk.

Denver neuromuscular dentist Dr. Kevin Berry understands how sleep apnea and TMJ can disrupt the lives of those who suffer from them. That’s why he is dedicated to helping people treat the source of their conditions and find lasting relief from their symptoms. If you believe you or a loved one may suffer from OSA or TMJ, please call the TMJ Therapy & Sleep Center of Colorado at (303) 691-0267 to schedule a consultation.