Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Monday, January 25, 2010

Bite Change with TAP 3 Oral Appliance Cures Sleep Apnea But Changes Your Bite. What comes next?

JIM:
I have a TAP3 appliance for OSA and I found that using it every night for 2 years changed my bite to where I could not get it back into alignment even using the little blue tabs every day. I am back on CPAP, but if you have any suggestions, I would love to hear them.

Dr Shapira Response: Bite changes often happen after long term year especially if patients do not do 2 minutes of exercise daily. I have a few thousand patients with oral appliances and rarely do they quit because of bite changes. Not wearing the appliance will often let bite settle back to its original position or possibly settle back incompletely.

I explain to my patients up-front about the changes because I hate surprises. The reasons that your bite changes is that it was pathological to begin with. The reason you had sleep apnea was due to a jaw relation that predisposed you to the problem. When you wore the appliance at night you corrected the 24/7 pathology eight hours a day. Your bite change is actually healing of the underlying pathology of your jaw position. Your apnea actually becomes less severe even when you are not wearing your CPAP. Therefore when they titrate you on CPAP it may be wrong in a few months. As your jaw returns to old position the apnea will worsen again. An advantage to a bite change is lower CPAP pressure initially.

Patients sometimes switch between oral appliances and CPAP to prevent bite changes (very effective) but in general dentists seem more upset by the bite changes than patients.

I have had many patients who report relief of neck pain, headaches, back pain, sinus pain and other problems and that pushing the bite back causes recurrence of symptom so they chose to ignore the exercises and let the bite changes happen.

When we treat patients with TMJ disorders or headaches we have them wear an appliance 24/7 and want the bite change an then if tx is successful make the new jaw position permanent with crowns, ortho or occlusal adjustment.

You did not say wether you are now wearing your CPAP all night - every night. Dying in your sleep or having a stroke is a big deal, a bite change is manageable.

The key to preventing bite changes is to do the exercises regularly from the beginning and continue. If bite changes begin discuss it with your dentist promptly.

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posted by Dr Shapira at 6:42 PM