Treating obstructive sleep apnea and snoring: Assessment of an anterior mandibular positioning device

Background, Dental devices have been used to help manage snoring and obstructive sleep apnea, or OSA. This article reports on patients' compliance with and complications of long-term use of an anterior mandibular positioning, or AMP, device. Methods, The device used was a custom-made, two-piece, full-coverage, adjustable acrylic appliance, connected with Herbst attachments. The appliance was used nightly and advanced the mandible by 75 percent of the patient's maximum protrusive distance. Patients were telephoned to determine whether they were still using the AMP device. If not, they were asked when and why they stopped using it. The study sample included 65 consecutive patients with mild-to-moderate obstructive sleep apnea and snoring. Results, Long-term use (three years or more) of the AMP device in these patients was 51 percent (27 of 53 patients). Of the 53 responding patients, 40 percent reported jaw/facial muscle pain, 40 percent had occlusal changes, 38 percent reported tooth pain, 30 percent reported jaw joint pain and 30-percent experienced xerostomia. Of the 27 long-term AMP users, 22 rated themselves as being very satisfied and four as somewhat satisfied; one was neither satisfied nor dissatisfied with the appliance. Conclusions, It was determined that with use of the AMP device, 40 percent of patients will develop some minor complications of jaw, mouth and/or tooth pain, and approximately 26 percent of long-term users might experience a painless but irreversible change in their occlusion. Annual followup office visits with the dentist appear necessary for early detection of these changes. Clinical Implications, Patients with mild-to-moderate OSA who receive a two-piece; adjustable AMP device should be informed that 50 percent of patients quit using the device in a three-year period and some will experience shifts in their occlusion.