Surgery for snoring and sleep apnea has potential risks and side effects.  As a surgeon writing this post, I feel like I have to emphasize that I know that these risks and side effects exist.  In fact, my previous blog post cited the research I have done showing that the risk of serious medical complication after sleep apnea surgery is 1.6%, mainly in those with major medical problems before surgery.  The goal of a surgeon and their team is to minimize those risks and discuss them with patients, who can weigh the benefits and risks of surgery.  A key part of that discussion is having quality knowledge of surgical risks so that a discussion can be based on accurate information.

Oral appliances for snoring or sleep apnea have risks too

Oral appliances are a possible treatment for snoring and obstructive sleep apnea that work by holding the lower jaw in a forward position during sleep.  Studies have shown that they can work well for some patients.  In fact, I refer a number of patients to my dental colleagues, whether based on my office examination or drug-induced sleep endoscopy.  Before referring my patients, I discuss the potential risks of oral appliances that are not life-threatening but that can be problematic.  The most likely side effects of oral appliances are drooling, temporomandibular disturbances (muscular or related to the joint–also known as the TMJ), tooth pain, and movements of the teeth that can change a person’s bite.  Tooth movements occur with oral appliances because the forces applied to the teeth, while not excessive, are applied for long periods of time while patients sleep.

The December 2014 issue of the Journal of Clinical Sleep Medicine included what is now the most thorough study of the long-term risks of tooth movements with oral appliances.  Based on limited studies, it has been felt that most of these occur in the first 2 years and then never worsen.  This study shows that the tooth movements continue far beyond the first 2 years of use.  Alan Lowe, DMD, PhD and Fernanda Almeida, DDS, MSc, PhD at the University of British Columbia in Vancouver, Canada, are some of the world’s true experts in the use of oral appliances to treat snoring and sleep apnea.  They have been using them for decades.  When their patients wear out their oral appliance and needs a new one, they take impressions of the teeth and have saved them.  Because they are such a busy center, they had a group of 77 patients with an average length of followup of 11 years.  By making various measurements of the teeth from these casts, including in the same patients over time, they were able to measure the tooth movements that occur over time.  They found the following:

  • Most patients experience movements of the teeth, with continued movement over time.
  • There were many types of tooth movements, ranging from pulling the upper teeth backwards to pushing the lower teeth forward to spreading out the teeth of the lower jaw (widening the arch of the teeth) to opening up spaces between the molars (potentially making chewing less effective).
  • These changes were greater than previous studies had suggested, likely because those studies had not followed people over time as closely.

Because oral appliances should be worn throughout the night, every night, this study suggests that these tooth movements will be more likely to occur with greater use.

The Bottom Line: Oral Appliances Have Risks, Just Like All Treatments

Oral appliances for snoring or sleep apnea are still a good treatment option for some patients.  However, just as with surgery, it is important to discuss the risks and benefits fully with patients.  Many patients will gladly accept these tooth movements for the chance to improve their snoring or sleep apnea.  However, for oral appliances to work, they should be worn throughout the night, every night, just like CPAP; this study suggests that these tooth movements will be more likely to occur with more use of the oral appliance.

49 Responses to “Oral appliances for snoring or sleep apnea have important potential dental side effects”

  1. Advanced Sleep Medicine

    It makes sense that dental appliances that change the position of the jaw would move the teeth over a long period, considering that something as small as not wearing a wire retainer can cause the teeth to shift. Every potential treatment for sleep apnea has its downsides–CPAP the inconvenience or discomfort, surgery the potential complications and down time, dental devices the movement of teeth. But the downside of living with untreated OSA and the potentially life-threatening side effects that come with it outweighs the risks of treatment.

    Reply
    • Kathy Revill

      I have been wearing a sleep apnea mouth appliance for over a year now. In the past 3 or 4 months I have noticed that my front upper and lower teeth do not meet up no matter how I move my jaw around. Even pressing my jaws together there is a small gap between the upper and lower. Could this be due to my appliance?

      Reply
      • Dr. Kezirian

        It sounds like this is a change in how your teeth come together (dental occlusion). This seems like it is due to the appliance and is one of the risks of appliances. This study would suggest that the tooth movements and changes in your dental occlusion will continue to change even more if you continue to use the appliance.

        Reply
  2. Alice adam

    Too bad, I was so happy with my mouth appliance until I noticed shifting of my upper teeth, I wasn’t sure until I read ur article, I hope their is a better treatment on the horizon.

    Reply
  3. Cindy Butcher

    I never had jaw pain before getting my dental appliance for sleep apnea, what has happened? They adjust it, but it doesn’t go away.

    Reply
  4. Bonnie

    I wore my appliance for over two years. But, it felt like the upper appliance pulled really hard on my upper teeth as I removed it. Now, I find out I have #13 and #14 root fractures that require extraction. Never smoked, no gum or bone disease. Could the continual pressure of the device cause root fractures?

    Reply
    • Dr. Kezirian

      I believe that it can because it does apply pressure to your teeth, but actual root fractures are certainly not a common scenario with oral appliances. You should definitely speak with your dentist about this.

      Reply
  5. Edie

    Love my dental appliance, more restful sleep and fewer headaches. But my bottom front teet are shifting. Can anything be done to correct this? I’m not giving up my appliance.

    Reply
    • Dr. Kezirian

      In my experience, there is not something obvious to do, aside from maybe backing off the degree of advancement of your lower jaw. Unfortunately, that will likely reduce the benefit of the oral appliance. When teeth move, that can also reduce the benefit of an oral appliance, leading to a need for greater degrees of advancement.

      The bottom line is that this is a challenging problem but one you should address with your dentist.

      Reply
      • Susie Cook

        I love my dental appliance for snoring but it causes nerve tingling and sometimes nerve pain as my jaw is getting back in alignment after wearing it. Has anyone else experienced nerve issues?

        Reply
  6. Mandi Weatherly

    I have been wearing my dental device for about a month now and I have noticed that I have felt sick for over 3 weeks now. I feel like I have sinus problems. I wake up in the morning and feel like saliva and sinus crap is backed up all in my head. When I take the device out in the morning, I immediately have saliva and sinus crap that pours out of my mouth sometimes gagging me. I also have been waking up with crusty, swollen and red eyes. I at first thought I had pink eye but after repeated episodes, I believe maybe the dental device is causing sinus stuff to back up in my head causing all these problems. In your opinion, could the device be causing these things?

    Reply
    • Dr. Kezirian

      Oral appliances may cause increased saliva production, but it is not typical for it to pour out when you remove it in the morning. The most important thing is what you feel and whether this clears up if you do not wear your oral appliance.

      Reply
  7. Margaret

    This study is such upsetting news. I’ve been using an oral appliance for 2 years and now my back teeth don’t touch on either side of my mouth. I’m having new crowns put in, so I think they can raise the height of them, which might help. How I wish I could use a CPAP instead.

    Reply
  8. Ian

    I have just started with a mouth guard for 3 weeks only and I already feel my jaw/ teeth take 30mins or so to realign after I take it out in the morning.
    The device works well regarding snoring but I am concerned about the longterm risks to my jaw and teeth structure. My snoring is a social issue only , at this time anyway. Would it be advantageous and recommended to do one or two nights a week without the device to maintain my jaw and teeth structure ?

    Reply
    • Dr. Kezirian

      You should discuss this with your dentist (if your oral appliance was provided by a dentist). These risks are common to all types of appliances; they occur in some but not all patients. If the snoring is a real social issue, then you might want to consider treatments other than oral appliances. I would be happy to see you to discuss those options.

      Reply
  9. Robin Kulibert

    I have had my dental apnea device for the better part of a year, for mild apnea, and have recently noticed pain in my temple, jaw, and side of my face. My jaw muscle is really sore and tight when I press on it with my fingers while moving my jaw. A dentist other than he who fitted the appliance said it might help with one problem but causes others, namely an altered bite (I must now use dental floss now after every meal). Are these side effects–pain, tightness, altered bite–reversible if I stop using the device? I had braces for 5 years as a teen, but would try them again if it took away this pain and tightness.
    Thanks

    Reply
    • Dr. Kezirian

      The potential side effects of oral appliances can be reversed if you stop using the device, and stopping use of the device sounds like the right first step for you because these side effects are problematic for you. I would recommend discussing these with your dentist, ideally the one who fitted the appliance.

      Reply
  10. Barry

    I have been using my sleep apnea appliance for over two years. I have recently been told that my lower left rear tooth is being reabsorbed and my jaw bone is growing into my tooth. Soon it will contact the nerve in this tooth. None of the options I have been given are pleasant and all are very costly and not covered by dental insurance.
    I believe this has been caused by the appliance. Would you like to comment on this and possibly offer a simple solution.

    Reply
    • Dr. Kezirian

      I have not heard of this specifically. I would recommend contacting a dentist with some experience in dental sleep medicine and oral appliances to discuss this with them.

      Reply
  11. Marilyn Lang

    I have been using the device for about 2 months and I am also having a tooth implant done, I have had a bone replant done on tooth 7. I am now experiencing extreme nerve pain in this area.
    Could this be caused by the device?

    Reply
  12. Kathy McGee

    I am having issues with tooth sensitivity since using the appliance. It was so bad that I went to my regular dentist. Xrays showed no cavities. I stopped wearing the device for 1 1/2 months and sensitivity slowly went away, except for 1 mating upper and lower tooth. Is this coincidence, or possibly caused by the appliance. I also have problems with jaw pain. I so wish that I hadn’t wasted my money on this, but I paid too much to not use it.

    Reply
    • Dr. Kezirian

      This is probably not entirely a coincidence, but I am glad most of the sensitivity went away. I am not a dentist, but I would discuss this with the dentist that provided the appliance, in addition to your primary dentist. I would expect that the sensitivity would continue to improve over time. You should probably stop using the appliance, at least for now.

      Reply
  13. Kevin

    After 4+ months use of otc mouthguard, my jaw has started to become painful and tight like what the others experience, especially in the morning. In the evening, even without wearing it, the pain on the side of my face especially near my ears, where the jaw muscles connect, is so painful. Sometimes I also get a weird sensation in my ear (external auditory meatus). What can I do?

    Reply
    • Dr. Kezirian

      You should definitely stop wearing the mouthguard. It sounds like you have developed some temporomandibular dysfunction, potentially some swelling of the temporomandibular joint (TMJ). I would see your dentist for help with managing this.

      Reply
  14. Judy.

    I have been wearing the oral appliance for 11 years or more
    During follow up visits. When I had regular work done on my teeth they adjusted my appliance. 2019. I was just told my bite has changed. And given a plastic tube to exercise with to prevent it from getting worse. It will not realign the teeth. I already worse the cap machine and chin strap. Several years before trying the oral appliance. What are the pros and cons of surgery.? Should I just stop treating the problem. And wake up more? Is there any way to correct my bite?

    Reply
    • Dr. Kezirian

      I would speak with your dentist about your bite.

      The short explanation about the pros and cons of surgery are different for different patients and different procedures. I would be happy to see you as a patient to discuss what might be best for you. Please feel free to reach out to me at [email protected].

      Reply
  15. Kellye Fisher

    I have noticed in the past couple of weeks that my right ear has a tickling sensation. I read on a forum that this could be caused by the use of an oral appliance. I have been wearing the appliance for about 9 months but am still going through the adjustment phase (problem with the first appliance so trying a different one) so it could possibly be adjusted too far forward. I’m not sure what to do but wondered if you ever heard of an appliance causing this tickling sensation

    Reply
    • Dr. Kezirian

      It is possible but not the most common finding. The reason why this might occur is that the oral appliance does put some stress on the temporomandibular joint (TMJ) and the surrounding ligaments and muscles. Swelling of these can produce a variety of feelings: usually pain but other feelings like a tickling sensation are possible. I would discuss this with your dentist.

      Reply
  16. Sally Jennings

    Hi I’ve been wearing my oral device for about 2 yrs and just lately I’ve noticed tenderness in my neck just under the jaw lie close to my glands – could this be caused by the device?

    Reply
    • Dr. Kezirian

      It is possible, but it depends on whether this is related to muscles in the area (masseter muscle) or the saliva glands. You should see the dentist who provided you with the appliance or see an ear, nose, and throat doctor for an evaluation.

      Reply
  17. Nancy

    I only use my dental device when I go on vacation. After using it for four or five nights in a row I start smelling smoke on and off all day. So strange!!

    Reply
  18. Keith Patterson

    I used my TAP appliance for approximately 2 years, achieving good relief from my OSA. During this time I noticed repeated problems with my teeth gnashing against each other in a misaligned manner while chewing my meals. My dentist attributed this phenomenon to my overactive masseters and excessive bruxism that effectively loosened my jaws. So, I embarked on an eight week course of therapy (massages, Botox, TENS, SC laser) in an effort to relax the masseters. During this time I continued wearing my TAP at nighttime. Well, one afternoon while eating lunch, I “gnashed” my teeth and broke off a crown on tooth #24. Ultimately, I needed an implant (at a cost of $6000). At this point I came to the conclusion that the TAP devise was likely to blame and not bruxism and/or overactive masseters. I discontinued the use of my TAP appliance and, since that time, I have had absolutely zero problems with teeth alignment and misaligned bites. I have not seen this potential side effect mentioned in any of the literature regarding mandibular advancement devices and thought it should be documented.

    Reply
    • Dr. Kezirian

      I am sorry you experienced these side effects and am glad you felt comfortable to share your experience with others. At the same time, I do want all readers to know that this post was not intended to criticize oral appliances. I know that surgery can have important side effects too. It is just that the different treatments for sleep apnea have different potential problems, and it is important to recognize these when considering options – and to stop treatments like oral appliances if one experiences the side effects that can occur.

      Reply
      • Susan Archer

        I have been using a “tongue stabilizing device” for about two years. I do not have sleep apnea, but I do snore…according to my husband! I have not heard mention anywhere of a TSD but I can say that it works well and holds my tongue forward with suction so it doesn’t drop back into my airway at night. Problem solved! Except now I have misalignment with my teeth. A couple of gap spaces have opened and my teeth no longer align in front for proper biting. I love the simplicity of the “pacifier” type design and really want to get keep using it, but I’m trying to find a way to realign my teeth and keep them from moving more. I believe a retainer could be worn at the same time, or perhaps during the daytime, but I’dlike to know if anyone else has used a TSD and/or had issues that were easily, and affordably, solved?

        Reply
  19. Mary Simmons

    I have been using my dental appliance for five months and I use an app and my snore card has dropped from 160 to 60 70 or 80 I still snore but I am breathing all night so I sleep better. Much better. My jaw is sore every morning but it appears to go away and I just feel it slightly during the day my problem is I think now I have thrush I’ve never had it in my life the inside of my cheeks Feel rippled and there’s a little sores from the little teeny metal pieces from the device… I’ve had to buy some special mouthwash this has been bothering me for a week now I brush my appliance every night brush my teeth before I put the appliance in so I’m not sure why. I believe this us thrush it’s on both sides and two little sores on both sides I will have to talk to the doctor but I’m so disappointed.

    Reply
    • Dr. Kezirian

      I am so glad you are experiencing substantial improvement in your snoring. You should definitely speak with your dentist, as this is not the most common side effect. It sounds a little less like thrush and more like irritation from the device itself, but they will be able to evaluate this.

      Reply
      • Mary Lynn Stoia Simmons

        thank you so much for your reply…blessings I go Wed Dentist said there is something he can put on the device to help with this so we will see.

        Reply
  20. Linda

    I started wearing my night guard again 3 weeks ago for teeth grinding, When I stopped using it for a while I had caused trauma to the side of my tongue from biting and grinding at night.My dentist prescribed oracort to bring the inflammation down in the affected area. After two weeks of wearing my night guard and using oracort 3 times a day (once before bed) I noticed that on the affected side under my tongue, it was red and started getting white patches and sore. Is this thrush? I don’t think I was cleaning my guard property.

    Reply
    • Dr. Kezirian

      You should discuss this with your dentist or someone who could examine you in person. It could be thrush, but I do not think it is. It is probably just from biting your tongue, even with the nightguard in place.

      Reply
  21. M. Martin

    Hi,
    I have worn a sleep apnea oral device for almost ten years now, and yes my teeth and jaw have moved and changed. I recently read in an article on Inside Dentistry of February 2019, Volume 15, Issue 2, about performing orthodontics while treating OSA. I gathered from reading it that there is such possibility. The problem is I don’/can not find a doctor in my area that does it. I am in the New York area. Do you know of anyone who can do it in this area?

    Thank you

    M. Martin

    Reply
    • Dr. Kezirian

      I am not a dentist, but my understanding is that you would generally not perform orthodontics while using an oral appliance. You obviously can have orthodontics while undergoing other OSA treatments. I am not familiar with sleep dentists in the New York area, but you can try looking at the American Academy of Dental Sleep Medicine website.

      Reply
  22. Idelle

    I’ve been using an oral device for sleep apnea for about 4 months now, and I’ve recently discovered that 3 of my teeth have turned black and I think it might be from trauma from the device. Have you ever heard of that happening? Will I need root canals?

    Reply
    • Dr. Kezirian

      You should definitely discuss this with your dentist and the person who provided the oral appliance (if these are not the same person).

      Reply
  23. Rachel Kelli Lacy

    I have two questions. I clench my teeth at night, causing small fractures in my teeth and have been wearing a night guard for years to help reduce that. I recently went to the sleep apnea device and my TMJ pain has increased considerably after the first titration, as well as headaches. After two weeks, I cannot wear it. I also had a history of a lot of whiplash and I am wondering about the impact on my neck, especially C1 and C2 since these have been historically unstable. So do you think that a sleep apnea device could make bruxism worse and could it contribute to neck misalignments that could lead to headaches? I am very prone to headaches and neck problems, so if that is the case, I am ditching the 1000$ device!

    Reply
    • Dr. Kezirian

      You should discuss this with your dentist. I do not think it would cause neck misalignments, but an oral appliance can definitely cause or contribute to headaches and TMJ pain or disturbances.

      Reply

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