Does everyone with sleep apnea oral appliance have TMJ pain?

Although sleep apnea treatment’s gold standard is a continuous positive airway pressure (CPAP) machine, sleep apnea mouth appliances (or oral appliances) are becoming more popular. The mandibular advancement device therapy is increasingly recognized as a viable treatment for obstructive sleep apnea  (Aarab, Lobbezoo, Hamburger, & Naeije, 2011; Ramar et al., 2015).

In April 2020, Nikolopoulou and colleagues performed a randomized, placebo‐controlled trial on temporomandibular side‐effects associated with oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea.

The authors found:

  • a low frequency of clinical signs of temporomandibular disorders and pain in mild to severe obstructive sleep apnea. patients after 6 months, regardless of treatment with mandibular advancement device (MAD) therapy  or nasal continuous positive airway pressure (nCPAP).

  •  In addition, no difference in mandibular function impairment was observed between the different treatment modalities.

In 2019, A Systematic Review and Meta-Analysis on the Effects of Mandibular Advancement Device for Obstructive Sleep Apnea on Temporomandibular Disorders by Alessandri-Bonetti et al found:

  • Patients with pre-existing signs and symptoms of temporomandibular disorders (TMD) do not experience significant exacerbation of symptoms using the Mandibular Advancement Device (MAD).

  • The presence of TMD does not appear to be routine contraindication for the use of used for the management of obstructive sleep apnea.

The phrase, “Temporomandibular Joint (TMJ) pain” can be quite broad. Medically speaking, we relate this common expression to the umbrella category of Temporomandibular Disorders (TMD). For so long, everyone has considered pain and dysfunction a TMJ issue, but we are moving more towards TMD now in clinical chatter and research.

This is because TMJ is just the joint, but pain and dysfunction in this area can be due to many reasons!

Clinically, I see patients in my office for treatment associated with pain and dysfunction of the jaw after prescription of an oral device for sleep apnea, medically known as mandibular advancement device (MAD) therapy.

Even though I cannot be certain whether or not these patients had pain and limitations prior to the MAD therapy, I do see lots of dysfunctions when they finally arrive at my office. Interestingly, the dysfunction is not just limited to the jaw itself, but to the postural dysfunction of the upper cervical spine.

Therefore, to answer the question, “Does everyone with sleep apnea oral appliance have TMJ pain?”, I have to say no but it does happen in a subset of individuals.

The good news —- if this does happen, we are able to help patients tremendously with pain and disability who have this condition, and even more importantly, get the patient back on track to using the sleep apnea oral appliance so it can do its job of improving health!

Call us: 919-728-0335