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

Background, Dental devices have been used to help manage snoring and obstru ctive sleep apnea, or OSA. This article reports on patients' compliance wit h 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, adjus table acrylic appliance, connected with Herbst attachments. The appliance w as used nightly and advanced the mandible by 75 percent of the patient's ma ximum protrusive distance. Patients were telephoned to determine whether th ey were still using the AMP device. If not, they were asked when and why th ey 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 pat ients 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-p ercent experienced xerostomia. Of the 27 long-term AMP users, 22 rated them selves as being very satisfied and four as somewhat satisfied; one was neit her 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 toot h 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 chan ges. Clinical Implications, Patients with mild-to-moderate OSA who receive a two -piece; adjustable AMP device should be informed that 50 percent of patient s quit using the device in a three-year period and some will experience shi fts in their occlusion.