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Oral Appliance Dental Side Effects in Severe Obstructive Sleep Apnea – A Case report
Oral Appliance (OA) as a clinical management of Obstructive Sleep Apnea (OSA) is shown to present better efficacy in mild to moderate patients. The last clinical practice guidelines recommend that sleep physicians prescribe OA for adult patients who are intolerant of CPAP therapy or prefer alternate therapy. OA treatment can present some dental side effects, mainly through prolonged use. Since it is a long-term treatment, it is mandatory to follow-up patients in terms of treatment efficacy and side effects.
Report a case of severe OSA patient successfully treated with OA, and the long-term follow-up on dental side effects.
MFS, 46 y.o., male, with complaints of snoring and excessive daytime sleepiness (EDS) was indicated for OA treatment.
On baseline polysomnography (PSG), AHI was 56.7 events/hour and total sleep time (TTS) with oxyhemoglobin below 90% was 3.6%. PSG with CPAP (8cm H2O) shown efficacy (AHI=4.7 events/hour) and 0.7% of the TST with oxyhemoglobin below 90%, but he did not adapt to CPAP. He presented atresic hard palate, dental crowding and gyroversions, midline deviation, dental Class II, skeletal Class II, grade IV Mallampati, grade I tonsils and absence of septal deviations. Patient was submitted to an orthodontic radiographic and photographic documentation. From a total mandibular range of 14 mm, the OA was started with 4 mm and titrated until 9 mm, with the improvement of snoring and EDS. A PSG performed with OA shown AHI of 0.5 events/hour and no desaturation and no more snore complaints.
After one year of OA, the patient was keeping the successful results, but he presented the first side effects: an increase in mesialization of lower premolars. After three years of use, he presented posterior bite opening, and four years later, more evident vestibularization of the lower incisors and lingualization of the upper incisors. Despite dento-occlusal alterations, the patient did not present functional and/or aesthetic complaints and was satisfied with the treatment results.
OA is an alternative treatment to severe OSA in patients who did not accept CPAP. Despite the dental side effects observed, the success of the treatment prevailed in the decision of continuity by the patient.
Obstructive Sleep Apnea, Oral Appliance, side effects
Relato de Caso
Instituto do Sono - Sao Paulo - Brasil
Andreia Gomes Schroeder Sguillar, Solange Marinho Oliveira, Rafael Balsalobre, Danilo Anunciatto Sguillar, Cibele Dal-Fabbro