Dr. Lowe is professor and chair of the Division of Orthodontics in the Faculty of Dentistry at The University of British Columbia and maintains an orthodontic practice in Vancouver, Canada.
Recently, the importance of resting tongue posture in the adult population has received a great deal of attention as it directly affects snoring, upper airway resistance syndrome and obstructive sleep apnea. Orthodontists, with their knowledge and training of functional appliances and established skills to evaluate jaw position, are ideally suited to provide oral appliance therapy in this field. Sleep disordered breathing patients are excellent adherents to therapy after only a few nights of uninterrupted sleep and the subsequent restoration of adequate REM sleep. Oral appliances have a direct effect on tongue posture during sleep and help to stabilize the mandible in a closed vertical position. They also have a direct effect on genioglossus muscle activity. However, a reduction in overbite and/or the development of open bites with long-term wear of oral appliances in adult patients have recently been identified. These long-term occlusal changes are predominantly dental in nature and typically occur after more than two or three years of nightly wear. A better response to appliance therapy is seen in those post titration subjects who exhibit a more anterior velopharyngeal wall, a larger radius of curvature of the airway and an increase in velopharyngeal size. Because sleep apnea is a progressive life-threatening disease and patients tend to be very compliant over time, the long-term occlusal changes may continue each decade.
Learn about the short and long term side effects of oral appliance wear in subjects with sleep disordered breathing
Evaluate Occlusal and cephalometric changes as a consequence of oral appliance wear
Appreciate the importance of skeletal subtype before treatment when predicting potential long term side effects