Consequences and Implications of Discontinuing Oral Appliance Therapy for Obstructive Sleep Apnea: Be True to the Tooth

Sustained direct pressure on the teeth applied by wearing a mandibular advancement device (MAD) would lead to unwanted tooth movement and occlusal changes in oral appliance therapy for obstructive sleep apnea (OSA).When the observed occlusal changes are rather serious, it is an appropriate decision for sleep dentists/physicians to propose that such patients discontinue MAD use and to offer a substitute to continue managing OSA.Both orthodontic treatment and continuous positive airway pressure (CPAP) therapy appear to be promising approaches to addressing such an unfavorable dental consequence, and offer an alternative to MAD.However, compared with teenage orthodontic patients and treatment-nave individuals with OSA, it is noteworthy that orthodontic treatment and CPAP therapy for elderly patients who discontinue MAD use are likely to clinically involve more risks and difficulties, which would consequently affect prognosis of each treatment.Moreover, most patients who discontinued MAD use are rarely indicated for surgical procedures or hypoglossal nerve stimulation therapy.Although the tongue-retaining device is currently not assumed as an option of OSA treatment, renovation of this device and/or innovation of devices to minimize or avoid known dental adverse effects of both MADs and CPAP will be an adequate future direction of patient-centered OSA treatment.