Editorial 1, Issue 2.1

“Getting Over” Occlusal Changes

Leslie C. Dort, DDS, Diplomate, ABDSM, Editor-in-Chief Journal of Dental Sleep Medicine
University of Calgary, Calgary, Alberta, Canada

The growing body evidence confirming the effectiveness of oral appliance therapy (OAT) in disease alleviation should increase demand for treatment.1 Patients should not be denied access to OAT because of possible side-effects but they need to be informed.

OAT for sleep disordered breathing results in occlusal changes. The evidence of occlusal change occurring with OAT has been growing for years.2,3 Pliska et al.2 recently confirmed that occlusal changes continue throughout OAT. Although most individual studies have documented the changes with the use of a particular appliance, all appliances can cause occlusal changes. If clinicians haven’t seen change perhaps they are not looking. For years Dr. Alan Lowe has told us to “get over it!”4 and now we could add, “go forward.” What does “go forward” mean from a clinical and a research perspective?

In patients intolerant of CPAP who have moderate to severe OSA, occlusal changes are of relatively minor importance when balanced against the long-term consequences of untreated OSA. Surprisingly, especially given some philosophies in dentistry concerning ideal temporomandibular joint position and occlusion, occlusal changes go unnoticed by many patients. Patients adapt with few problems given that they return for multiple replacement appliances over years of treatment. However, there will be those who will find occlusal changes unacceptable and they should be given the opportunity to refuse treatment. The fact of occlusal change should be part of every treatment plan presentation and the importance placed in context of the individual disease severity.

Clinicians employ a variety of strategies intended to help patients maintain their occlusion. These strategies include: stretching exercises, biting with a jig or occlusal splint and chewing gum. There is some evidence to show the effectiveness of these strategies in the short term5–7 but no evidence to show the long term effect of any of the occlusal maintenance strategies.

We need to respond with scientific evidence to the patient questions of “if I do the exercises, by what percent will my chance of significant occlusal changes decrease?” “Will the exercises cause any long term detrimental effects to my teeth?” We need the studies looking at strategies to mitigate occlusal changes. Hopefully 2015 will bring some answers to these questions.


Dort LC. “Getting over” occlusal changes. Journal of Dental Sleep Medicine 2015;2(1):3.


1. Phillips CL, Grunstein RR, Darendeliler MA, et al. Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial. Am J Respir Crit Care Med 2013;187:879–87.

2. Pliska BT, Nam H, Chen H, Lowe AA, Almeida FR. Obstructive sleep apnea and mandibular advancement splints: occlusal effects and progression of changes associated with a decade of treatment. J Clin Sleep Med 2014;10:1285–91.

3. Marklund M, Franklin KA, Persson M. Orthodontic side-effects of mandibular advancement devices during treatment of snoring and sleep apnoea. Eur J Orthod 2001;23:135–44.

4. Lowe A. AADSM Annual Meeting, 2007.

5. Marklund M, Legrell PE. An orthodontic oral appliance. Angle Orthod 2010;80:1116–21.

6. Ueda H, Almeida FR, Chen H, Lowe AA. Effect of 2 jaw exercises on occlusal function in patients with obstructive sleep apnea during oral appliance therapy: a randomized controlled trial. Am J Orthod Dentofacial Orthop 2009;135:430.

7. Cunali PA, Almeida FR, Santos CD, et al. Mandibular exercises improve mandibular advancement device therapy for obstructive sleep apnea. Sleep Breath 2011;15:717–27.


Submitted for publication January, 2015
Accepted for publication January, 2015

Address correspondence to: Leslie C. Dort, DDS, 1016-68th Ave SW, Suite 150, Calgary, AB T2V 4J2, Canada; Tel: (403) 202-4905; Fax: (403)202- 0266; Email:


Dr. Dort is Editor-in-Chief of Journal of Dental Sleep Medicine.