What are the side effects of wearing a dental sleep apnea appliance?

In this article, we will review common side effects when wearing dental sleep apnea appliances.

Oral appliances are dental mouthguards prescribed by sleep medical professionals for the treatment of snoring and sleep apnea.

Oral sleep appliances are a very effective treatment alternative to CPAP therapy (Continuous Positive Airway Pressure). They are often prescribed for individuals suffering from snoring or obstructive sleep apnea who cannot tolerate a CPAP machine or are looking for a more portable option.

If you have started wearing an oral appliance recently, this article will help you learn more about the common side effects.

Here are some common questions you may have when you begin to wear your oral sleep appliance.

What can I expect the first few days of wearing a sleep apnea dental mouthguard?

For the first several days, the appliance will feel foreign in your mouth.

Most patients adjust quickly to the snug feeling around the teeth and can wear it the entire night. 

For some, this may take just a few nights. Others may need to build up usage tolerance over several weeks.

What are the possible side effects I may experience with dental sleep apnea mouthguards?

Here are the more common side effects that you may experience when wearing a dental sleep apnea device. 

Increase in saliva production

• You may feel like you are drooling more after inserting your sleep device 
• Within the first 30 minutes after inserting your device, you may notice an increase in saliva production 
• This improves after the first few weeks of wearing your device
• Once your device is inserted, you can swallow normally

Sore teeth and gums 

• Having sore teeth or gums are common but usually gone within minutes to an hour after removing the appliance
• If soreness persists, a minor device adjustment may be made to the appliance at your next visit

A slight change in the bite when you wake up

• Usually occurs for 5-60 minutes after removal
• Your bite should return to normal once you have done your morning jaw stretches or have worn a morning aligner 
• Some patients do not experience this ‘strange bite’ sensation after removing their oral appliance

Slight Jaw pain

• Many patients will have mild to moderate jaw pain when they begin wearing a dental sleep appliance 
• Jaw pain almost always lasts a short amount of time and is rarely a persistent problem

Moderate jaw pain

• If you need pain relief, use the type of over-the-counter pain medication that your doctor suggests for pain relief (Ibuprofen, Tylenol or Aleve) before bed, upon waking, and if needed in the afternoon 
• ​​If the pain becomes severe, stop wearing the appliance and contact your oral appliance provider
• Other options include very short interval usage with a slow increase in use. 
• Consider wearing your device only for one hour the first night while watching TV and focusing on something other than sleep.  Then build to slightly longer until you transition to a half or a whole night of sleep.  

Dry mouth

• If you experience dry mouth, you may be sleeping with your mouth opened 
• In this event, you may use elastics on your device to help keep your mouth closed. This may increase comfort and, in many cases, improve the results of therapy. 

Elastics can help dry mouth

• If elastic hooks were not included in the design of your device, contact your sleep apnea dentist. They may contact the dental lab of choice to see if hooks can be added to your device
• If you have a latex allergy, make sure you use latex-free elastics 
• If elastic hooks are not an option for you,  mouth tape may be recommended by some practitioners

Long-term and other less common side effects 

Here’s a list of other side effects of oral appliance therapy that are less common. If you are experiencing any of these side effects, reach out to your sleep apnea dental provider to discuss: 

Soft tissue irritations: Tongue, cheek or gum irritations

Joint sounds: Change in joint sounds or elimination of joint sounds (elimination of clicking).

Significant bite changes or teeth movements: less overbite, gaps in between teeth, and other changes can develop over long-term usage. Some changes may be considered as positive changes by patients and practitioners. 

The best way to prevent or minimize adverse effects is to perform regular jaw stretching exercises and to use a morning aligner tool if provided

Regular flossing is strongly recommended for regular dental sleep mouthguard users. Small gaps may form in between teeth trapping food.

Allergy to materials

Loosening of dental work may occur with dental work that was compromised in some way (older filling, cement under crown washing away, etc.)

Gagging:

• If you have an increased response to gagging when your device is inserted, your dentist may suggest desensitizing yourself by wearing only one-half of the appliance. Please note: not all types of dental sleep mouthguards have the capability of using only one half of it. It is important to ask your prescribing dentist if this is an option for you.
• Your dental provider may suggest wearing only the upper or lower segment individually. Insert one segment and watch TV for an hour. Focusing on a television program instead of sleeping with a strange object may be a  good start 
• Slowly increase interval usage and eventually try both pieces at one time.

A side note on side effects of dental sleep apnea mouthguards

All treatments for sleep apnea have the potential for side effects. 

CPAP therapy, the most commonly prescribed treatment for sleep apnea is no exception. Some common side effects of CPAP include dry mouth, dry eyes, skin irritations, nasal dryness and sinus infections.

Often not included in most CPAP side effect discussions is the possibility of tooth movements caused from the pressure of the masks.

Dental sleep device patients find that even with the possibility of the side effects discussed above, wearing an oral appliance device is more comfortable and portable than wearing a CPAP.

Most patients adapt to the device quicker than they did when using a CPAP machine initially. 

Most side effects are minor and very transient. Others may be preventable or addressed with your dental sleep apnea provider. 

If you are having issues with your oral appliance, please discuss them with your sleep apnea dentist.  He or she can help troubleshoot most problems.

Oral appliance therapy remains a wonderful treatment option for those suffering from snoring or obstructive sleep apnea.

Sources

1. Sheats, R. D. (2020). Management of side effects of oral appliance therapy FOR SLEEP-DISORDERED BREATHING: Summary of American Academy of Dental sleep MEDICINE RECOMMENDATIONS. Journal of Clinical Sleep Medicine, 16(5), 835–835. https://doi.org/10.5664/jcsm.8394 
2. Murphy, S., Maerz, R., Sheets, V., McLaughlin, V., Beck, M., Johnston, W. M., & Firestone, A. R. (2020). Adherence and side effects among patients treated with oral appliance therapy for obstructive sleep apnea. Journal of Dental Sleep Medicine, 7(1). https://doi.org/10.15331/jdsm.7104