A Surprising Dental Pitfall of CPAP that Oral Appliance Therapy Can Avoid

There are two big reasons why people look into the option of oral appliance therapy for obstructive sleep apnea. One is that they’ve heard that it works.

The other reason? It’s not CPAP.

While CPAP – a device for keeping the airway open and oxygen flowing through the night – can be a literal lifesaver, many folks just don’t stick with it. According to one recent study, about half of all CPAP patients don’t use it regularly, although some studies have put the number as high as 83%.

There are plenty of reasons for this “non-adherence.” The mask is uncomfortable. Their sleeping partner doesn’t like it. They don’t understand why using it matters so much or don’t believe it will help. The list can – and does – go on.

But there’s an important dental reason to consider appliance therapy instead of CPAP, too: Over time, CPAP can actually move your teeth and even change the shape of your face.

This is because of how CPAP works. The acronym stands for “continuous positive airway pressure,” which is a fancy way of saying that the device continually delivers air – via a nasal mask or pillows – to help keep the airway open (unobstructed). This greatly reduces the number of episodes each night in which breathing stops altogether.

As the authors of a case study on the matter put it,

Any sustained force or pressure on teeth has the potential to cause tooth movement. As such, it is reasonable that flaring of the anterior [front] teeth would occur as a consequence of delivering positive pressure posterior to [behind] the tongue that functions to position it forward in the oral cavity and against the anterior teeth.

That’s what happened to the woman in the case they presented. She had been benefiting from CPAP for 18 months, but gaps had developed between teeth in the front of her mouth. All other possible causes, such as bone loss due to gum disease, had been ruled out.

Follow-up questioning revealed that shifting of the teeth was first noticed in the months following the initiation of CPAP use. Dental casts of the patient taken for a crown restoration of a lower molar in the year prior to CPAP treatment confirmed the spacing was a recent phenomenon. The patient commonly felt tooth sensitivity in the mornings upon wakening [sic], and reported that she forced her tongue forward against her teeth when the CPAP interface was in place.

Orthodontics corrected the problem, and a retainer was prescribed to keep the teeth from moving again. Still, the problem could have been prevented altogether by opting for appliance therapy from the start.

The consequences of this problem of shifting teeth aren’t just cosmetic. When teeth shift, the bite can shift out of alignment, too. Such malocclusion can contribute to tooth pain, chronic headaches, and even neck and back pain. It can prompt tooth grinding and clenching, which can both worsen pain issues and potentially damage teeth. It can damage the temporomandibular (jaw) joints (TMD).

Another study tracked 46 CPAP patients for two years to investigate CPAP’s potential impact on facial structure. Each had a cephalometric x-ray taken at the beginning and end of the study. A “ceph” is taken outside of the mouth and shows the whole side of the head so a dentist can see the relationship between the teeth, jaws, and overall profile.

Though patients didn’t report any change in their bites, the cephs showed otherwise. After using CPAP for at least two years, patients showed significant changes in the dental arches. The upper and lower jaws had shifted backward a bit – something that can actually make apnea symptoms worse, since a retruded jaw can contribute to airway obstruction.

Combination CPAP Oat therapyBut all of these issues are preventable with the advent of oral appliance therapy as a front line therapy; likewise, other dental complications of CPAP, such as dry mouth, which raises the risk of both gum disease and tooth decay.

But just as the force created by CPAP can move teeth, so can the wrong appliance. So it’s important that you consult with a dentist like Dr. Abdulla here at the Laguna Hills Center for Sleep Apnea & CPAP Intolerance who is well versed in occlusion (how the teeth come together) and attentive to any potential movement so adjustments can be made as needed. In fact, she is board certified in dental sleep medicine, which requires considerable training and case success, as well as passing a rigorous board.

When choosing the right appliance for your needs, she will be attentive to the possibility of movement and customize your treatment plan accordingly. That starts with getting the fullest picture possible of your case, including the root cause of your apnea.

That first step sets the stage for the most positive outcomes possible – outcomes that respect the bite.

Contact Us to Book a Consultation

(949) 420-9669

This field is for validation purposes and should be left unchanged.