Short- and long-term effects of mandibular advancement device therapy for obstructive sleep apnea on temporomandibular disorders: A systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Statistically significant for both short-term increase and long-term decrease in pain symptoms

• Effect Size: Short-term: OR 4.49 for pain-related TMDs, OR 2.90 for TMJ/muscle pain; Long-term: OR 0.21 for TMJ/muscle pain

• Primary Outcome: Pain-related temporomandibular disorders and TMJ/masticatory muscle pain

• Nnt Or Sensitivity: Short-term: approximately 1 in 4 patients may experience increased TMD pain; Long-term: protective effect with 79% reduction in odds of pain

• Confidence Interval: Short-term pain-related TMDs: 95% CI 1.46-13.81; Long-term TMJ/muscle pain: 95% CI 0.05-0.89

Clinical Application

Highly feasible in Australian practice with established sleep medicine and dental sleep medicine services Relevant to Australian sleep physicians and dentists; MAD therapy increasingly used as CPAP alternative; aligns with Sleep Health Foundation guidelines for OSA management Adult OSA patients requiring MAD therapy, particularly those without pre-existing severe TMD

Abstract

PURPOSE: This systematic review and meta-analysis investigated the effects of mandibular advancement device (MAD) therapy on temporomandibular disorders (TMDs) in patients with obstructive sleep apnea (OSA). STUDY SELECTION: We included 14 clinical studies assessing the signs and symptoms of TMDs in patients with OSA treated with MAD therapy. The analysis was divided into short-term (<6 months) and long-term (≥1 year) follow-up phases. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for each study during follow-up. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology, and meta-analysis was conducted using Review Manager version 5.4. RESULTS: Across the 14 studies included, the average follow-up period was 18.4 months, and the overall certainty of the evidence was rated as very low. Four studies used the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), six used the Helkimo Anamnestic Index, and four employed questionnaires. In short-term follow-up, a significant increase in pain-related TMDs was observed, including pain in the temporomandibular joint (TMJ) or masticatory muscles (pain-related TMDs: OR:4.49; 95%CI: 1.46 to 13.81, TMJ or masticatory muscles pain: OR:2.90; 95%CI: 1.26 to 6.71). Conversely, during long-term follow-up, the odds of pain in the TMJ or masticatory muscles were significantly reduced (OR:0.21; 95%CI, 0.05 0.89)Conclusions: MAD therapy for OSA did not cause long-term adverse effects on the TMJ or masticatory muscles. However, its short-term use may result in pain-related TMDs, highlighting the need to monitor and manage these symptoms during this period.

References

1. 1.Liu, S., Ishiyama, H., Angkulmahasuk, S., Nishiyama, A., & Fueki, K. (2026). Short- and long-term effects of mandibular advancement device therapy for obstructive sleep apnea on temporomandibular disorders: A systematic review and meta-analysis. Journal of Prosthodontic Research. https://doi.org/10.2186/jpr.JPR_D_25_00034