Identifying patients at risk for jaw pain during oral appliance therapy for obstructive sleep apnea: clinical and craniofacial risk factors from a consecutive cohort.

PURPOSE: Oral appliance therapy (OAT) is an established treatment for obstructive sleep apnea (OSA). Temporomandibular disorder (TMD) symptoms, particularly jaw pain, are frequent side effects that may reduce adherence. This study evaluated clinical, behavioral, and craniofacial risk factors for OAT-related jaw pain as a symptom of TMD.

METHODS

We retrospectively reviewed charts of 595 adults with OSA referred for OAT at Mayo Clinic, Rochester (Jan 2021-Sep 2023). Demographics, comorbidities, parafunctional habits, TMD symptoms, and craniofacial measurements were collected. Inclusion required OSA diagnosis, OAT initiation, at least one follow-up visit, and research consent.

RESULTS

Median age was 58 years, BMI 31, and AHI 11/h; 53% were male. At baseline, 11% reported jaw pain. Post-OAT TMD-related jaw pain was more common in patients with headache, fibromyalgia, pre-OAT pain, jaw noises, limited opening, clenching/grinding, and masseter or temporalis tenderness (all p < 0.05). Craniofacial features including mandibular retrusion and Class II Division I malocclusion were significantly associated with post-OAT pain.

CONCLUSION

In this exploratory study, post-OAT TMD-related jaw pain was associated with pre-existing TMD symptoms (e.g., pain, joint noises, muscle tenderness), systemic comorbidities (headache, fibromyalgia), parafunctional behaviors, and craniofacial features such as mandibular retrusion and Class II Division I malocclusion. Recognition of these factors may help clinicians identify higher-risk patients and guide monitoring strategies to support sustained OAT adherence.