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Yes, long-term oral appliance use can produce small bite changes in some patients. This is a well-documented side effect that the American Academy of Dental Sleep Medicine takes seriously and has published consensus guidance on. The honest picture: the changes are usually small, they develop slowly over years, most patients don't notice them, and they're managed by regular follow-up and morning repositioning aids. For most patients with diagnosed sleep apnea, the cardiovascular benefits of treatment far outweigh the dental side effects.
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What the Research Actually Shows
The research literature on oral appliance side effects is robust. The AADSM published consensus recommendations in 2017 on managing side effects of oral appliance therapy, and multiple longitudinal studies have tracked bite changes in patients using devices for years at a time. Here's what's consistently reported:
• Tooth movement is the most common dental side effect. Specifically, small changes in how the teeth come together (the bite) and small repositioning of individual teeth.
• Changes are typically gradual. Studies that have measured bite changes objectively have found that significant changes usually develop after at least a year of nightly use.
• The changes are progressive. Continued nightly use can produce continued slow change over years.
• Patients underreport what's there. Studies comparing patient self-reports with objective dental measurements consistently find that patients notice fewer changes than dentists actually measure. This is part of why follow-up matters.
What Kind of Changes
The most common patterns described in the research:
• Decreased overjet. The horizontal distance between the upper and lower front teeth gets smaller.
• Decreased overbite. The vertical overlap between upper and lower front teeth decreases.
• Posterior open bite. In some patients, the back teeth don't come together as fully as they used to. This is one of the more noticeable changes when it occurs.
• Slight tooth movement. Front teeth in particular can tip or shift slightly over years of use.
These changes happen because the appliance positions the lower jaw forward every night for hours. Over time, that forward positioning can transmit gentle forces to teeth and joints that produce small accumulated effects.
How Significant Are the Changes?
Honest answer: variable. The published studies show ranges. Between 2% and 45% of long-term users self-report some bite change. Objective dental measurements typically find changes in a higher percentage - one study found up to 86% of patients had measurable occlusal changes after five years of nightly use, even though only a fraction of those patients had noticed.
Importantly, in most cases the changes are small. A few tenths of a millimeter of tooth movement. A small reduction in overjet. Few patients in the research literature report that the changes interfered with chewing, speaking, or appearance. Even fewer reported that they stopped therapy because of the changes.
How Bite Changes Are Managed
This is where the dentist's role matters. The AADSM specifically recommends ongoing dental oversight of patients on long-term oral appliance therapy; not as an optional add-on, but as the standard of care. Management strategies include:
1. Periodic dental exams. Every 6 to 12 months, the dentist takes measurements (sometimes with digital impressions) to track any developing changes objectively.
2. Morning repositioning aids. These are small custom devices designed to be bitten into for a few minutes after removing the appliance each morning. They help reset the bite to its natural position. Multiple studies suggest they reduce the rate of cumulative bite change.
3. Appliance design choices. Hard-acrylic, rigid appliances with full tooth coverage tend to produce less unintended tooth movement than flexible designs with partial coverage. We discuss the trade-offs at your fitting.
4. Treatment-related stretches and exercises. Some patients benefit from gentle jaw stretches in the morning to help the muscles return to their resting position.
5. Communication. Tell us if you notice anything different about your bite, your chewing, or how your teeth fit together. Earlier conversations make smaller corrections possible.
The Trade-Off Worth Naming
Long-term users of oral appliances, when surveyed, overwhelmingly say the cardiovascular and quality-of-life benefits outweigh the dental side effects. In one study, 34% of long-term adherent patients reported some tooth or bite change and the same patients reported high overall satisfaction, better partner relationships, and willingness to continue therapy.
This is the framing that matters: oral appliance therapy treats a condition with serious long-term health consequences (untreated sleep apnea). It does so with side effects that are typically small, slow to develop, and largely manageable with proper follow-up. For patients with diagnosed sleep apnea, the math has been studied and the answer is consistent - treat the apnea.
What This Means for You
If you're considering oral appliance therapy, three things to expect from a qualified dentist:
• Honest disclosure of potential side effects at the start of treatment - not after.
• A long-term follow-up plan: regular visits to track any developing changes.
• A morning repositioning aid or equivalent strategy to reduce cumulative bite change.
If you're already on an appliance and worried about bite changes, the right next step is a check-up. We can take impressions, compare them to records from when you started, and see objectively whether changes have developed and how much. From there, the management plan is straightforward.
Worried About Bite Changes? Let's Take a Look.
Call (303) 790-9323 to schedule or book an appointment online.
About the Authors
Drs. Bart & James Christiansen, DDS are brothers practicing in Centennial, CO. Bart has been practicing since 1988 and James since 2009. They offer general, restorative, cosmetic, and emergency dentistry for the whole family.
