Dental Sleep Medicine Insider February 2016 | Page 18

DR. PAUL MCLORNAN

MITIGATING SIDE EFFECTS WITH THE

AM ALIGNER
Dr. Paul McLornan

Dr. McLornan is a board certified Prosthodontist in Private
Practice in San Antonio, Texas. He is an Adjunct Assistant
Professor in the Department of Comprehensive Dentistry
at the Dental School in San Antonio. The treatment of
Sleep Disordered Breathing was the subject of his Master’s research
and has been a major part of his practice for nearly
10 years. He lectures extensively on the topic across the country.

M

andibular Repositioning
Devices (MRDs) used to treat
Sleep Disordered Breathing (SDB)
with prolonged wear, can cause
permanent tooth movement
and/or occlusal changes. Dental
changes resulting from prolonged
MRD wear described in the
literature include reduction in
overbite, reduction in overjet,
decrease in mandibular crowding,
development of an anterior
cross bite and development of a
posterior open bite. The risk of
occlusal change is real and should
not be down played. We must be
clear in explaining that risk to our
new patients and clearly describe
the risk in our written informed
consents. So can we prevent these
dental side effects from occurring
in our patients?
The two techniques I instruct all
my MRD patients to use are an AM
Aligner from Airway Management
every day and chewing gum
when necessary. The AM Aligner

is simple to make and simple for
the patient to use. I instruct the
patients to insert the AM Aligner
every morning after removing
the MRD and bite firmly on it until
they can see in the mirror their
anterior teeth fitting perfectly in
to the indentations on the device.
I also explain that if the teeth are
not perfectly fitting they must
continue to bite on the device
until they are. If they cannot
achieve that I ask them to contact
my office because that means their
occlusion is starting to change.
Anecdotally, my patients who have
experienced occlusal changes
nearly all confess to not using
the AM Aligner daily. However,
I also have a quite a number of
patients who freely admit to never
using the AM Aligner and their
occlusion has experienced no
changes. A statement I make to all
new patients on the use of the AM
Aligner is “Your new MRD has the
ability to act like an orthodontic

device and move your teeth or
change your bite. You must use
the AM Aligner every morning to
reverse the orthodontic effect.” I
also instruct patients to chew gum
(sugar free of course!) if they are
having difficulty getting their teeth
to fully fit into the indentations on
the AM Aligner or if their bite feels
off or unusual anytime during the
day after wearing their MRD.
By doing this I feel we dentists
can continue to provide a life
changing and often lifesaving
treatment while doing our best to
inform and protect our patients
from adverse dental side effects.

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