Titration, Follow-Up, and Treatment Adherence
What the candidate must know
Titration is iterative. After delivery, schedule early follow-up to check fit, comfort, and tissue response, then advance the mandible in small increments (commonly fractions of a millimeter to about 1 mm per step) while monitoring symptoms. Objective confirmation of efficacy ideally uses a follow-up sleep study, especially for moderate-to-severe disease; symptom improvement alone is not proof. Track adherence with usage data where available and with structured questioning. Manage common side effects: salivation changes, dry mouth, tooth discomfort, gingival irritation, and transient TMJ or muscle soreness. Screen for occlusal change and dental migration at each visit. Address nasal obstruction, since it impairs tolerance.
Traps in questions
A frequent trap is equating patient-reported satisfaction with objective efficacy. Another is advancing too aggressively, causing joint pain or patient abandonment. Questions may test that follow-up sleep testing is recommended to confirm control rather than assumed from symptom relief. Also remember adherence is not binary; partial use still matters, and side effects should be managed rather than prompting immediate discontinuation.
Worked example / rule of thumb
A patient reports less snoring but still feels sleepy after two months. Rule of thumb: do not declare success on symptoms alone - consider objective retesting and further titration. Advance in small steps, document each change, and reassess the joint and occlusion. If discomfort limits advancement, slow the pace rather than abandoning therapy.