Oral appliance caused extreme chewing pain, is it safe to use again?

I was fitted with a custom oral appliance by a doctor to treat my moderate sleep apnea. Over the course of about 5 months the appliance was adjusted using flexible plastic straps to bring my lower jaw further forward. Around the 5 month mark the appliance fit was very tight and my teeth were a bit sore in the morning. Even after doing the exercises to re-align my jaw, I started to experience pain while chewing. After a few weeks the pain subsided which I attribute to the appliance straps stretching.

At the 6 month mark I had a sleep study performed with the appliance in and my apneas had improved to the point where the doctor said I was treated. Shortly afterward I got a new strap for the appliance as they need to be replaced regularly due to stretching. Right after putting on the new strap I started to experience pain again in the left side of my jaw the next day when chewing. I tried backing off one step and using a larger/looser strap. The appliance was less tight but I still experienced pain chewing. Within a week the pain in my left side while chewing was too much to handle and I could not eat solid food. I now had a "click" or "pop" feeling near my ear when I chewed. I discontinued use of the appliance. Pain while chewing finally subsided about 2 weeks later but now I can hear and feel clicking in my left and right sides (near my ear) when I chew. I don't feel pain but the clicking is somewhat annoying. Prior to using the appliance I never had any jaw issues or pops.

The doctor recommended putting the appliance back in and starting over at the beginning setting and slowing working my way back to where I was. The question I have is: now that my jaw clicks when it used to be quiet and because I experienced a lot of pain chewing, is it safe or even a good idea to use the appliance? Could my jaw be weakened or prone to getting injured again due to this?

I am a dentist working in dental sleep medicine. Based on what you have related, it appears that you may have strained your jaw by over-protruding it. I think that the early symptoms that you had around the 5 month mark should have acted as a red flag and that you should probably have gone to a less aggressive level of protrusion at that point very quickly. Of course this is 20/20 hindsight. This is one reason why I do not particularly like the appliances that adjust via straps. Most often the adjustments are too coarse(too much protrusion at one time). I prefer appliances that can be adjusted very gradually in increments of about a tenth of a mm at a time. Gentler and more easily controlled. It is impossible to tell long distance, but it sounds from the clicking that you may have developed a TMJ condition called anterior disc derangement. The best bet might be to find a dentist who specializes in TMJ problems and let him do a complete diagnostic work-up to determine the health of your TMJs. At that time, he may be able to tell whether or not your condition is structural or muscular and what treatment would be necessary. Personally, I would not attempt to use the appliance again until this is done. And it could well be the case that you may be advised not to attempt to use it again. It depends. Arthur B. Luisi, Jr., D.M.D.. The Naples Center for Dental Sleep Medicine. Practice partner, dental sleep medicine, The NCH Healthcare System. Practice partner, dental sleep medicine. The Millennium Physician Group.

Thank you for your reply Dr. Luisi!