Mandibular Advancement Devices (MAD)

Since 2010, oral appliance therapy has emerged as a recognized alternative treatment for obstructive sleep apnea (OSA). In fact, since 2015, both the American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM) have recommended oral appliances for patients who are CPAP-intolerant, as well as for those with mild OSA or primary snoring.

These devices include Mandibular Advancement Devices (MADs) and Tongue Stabilizing Devices (TSDs), both designed to keep the airway open during sleep by repositioning the jaw or tongue.

🦷 Oral appliances for sleep apnea are custom-made dental devices worn in the mouth during sleep to help keep the airway open. Sleep specialists prescribe them to treat certain cases of obstructive sleep apnea (OSA) and to manage chronic snoring.

In OSA, the upper airway becomes partially or completely blocked during sleep. This obstruction reduces airflow, causing the brain to briefly wake the person just enough to resume breathing. This cycle of airflow limitation, arousal, and return to sleep can repeat throughout the night. These frequent interruptions prevent deep, restorative sleep and limit oxygen delivery to vital organs.

If left untreated, OSA can lead to serious health complications and may even become life-threatening.

Oral appliances reposition the mouth and jaw to ensure an open airway during sleep. By improving airflow, they help patients breathe more easily and reduce the number of apnea-related awakenings, leading to better sleep quality and improved overall health.

Want to know everything about Obstructive Sleep Apnea Syndrome (OSAS)?

There are two main types of oral appliances used to treat Obstructive Sleep Apnea Syndrome (OSAS):

• Mandibular Advancement Devices (MADs)

• Tongue Stabilizing Devices (TSDs)

Mandibular Advancement Devices (MADs) are the most common oral appliances for managing OSAS. Also known as mandibular advancement splints, mandibular repositioning devices, or mandibular advancement prostheses, these devices work by gently pulling the lower jaw (mandible) forward. By moving the jaw forward, they also shift the tongue forward, helping to open the airway and improve airflow at the back of the throat.

How MADs work:
MADs fit snugly over your teeth. Most models consist of two separate pieces—one for the upper teeth and one for the lower teeth. These pieces are connected by adjustable screws, hinges, or rubber bands that allow the lower part of the device (which controls the jaw) to be advanced forward. Some models feature interchangeable, independent arch pieces for customized adjustments.

MADs can vary widely in design, including:

• Size

• Materials used (ranging from firm to soft)

• The mechanism connecting the upper and lower pieces (in two-piece models)

• The amount of tooth contact when the mouth is closed

• The degree of mandibular advancement provided

These variations allow for personalization to ensure comfort, effectiveness, and optimal airflow, making MADs a popular and effective treatment option for many people with OSAS.

Tongue Stabilizing Devices (TSDs) — also known as tongue-retaining devices — treat Obstructive Sleep Apnea Syndrome (OSAS) by pulling the tongue forward using gentle suction.

A suction bulb at the front of the device holds the tongue in a forward position during sleep. Unlike mandibular advancement devices, part of the TSD remains outside the mouth. By advancing the base of the tongue, TSDs help keep the upper airway open and reduce airway obstruction during sleep.

While TSDs are less commonly used than Mandibular Advancement Devices (MADs), they can be a valuable alternative for certain patients. For example, people with dental conditions—such as weak or missing teeth—that prevent them from wearing a MAD may benefit from using a TSD instead.

Key features of Tongue Stabilizing Devices include:

• Suction-based mechanism to hold the tongue forward

• No need for dental support or fitting to the teeth

• Helps improve airflow by preventing tongue collapse

• A non-invasive, alternative oral appliance for OSAS treatment

TSDs offer a useful solution for individuals seeking a non-dental option for managing sleep apnea and are especially helpful when MADs are not suitable.

The most effective oral appliances for sleep apnea are custom-made to fit your mouth — similar to night guards used for bruxism.

While over-the-counter oral appliances are available, including "boil-and-bite" models that mold to your teeth at home, these options offer only limited effectiveness. Although they may provide some relief, clinical studies consistently show that custom-fitted oral appliances deliver the best results for treating Obstructive Sleep Apnea Syndrome (OSAS).

Key points:

• Custom oral appliances are tailored by dental professionals for optimal fit and comfort

• “Boil-and-bite” devices are more affordable but less effective

• Custom devices provide better jaw alignment and airway support

• Backed by scientific evidence for superior treatment outcomes

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For patients serious about managing their sleep apnea, investing in a professionally made, custom-fit oral appliance is the most reliable and clinically proven choice.

Oral appliances work by pulling the base of your tongue forward, creating more space at the back of your throat.

Some types attach directly to the tongue and gently pull it forward. However, most devices work by advancing the lower jaw while the tongue stays in place. This forward positioning helps keep the airway open and reduces the risk of obstruction during sleep.

How oral appliances are used:

• The device is inserted before bedtime

• It is worn throughout the entire night

• It is removed in the morning upon waking

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These appliances are a non-invasive, effective treatment option for many individuals with Obstructive Sleep Apnea Syndrome (OSAS), especially when custom-fitted and used consistently.

Oral appliances work best for people with mild to moderate Obstructive Sleep Apnea Syndrome (OSAS) who are unable to tolerate CPAP therapy (Continuous Positive Airway Pressure).

While CPAP remains the gold standard for improving airflow in sleep apnea patients, many individuals struggle with adherence and eventually stop using it due to discomfort or inconvenience.

Oral appliance therapy is not as effective as CPAP, but it can significantly reduce symptoms in some patients. In certain cases, people use both treatments together.
For example:

• You might use a CPAP machine at home and switch to an oral appliance while traveling.

• Some patients combine an oral appliance with CPAP to reduce the amount of air pressure required from the CPAP machine.

This hybrid approach can improve comfort and compliance while still effectively managing sleep apnea symptoms.

Oral appliances may not be suitable for everyone, including:

• People with central sleep apnea: This type of sleep apnea is caused by a lack of brain signals to initiate breathing during sleep. Oral appliances are not effective in treating central sleep apnea.

• Children: The treatment approach for sleep-disordered breathing in children is different from that in adults. Oral appliance use in children should only be considered under the guidance of a pediatric healthcare provider.

• People with severe obstructive sleep apnea: For individuals with severe OSAS, using an oral appliance alone may not provide adequate treatment and could be unsafe without proper medical supervision.

Always follow the guidance of your sleep specialist or pulmonologist to determine whether an oral appliance is appropriate for your specific condition.

How to Get a Dental Device for Obstructive Sleep Apnea (OSA): Step-by-Step Guide

1. Undergo a sleep study to diagnose or rule out Obstructive Sleep Apnea (OSA).

2. Consult with a board-certified sleep specialist to determine whether an oral appliance is a suitable treatment option for you.

3. Get a referral to a sleep-trained dentist with experience in oral appliance therapy.

4. During your dental consultation, the dentist will take dental impressions or perform a 3D scan, along with a bite registration.

5. These records are sent to a specialized lab, where your custom oral appliance is crafted according to your dentist’s specifications to ensure a precise fit.

6. At your next appointment, the Mandibular Advancement Device (MAD) will be fitted and adjusted to ensure comfort and therapeutic effectiveness during sleep.

7. You’ll receive detailed instructions on how to clean and care for your oral appliance.

If needed, your dentist or sleep specialist may recommend a follow-up sleep study to assess how well the device is working. Based on those results, further adjustments may be made to optimize its performance.

By following this process, a qualified sleep dentist can help you get the right "anti-snoring device" or "sleep apnea mouthguard" tailored to your needs.

Short-Term and Long-Term Side Effects of Oral Appliances for Sleep Apnea

During the first week of using an oral appliance for sleep apnea or snoring, while your body is adjusting, you may experience some temporary side effects. These are usually mild and tend to improve with continued use.

Short-Term Side Effects of Oral Sleep Devices

• Excessive salivation while wearing the appliance

• Jaw pain, including discomfort in the teeth or temporomandibular joint (TMJ)

• Dry mouth during or after use

• Gum irritation or tenderness
  
  

These side effects are generally short-lived and often resolve as your mouth adapts to the device.

Long-Term Side Effects (Rare with Proper Adjustment)

When an oral appliance is not properly adjusted or monitored over time, more persistent issues may occur. These are rare with routine follow-up and correct fitting:

• Changes in your bite (malocclusion)

• Tooth movement or loosened teeth

• TMJ discomfort or jaw muscle changes
  
  

Dental Follow-Up is Essential

To reduce the risk of complications and ensure optimal treatment outcomes:

• Visit your dentist regularly to monitor your oral health.

• Bring your oral appliance to every dental appointment.

• Your dentist will check for any changes in your bite, teeth alignment, or TMJ, and make necessary adjustments to the device.

• Regular maintenance also ensures your appliance stays in good working condition.

Mandibular advancement devices (MADs), a form of oral appliance therapy, can significantly improve symptoms of obstructive sleep apnea (OSA), particularly in patients with mild to moderate cases.

Benefits of Oral Appliance Therapy for OSA:

• Reduces daytime sleepiness and improves concentratio

• Promotes deeper, more restful sleep with fewer interruptions

• Reduces or eliminates snoring

• Offers a CPAP alternative for patients who cannot tolerate or prefer not to use CPAP therapy

• Lightweight and portable—ideal for frequent travelers
  
  

Who Benefits from a Mandibular Advancement Device?

Effectiveness varies depending on each patient's oral anatomy and the severity of OSA. Some individuals with mild to moderate OSA may experience complete symptom relief with an oral device. Others may require additional treatments for full symptom control.

Your sleep dentist can explain the advantages and limitations of oral appliances for both OSA treatment and snoring relief.

Considering Oral Appliance Therapy? Ask These Key Questions:

Before starting treatment, it's important to be fully informed. Here are essential questions to discuss with your dental sleep specialist:

• What is the total cost of oral appliance therapy?
  
  

• Is this treatment covered by my insurance?

• How many visits are required to fit and adjust the device?

• How many sleep studies (polysomnography) will be needed during the process?

• What are the potential side effects, and how can I monitor them?

• What is the expected lifespan of the oral appliance?
  
  

These questions will help you make an informed decision and prepare for the financial and practical aspects of treatment.

A Proven Alternative to CPAP for Many Patients

Oral appliances are an evidence-based solution to improve sleep quality in people with obstructive sleep apnea. They also effectively reduce loud or chronic snoring, enhancing sleep for both the patient and their bed partner.

If you struggle to use a CPAP machine consistently, consider discussing oral appliance therapy with your sleep specialist. While CPAP remains the gold standard in severe OSA, a well-fitted oral device may be a viable and effective alternative for certain patients.

Your pulmonologist or sleep physician can help determine whether a mandibular advancement device is appropriate for your specific symptoms and OSA severity.

The cost of mandibular advancement devices (MADs) can vary based on several factors, including the type of device, complexity of the case, and geographic location.

To get an accurate estimate, it is important to consult a dentist specialized in dental sleep medicine. In most cases, the final price depends on the level of customization of the oral appliance and any additional services, such as follow-up appointments and device adjustments.

Booking a consultation with a qualified sleep specialist is the first step toward understanding the total cost and identifying the most suitable treatment for your individual needs.