Mandibular advancement devices (MADs) are a non-surgical treatment option for certain sleep-related breathing disorders. These oral appliances are designed to be worn in the mouth during sleep, gently repositioning the lower jaw. Their purpose is to help maintain an open airway, addressing issues that can disrupt sleep patterns. MADs provide a portable and often quieter alternative to other treatments.
Understanding Mandibular Advancement Devices
A MAD typically consists of two custom-fitted pieces, one for the upper teeth and one for the lower, often connected by hinges, screws, or elastic bands. These components work together to gently move the lower jaw forward and slightly downward. This forward positioning of the jaw also pulls the tongue and soft tissues at the back of the throat forward.
The device increases space in the upper airway, particularly in the oropharynx. By physically advancing the mandible, the device prevents the soft palate and tongue base from collapsing backward and obstructing the airway during sleep. This mechanical repositioning stabilizes soft tissue, reducing the likelihood of airway narrowing or complete closure that can disrupt breathing. This increase in airway size is the primary mechanism by which MADs reduce airway collapsibility.
Conditions Treated by Mandibular Advancement Devices
Mandibular advancement devices treat snoring and mild-to-moderate obstructive sleep apnea (OSA). Snoring results from narrowed airway tissues, and by expanding the airway, MADs can reduce or eliminate these sounds. In OSA, the airway repeatedly collapses during sleep, leading to pauses in breathing and disrupted sleep.
MADs address these obstructions by maintaining an open airway. They are considered a first-line therapy for mild to moderate OSA, as recommended by organizations like the American Academy of Sleep Medicine. MADs are also an accepted treatment option for individuals with severe OSA who cannot tolerate or do not respond to continuous positive airway pressure (CPAP) therapy, which is often considered the gold standard for more severe cases.
Choosing and Customizing Your MAD
When considering a MAD, two types are available: custom-fitted oral appliances and over-the-counter “boil-and-bite” options. Custom-fitted MADs are prescribed by a sleep specialist or dentist and fabricated in a dental laboratory to precisely fit an individual’s dental anatomy. These devices offer advantages in comfort, effectiveness, and minimizing long-term oral health issues. Clinical studies indicate that custom-made devices can reduce apnea events by an average of 23% more for mild sleep apnea sufferers compared to boil-and-bite devices.
Obtaining a custom MAD begins with a consultation with a dentist or orthodontist specializing in sleep disorders. During this visit, they evaluate your medical history, sleep habits, and symptoms, and may recommend a sleep study to confirm an OSA diagnosis and its severity. Impressions or digital scans of your teeth and bite are then taken to create a precise model of your mouth, used by a specialized dental lab to fabricate your MAD. Once ready, you return for an initial fitting where adjustments are made for comfort and proper function, and you receive instructions on how to use and care for the appliance.
Using and Maintaining a Mandibular Advancement Device
Daily use involves inserting the appliance before sleep and removing it upon waking. Some individuals may find it helpful to wear the device for a few hours during waking hours initially to acclimate to the sensation. Upon waking, it is common to experience temporary jaw stiffness or a feeling that teeth do not align perfectly; this usually resolves within 15 to 60 minutes, and morning jaw exercises can help re-establish normal jaw position.
Proper cleaning and storage are important for hygiene and device longevity. The device should be cleaned daily after each use with a soft-bristled toothbrush and mild liquid soap or a non-abrasive cleanser; abrasive toothpastes should be avoided. Weekly deep cleaning, often involving soaking the device in a denture cleaner or a solution of warm water and vinegar for 5 to 15 minutes, helps eliminate odors and remove plaque. After cleaning, the MAD should be thoroughly rinsed with lukewarm water, dried, and stored in its protective case in a cool, dry place, away from heat or direct sunlight, to prevent warping or bacterial growth.
Common initial side effects of MAD use can include jaw soreness, tooth tenderness, increased salivation, or dry mouth. These symptoms are typically mild and temporary, often resolving within a few weeks as the mouth adjusts. While some minor changes in bite or tooth position can occur with long-term use, regular follow-up appointments with your dental professional are important to monitor for these changes, make necessary adjustments to the device, and ensure its ongoing effectiveness in managing snoring and sleep apnea symptoms.