Mandibular Advancement Device

Mandibular advancement devices (MADs) are devices that hold the tongue and lower jaw forward in order to make more space for you to breathe and to prevent the reoccurrence of snoring. This is one of several appliances used for the sake of dealing with sleep apnea, specifically obstructive sleep apnea (OSA). The mandibular advancement device keeps you from snoring by enlarging the collapsed or blocked air passageway with the right appliance.

Even non-sleep-apnea-induced snoring can be “cured” or assisted with the right custom-fit MAD. MADs are particularly helpful for any tongue-based snorers out there since it positions your tongue in a way that encourages better breathing. If your teeth are uneven, false (as in dentures), or have diseased gums under them, you should contact the manufacturer of the mandibular advancement device first before making a MAD purchase to correct your snoring and sleep apnea. Ditto for those who have temporomandibular joint dysfunction.

What Is a Dental Device for Sleep Apnea?

When it comes to FDA-approved dental sleep devices, you have the following available categories to choose from.

1. Mandibular Advancement Devices (MADs): The most common dental sleep device and sleep apnea/snoring solution available is the MAD or JAD (jaw advancement device). It takes good care of OSA in particular. These oral appliances open your airway through moving your lower jaw forward. Since the tongue is connected to the lower jaw from behind the chin, moving that jaw forward ensures that the collapsible part of your airway is kept open by the tongue’s current forward movement along with the readjusted jaw and other muscles for your airway.

The rigidity and strength of the airway is also improved significantly with the assistance of MADs, which can either be in the form of specialized mouth guards or outright orthodontic-like appliances with springs and joints. It could also be a combination of a mouthpiece with moving parts inside of it to better combat obstructive sleep apnea. These all work by increasing your tongue’s muscle activity as well as the activity of other airway muscles.

1. Tongue Retaining Devices (TRDs): As for tongue-retaining devices or TRDs, it goes about moving or adjusting your tongue muscles more directly than MADs. Like its mandibular counterpart, it also holds the tongue forward. However, in the case of TRDs, they directly control the tongue itself rather than affect your lower mandible. As a consequence, though, you need to first remove the TRD before you can speak. That doesn’t matter as much since it’s a dental sleep device (you don’t need to talk in your sleep), but still.

You can still somewhat speak with a mouthpiece or MAD within your oral orifice, after all. It’s also a mouthpiece, but this time around you bite into it rather than wear it like a sports mouth guard. It clamps onto your tongue and keeps it in place to prevent OSA symptoms. It also has decreased therapeutic complications compared to its MAD counterpart. What’s more, TRDs are less comfortable than MADs, so it takes a few weeks to a couple of months to get used to it.

1. CPAP and Combination CPAP/Dental Sleep Device Therapy: Instead of availing of a tongue retaining device or a mandibular advancement device, you can instead use Continuous Positive Airway Pressure (CPAP) therapy, which is a machine that helps someone breathe easier when suffering from an OSA episode using a breathing mask. The mask can be for your mouth and nose or your nose only. Sure, there are complaints about it being uncomfortable due to the fit and tightness of putting it on, particularly on the nose area.

One way to go about improving CPAP effectiveness is to combine a JAD or a TRD with your CPAP in order to make absolutely sure you’re not suffering from OSA and your airways are open when they’re supposed to be open as you sleep. Your CPAP can even be modified in such a way that your oral or dental sleep appliance can connect directly to the CPAP machine for the best results. When you put together a jaw advancement device with the CPAP, you can put your CPAP in a much lower pressure setting, resulting in more comfort while you sleep and rest.

Cooperation between Doctor and Dentist

Sleep apnea is typically treated with a combination of a dentist and a doctor. This is especially true of the treatable OSA disease that can leave a patient to end up lacking sleep while at the same time increase his risks for heart disease, arrhythmia, and a host of other complications.

It’s their combined expertise in sleep healthcare that allows for the right sleep apnea solution to be prescribed. To wit:

• The sleep physician is the one who diagnoses the ailment then prescribes the right appliance to fix it.
• The dentist is responsible for the oral or dental fit of the final product.
• CPAPs, JADs, and TRDs are the first and second line of defense against OSA.
• The sleep dentist will then customize the right oral appliance for you through a dental impression kit or digital scan.
• Customization of the mouth piece or device is important to maximize ergonomic comfort and fit.
• The device is supposed to be tailor-made to make sure that your treatment is specifically suited to your unique mouth structure that has led to OSA.

Finding the Right Device

Aside from MADs that are metallic appliances, you also have the option to use mouth guards or mouthpieces in order to keep your sleep apnea and snoring from bothering those around you and robbing yourself of deep sleep (you revert to light sleep whenever your breathing gets shallow and you start snoring loudly due to it). With that said, is a MAD necessarily the best and most appropriate anti-snoring appliance for your needs? It depends on whether or not your snoring is caused by sleep apnea or some other origin.

You should check out comparison tables or consult further with your dentist if you’re unsure about the suitability of one mandibular advancement device over the other. Value Added Tax or VAT might be included with your purchase of JAD unless you’re using the device in order to treat obstructive sleep apnea, in which case you’re entitled to VAT relief. There are sites or clinics that allow you to apply for VAT relief right at the checkout. Also make sure to find devices that have received FDA 510(k) approval in the United States.

How Does the Sleep Apnea Oral Appliance Work?

Oral appliances for sleep apnea treat the ailment by moving the jaw or tongue forward, which increases the upper airway size and decreases oxygen deprivation due to shallow breathing as you sleep. It also ensures air resistance reduction that leads to the condition in the first place. As a consequence, your snoring will also be treated with products like the mandibular advancement device.

Here are the things you should expect from your MADs and other dental device options:

• A Method to MADness: Oral appliances like JADs work by elevating the posterior rotation axes, thus the patient’s jaw line ends up parallel to the connecting rods of the appliance. This allows the retention force to work along the occlusal plane, resulting in a wider breathing space.
• Biomechanical Simulation Study: According to the biomechanical simulation study on MADs, its articulation creates 10 percent less stress on the temporomandibular joint (TMJ) than a conventional CPAP machine, allowing sustained mouth-closing and physiological breathing during slumber.
• MADs are Simply More Convenient: Instead of using a bulky and uncomfortable CPAP machine or going under the knife for sleep apnea surgery, you can fix your OSA through oral appliances instead that move your jaw or hold your tongue.
• MADs and Weight Loss: For overweight individuals, the mandibular advancement device and tongue retaining device are typically used together with diet and exercise, since being overweight also contributes to the development and aggravation of OSA.
• MADs are Plastic Molds Custom-Fitted to Your Mouth: JADs are simply more comfortable to wear because these sleep apnea mouth guards or mouthpieces are tailor-made by your dentist to perfect fit your mouth in accordance with your bite impression or digital oral scan.
• MADs for Moderate Treatment and CPAP Combo for Severe OSA: These mouthpieces or mouth guards are effective enough to treat moderate to mild OSA. If it gets more severe, combination CPAP therapy with the oral device will be called for.

Step-by-Step Diagnosis and Treatment for OSA Using MADs

Here are the steps to getting your OSA treated with MADs.

• Diagnosis: If you have sleep apnea symptoms suspected by you and/or identified by your family and/or loved ones, you should seek medical attention immediately. If you’re already diagnosed with OSA, discuss with your physician your potential treatment plan. You’ll probably be referred to a dentist specialist when it comes to sleep apnea treatment if you legitimately suffer from the disease.
• Dental Impression Kit: You will then have to produce a dental impression that will serve as a mold of your teeth, which the final mouthpiece or appliance will be based on. Just bite down on the bite kit as instructed by your dentist. You can also opt for the more accurate (and expensive) digital oral scan to get a digitized 3D model of the inside of your mouth. 
• Manufacturing the MAD: After you’re done with the oral scan or bite impression, you will then wait while the sleep dentist and his designated dental laboratory synthesize the mandibular advancement device appropriate to the shape, size, and bite of your mouth and jaws. After it’s been made, you’ll be called back to the clinic to test how well it fits and for instructions on how to maintain it.
• Reminders and Insurance Coverage: Remember to avail of only FDA-cleared clinics and sleep apnea mouth devices for treatment of your OSA. A MAD treatment is best used for moderate to mild OSA as well as severe OSA for patients who can’t stand CPAP. Typically, your insurance will cover this treatment unless otherwise stated (like if it’s only the most basic of healthcare and dental plans).
• Before and After Sleep Studies: Before recommending the appliance, the sleep physician will conduct a sleep study first to help determine his diagnosis. Another sleep study will then be done after the oral appliance has been fitted and used to determine its effectiveness. If you’re suffering from discomfort or if your OSA is more severe than initially diagnosed, adjustments will be made (like adding CPAP to your treatment or moving from MADs to TRDs).

Why MADs? Why Not TRDs and CPAPs?

Simply put, the mandibular advancement device is easier to customize and wear compared to CPAPs and TRDs. However, they’re limited to mild and moderate OSA. If you want to treat severe OSA, you typically stick with TRDs and/or CPAPs or some combination of CPAP with MAD or TRD due to and depending on the severity of the sleep apnea condition in question. This is why your sleep physician should work with your dentist in order to customize your CPAP perfectly, particularly when it comes to combining it with your MAD or TRD.

With that said, you should also be aware of the potential drawbacks or consequences to using MADs, TRDs, CPAPs, or any combination of the three. It includes the following:

• TMJ arthritis
• TMJ arthralgia (pain)
• Teeth shifting after prolonged use
• Unusual sensation after removing the device
• Difficulty in bringing teeth together in normal position

Even though oral appliances like MADs and TRDs are available online through mail order, it’s still best that you get diagnosed first by a sleep physician and/or primary care doctor before getting a tailor-made MAD or TRD (as well as CPAP) fitted to your mouth by a competent dental specialist.

Many “boil and bite” mouth pieces over the Internet are not effective, not customized to your specific sleep apnea problems or mouth shape, and could give you worse side effects than a mandibular advancement device that’s customized for you specifically. In conclusion, as long as your OSA or sleep apnea is merely mild or moderate, you can get away with simply putting on your MAD nightly to finally get some rest.

Thantakit International Dental Center is Thailand’s longest established dental center. Situated in Bangkok, our clinic is renowned across the world as a destination for world-class dentistry, with most of our patients flying to us from Australia.

Contact us today and get a FREE dental consultation.