Explaining Mandibular Advancement Devices (MADs)
What Is A Mandibular Advancement Device?
A mandibular advancement device, or MAD, is a device that advances the jaw forward by using the teeth. The mandible is a jawbone and it is advanced forward using this device. A MAD is commonly used to treat snoring and sleep apnea.
What Other Names Does A Mandibular Advancement Device Have?
MADs are also sometimes called: "oral appliances," "dental sleep devices," "mandibular advancement splints" (MASs), "mandibular repositioning devices" (MRDs), "sleep apnea oral appliances," "oral airway dilators," "sleep apnea mouth guards," "snoring mouthpieces," "snore guards," "sleep apnea mouthpieces" or "snoring mouth guards."
A MAD is different than a tongue stabilizing device (TSD), a TSD works by pulling the tongue forward and does not rest on your teeth.
What Does a Mandibular Advancement Device Do?
Using a mandibular advancement device can open the airway by moving the mandible (the lower jaw) forward. This can reduce or eliminate snoring.
The tongue is attached to the lower jaw, as the jaw is moved forward, the part of your airway which can collapse is held open. MADs also improve the strength of the airway by increasing muscle activity of the tongue.
A mandibular advancement device typically fits inside the mouth and is molded to your teeth. The upper jaw acts as a fixed frame which enables the lower jaw to be pushed forward. Some MADs provide multiple settings to find the ideal balance between the back of the tongue and the soft tissue in the throat.
Tongue Stabilizing Device vs. Mandibular Advancement Device
For a detailed review comparing TSDs to MADs, see this article comparing them.
Types of Mandibular Advancement Devices
- Non-fitted. These are MADs that do not require custom fitting, they simply go into your mouth and come in various sizes. These are generally the easiest to use but can also be uncomfortable due to the lack of custom fit.
- An example of a non-fitted MAD is ZQuiet
- Boil and bite. These are devices that can be bought online that allow you to make an impression of your teeth. You make an impression of your teeth by using boiling water which softens the resin/ silicone. After biting into the mouthpiece, you can see an impression of you teeth which will keep the device more secure.
- An example of a boil and bite mouthpiece is SleepTight Mouthpiece
- Adjustable boil and bite. These are mouthpieces which use the boil and bite fitting process but also allow you to make a jaw positioning adjustment unique to your bite using defined settings. Sometimes these devices require using adjustment tools. These devices can sometimes be used to make multiple adjustments, advancing the lower jaw incrementally until it's at a maximum position to open the airway. Some of these devices cannot be adjusted after their initial fitting because the impression material heats up and locks the initial setting in place.
- Semi-custom. These are MADs which allow a person at home to make their own impression, not using boiling water, but a dental material. The impression is generally better than those made with boiling water. Once an impression is made, the user needs to mail the impression to a dental lab which will make a mouthpiece for them.
- Dental custom. These are MADs that are made with the assistance of a dentist or sleep specialist. The difference between a semi-custom and dental custom MADs can be small or large depending on the impression. A dentist generally will help you find the ideal position for your jaw and this can contribute to a better impression of your teeth.
- An example of a mouthpiece which is fit by a dentist and created in a lab is SomnoDent.
What Are The Possible Side Effects of Using a Mandibular Advancement Device?
Possible side effects include:
- Sore or stiff jaw
- Tooth ache
- Changing to alignment of teeth
- Jaw joint pain or tenderness
- Excess salivation
- Dry mouth
Who Should NOT Use A Mandibular Advancement Device?
People with the following should avoid MADs:
- Recent dental implants
- Temporomandibular Joint Disorders (TMJ/ TMD)
- Severe sleep apnea
Cost of Mandibular Advancement Device
There are various types of MADs and so there are various prices and costs. The least customized devices could cost as low as $40 while the most customized and professionally made devices could cost as much as $2,000.
How Long Does a Mandibular Advancement Device Last?
The lifespan of a MAD will depend on how often it's worn and how often it is cleaned. In general, using a MAD every night should last at least 6 months. It can last 2 or more years but should probably be replaced after 3 years.
Some parts on a MAD may break if you clench your teeth at night, this could shorten the lifespan of the device.
Why Use A Mandibular Advancement Device?
The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) recommend the use of a MAD for adult patients who request treatment for primary snoring (without obstructive sleep apnea), as cited here.
Sleep Apnea Treatment and Mandibular Advancement Device
MADs are generally more effective at treating mild to moderate sleep apnea as opposed to treating severe sleep apnea. Sleep apnea can be reduced but not completely eliminated by using a MAD. In 2014, oral appliances were found to be effective at treating severe sleep apnea (OSA) after a first-line treatment had failed.
How Does CPAP Compare To A Mandibular Advancement Device?
Both MADs and CPAP (continuous positive airway pressure) devices result in similar benefits to cardiac autonomic function during daytime for blood pressure. CPAP is more effective than a MAD at eliminating respiratory events according to this article.
According to 51 studies that analyzed 4,888 patients, both CPAP devices and MADs were associated with reductions in blood pressure for those that suffer from obstructive sleep apnea. Some studies indicate similar effectiveness of the devices for some patients.
Many patients find MADs to be less bothersome than CPAP masks. Patients are more likely to continue wear a MAD than a CPAP mask.
Which Mandibular Advancement Device Is Best For Me?
The best MAD for you will depend on various factors relating to your comfort that addresses any dental issues you may have. See the reviews section on this site for more details on selecting a MAD for you.
Where Are Mandibular Advancement Devices Used?
The use of MADs for snoring is widespread in the United States, United Kingdom and Australia. Sleep physicians are recommended to prescribe MADs for treatment of snoring in these countries.
Long Term Effects of Using a Mandibular Advancement Device
Long term use of a MAD is not associated with affecting TMJ/ TMD becoming more prevalent. Long term use is associated with permanent changes in how the upper and lower teeth meet during the first 2 years of usage. A significant reduction in overbites was observed for long term MAD use.
Does Insurance Cover The Cost of a Mandibular Advancement Device?
Medical sleep devices are covered by many medical insurance companies but the policies vary. It is possible that you could get a MAD paid for from your insurance.
Professional Fitting vs. At Home
A mandibular advancement device can be fit by a sleep professional or dentist. A MAD can also be fit at home. The types of materials a professional will use is generally going to give a better impression and fit.
It is possible to use the same impression material a sleep doctor or dentist would use at home and send it to a lab. In this case, which fits better will be based on the impression and lab doing the work.
Most DIY/ at home mouthpieces use the boil and bite method to make an impression as opposed to dentists who often use a base and putty that solidifies after a short time. Many people are unable to make a good impression of their teeth using the base and putty material and need to do the impression over. Therefore, it is probably best to see a dentist if you want a mouthpiece fit using a base and putty.
Can You Adjust a Mandibular Advancement Device?
Some MADs offer you the ability to make adjustments. You can often make a boil and bite impression of your teeth 2 or 3 times with the same device before the material becomes too soft to do its job.
Some MADs have parts which can be adjusted, usually in 1 millimeter increments. With these devices, you can slowly move the device every night, or few nights, until the lower jaw is comfortably in the right place to stop your snoring. It is best to do this incrementally so that the bite can adjust. You may need a "chew toy" in the morning to help with any bite changes you go through in the process.
How Do You Clean A Mandibular Advancement Device?
Most MADs can be cleaned using denture solution. It is usually a bad idea to use mouthwash, toothpaste or any type of harsh or abrasive chemicals which may damage the device.
What If Snoring Persists After Using A Mandibular Advancement Device?
A MAD is not guaranteed to stop snoring for all people using them. If you continue to snore, make sure the device is fitted properly and is in working order.
You may snore due to nasal passageway problems. In this case, you can try nasal decongestant or nasal strips with your MAD.
If you have tried opening your nasal passageway while using a properly fitted and well functioning MAD without success resolving your snoring, you may need lifestyle modifications. See this article on causes of snoring to help identify you own snoring issues.
If you are unable to identify your snoring cause on your own, you may need to take a sleep study. A sleep study can help identify what the cause of snoring is for an individual. Sleep studies are usually conducted at sleep clinics run by sleep doctors.
Use of a mandibular advancement device can be an effective way to stop snoring. It can be fit at home or through a professional. A MAD is generally more comfortable than CPAP or a device that pulls your tongue forward. This means that a MAD is more likely to be worn at night and do its job. MADs that you buy online are not expensive and provide great benefit in understanding your own unique snoring issues.