What is a Mandibular Advancement Device?



Last updated: January 28th, 2024

Mandibular Advancement Devices (MADs), encompassing terms like MRD, MAS, MAA, and various dental snoring solutions, are a simple, non-invasive fix for sleep apnea and snoring.

This piece explores their functions, varieties, effectiveness, side effects, and selection, alongside alternatives and expert consultation advice.

mandibular-advancement-devices

Key Takeaways

  • Mandibular Advancement Devices (MADs) are an effective sleep apnea treatment option that can reduce snoring and sleep apnea episodes.

  • Factors such as the design, adjustability, patient compliance, severity of sleep apnea and individual anatomical factors influence MAD success in treating Sleep Apnea.

  • Consulting a healthcare provider is essential for selecting the appropriate Mandibular Advancement Device (MAD) to ensure proper fitting and adjustment for optimal efficacy.

Understanding Mandibular Advancement Devices (MADs)

Mandibular Advancement Devices (MADs) are oral appliances designed to treat snoring and sleep apnea by advancing the lower jaw, improving airway patency during sleep. Patients with obstructive sleep apnea often have physical traits like:

  • being overweight

  • having large neck

  • structural abnormalities such as nasal obstruction, low-hanging soft palate, enlarged tonsils, or small jaw with an overbite

These all reduce the diameter of their upper airway. Maintaining a healthy weight, abstaining from smoking, limiting alcohol intake, and sleeping in a lateral position may all be beneficial in reducing snoring and managing sleep disorders.

MADs operate by advancing the mandible, thereby forestalling airway obstruction and diminishing snoring and sleep apnea episodes, making them a potential treatment option for obstructive sleep apnea patients. Keep in mind that various types of MADs are available, offering different levels of adjustability and comfort. These are suitable for treating moderate obstructive sleep apnea.

How MADs Work

jaw diagram

By moving the lower jaw forward, Mandibular Advancement Devices can prevent airway collapse, thereby reducing snoring and sleep apnea episodes. While there is currently no consensus on the best approach for quantifying and characterizing the degree of mandibular repositioning in a specific patient, consulting a sleep specialist may help in determining the best approach. MADs have been demonstrated to decrease snoring and sleep apnea episodes, enhance sleep quality, and diminish daytime fatigue, making them a viable sleep apnea treatment option.

Potential side effects and concerns associated with MADs, such as physical discomfort, maintenance and cleanliness requirements, and possible long-term impacts, should not be overlooked. These factors should be considered, especially for patients with mild sleep apnea.

Types of MADs

MADs come in various designs, including over-the-counter and custom-made options, with varying levels of adjustability and comfort. When selecting an anti-snoring mouthpiece, the primary factor to consider is whether you favor the manual jaw advancement of an MAD or the tongue-restraining suction of tongue retaining devices.

Keep in mind that MADs are better suited for treating obstructive sleep apnea as opposed to central sleep apnea.

The SnoreRx Plus is an advanced Mandibular Advancement Device designed for custom fitting through boil-and-bite molding, making it a potential treatment option for obstructive sleep apnea.

To prepare and mold the SnoreRx Plus, follow these steps:

  1. Boil the device in a cup of water in the microwave for 60 seconds.

  2. Submerge the device in a cup of tap water for 2 seconds.

  3. Bite down on it with your upper and lower teeth for 30 seconds.

This process ensures a proper fit for treating obstructive sleep apnea, also known as obstructive sleep apnoea.

Effectiveness of MADs in Treating Sleep Apnea

guy-laying-in-bed

Mandibular Advancement Devices (MADs) are effective in treating mild to moderate sleep apnea, with similar improvements in daytime sleepiness and quality of life as Continuous Positive Airway Pressure (CPAP) therapy.

Untreated sleep apnea may lead to:

  • hypertension

  • stroke

  • arrhythmias

  • cardiomyopathy

  • congestive heart failure

  • diabetes

  • heart attacks

Hence, exploring treatment options, such as MADs, which can help manage this serious sleep disorder is of utmost importance.

While CPAP therapy remains the most widely used treatment for sleep apnea, MADs have shown comparable advantages in terms of sleep quality and daytime functioning. However, it’s worth mentioning that CPAP therapy is more successful in reducing apnea episodes.

Treatment success with MADs depends on factors such as:

  • the severity of sleep apnea

  • patient age

  • body mass index

  • jaw structure

Comparing MADs to CPAP Therapy

Continuous Positive Airway Pressure (CPAP) therapy is the most widely used treatment for sleep apnea, involving a machine that delivers a continuous flow of air through a mask covering the mouth and/or nostrils to maintain an open airway. Despite CPAP therapy’s superior effectiveness in reducing apnea episodes, MADs and CPAP provide similar benefits in terms of sleep quality and daytime functioning.

MADs offer certain advantages over CPAP therapy, such as being less invasive, more portable, and easier to use. However, they may not be as efficacious in abating apnea episodes. Evaluating the pros and cons of both treatments and consulting a healthcare provider to ascertain the most suitable treatment for your unique condition is vital.

Factors Influencing Treatment Success

Factors such as the severity of sleep apnea, patient age, body mass index, and jaw structure are known to affect the efficacy of MADs. Various techniques for mandibular advancement have shown promising results in terms of predicting treatment outcomes. These techniques have resulted in an improvement in pharyngeal size. Airway collapse in the oropharyngeal region can be an indication of success. Identifying it could be useful for determining a successful outcome..

When it comes to the success of Mandibular Advancement Devices (MADs) in treating sleep apnea, several factors play a crucial role:

  • The design and adjustability of the device

  • Patient compliance and adherence to treatment

  • Severity of sleep apnea

  • Individual anatomical factors such as the size and position of the mandible and tongue

Proper monitoring and follow-up with a healthcare provider can help ensure the most effective treatment outcome.

Potential Side Effects and Concerns with MADs

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While MADs offer numerous benefits in the treatment of sleep apnea and snoring, it is important to be aware of potential side effects and concerns associated with their use. Some users may experience physical discomfort, such as sore jaw, toothache, and changes in teeth alignment. Additionally, proper maintenance and cleaning are essential to ensure optimal performance and longevity of the device.

When using a MAD, potential side effects may include:

  • Tenderness of the teeth and jaws

  • Gum irritation

  • Excessive salivation or dry mouth

  • Jaw discomfort

  • Tooth tenderness

  • Skeletal and dental changes

Particularly for patients with mild sleep apnea, these factors should be taken into account and a healthcare provider consulted to discuss the suitability of using a MAD.

Physical Discomfort

Some users of MADs may experience physical discomfort, including sore jaw, toothache, and changes in teeth alignment. Temporomandibular joint discomfort is another type of physical discomfort that can be caused by the use of Mandibular Advancement Devices (MADs) and may manifest as pain or stiffness in the jaw, teeth, and temporomandibular joints (TMJ), along with excessive salivation and discomfort upon waking.

To alleviate these discomforts, it is important to:

  • Ensure proper fitting and adjustment of the MAD

  • Give yourself time to acclimate to the sensation of having the device in your mouth during sleep

  • Regularly follow-up with a healthcare provider to monitor and address any physical discomfort associated with the use of a MAD.

Maintenance and Cleanliness

Mandibular Advancement Devices require regular cleaning and maintenance to ensure optimal performance and longevity. To clean a MAD, follow these steps:

  1. Use a soft cloth and mild soap and water to clean the device. Avoid using abrasive cleaners or scrubbing too vigorously, as this could potentially damage the device.

  2. Rinse the MAD thoroughly to remove any soap residue.

  3. Dry the MAD completely before reinserting it.

By following these cleaning instructions, you can keep your MAD in good condition and ensure its effectiveness.

Maintaining and cleaning MADs is essential for preserving oral hygiene and preventing the accumulation of bacteria and plaque on the device. Regular cleaning can help extend the lifespan of the device, guaranteeing that it continues to operate efficiently in treating sleep apnea and improving sleep quality.

Choosing the Right MAD for You

man-and-women-sleeping

Choosing the right MAD involves considering factors such as:

  • cost

  • lifespan

  • comfort

  • consultation with a healthcare provider

It is crucial to weigh these factors and discuss your specific needs and health condition with a healthcare professional who can help determine if a MAD is suitable for your particular condition and recommend the appropriate type.

When selecting a MAD, it is important to consider the following factors:

  • Medical evaluation

  • Adjustability

  • Mandibular position adjustment

  • Patient preference

A healthcare provider can provide tailored advice and directions based on your particular requirements and medical history.

Cost and Lifespan of MADs

MADs vary in cost and lifespan, ranging from $40 to $2,000, and lasting from six months to over two years with proper care. The cost of Mandibular Advancement Devices (MADs) can vary depending on the type and customization level, with an average sleep apnea mouth guard priced between $1,800 to $2,000, including the appliance, dental visits, and follow-ups. However, over-the-counter (OTC) options can be more affordable, with prices ranging between $50 and $150.

The lifespan of a MAD depends on its usage frequency and proper cleaning and maintenance. It is recommended to replace the device after approximately three years. Proper care and maintenance can help ensure the longevity and effectiveness of the MAD.

Consulting a Healthcare Provider

doctor-with-staff

A healthcare provider can help determine if a MAD is suitable for your specific condition and recommend the appropriate type. When selecting a MAD, a healthcare provider should assess the severity of the patient’s sleep apnea and determine if the device is a suitable treatment option. Furthermore, the healthcare provider should ensure that the device is properly fitted and adjusted to ensure its efficacy and reduce the risk of adverse effects.

Consulting a healthcare provider is essential when selecting a Mandibular Advancement Device (MAD) as they can offer tailored advice based on your particular requirements and medical history. Before purchasing an anti-snoring mouthpiece, it is advised to consult a doctor to evaluate what type (if any) will be suitable for you.

Snoring vs. Sleep Apnea MADs

Different MADs are designed for snoring and sleep apnea, so it’s important to choose the right one based on your diagnosis. MADs for snoring mainly target snoring by repositioning the jaw to avert the collapse of the airway, while MADs for sleep apnea are tailored to treat obstructive sleep apnea (OSA) by preserving the airway open and diminishing apnea events.

Research has indicated that MADs are effective in mitigating snoring and sleep apnea symptoms, with studies demonstrating that MADs can reduce snoring by up to 70%, and diminish the number of apnea events by up to 50%.

It is crucial to consult with a healthcare provider to diagnose your condition and determine if a MAD is an appropriate treatment for you.

Alternative Treatments for Sleep Apnea

In addition to MADs, there are alternative treatments available for sleep apnea, such as:

  • Continuous Positive Airway Pressure (CPAP) therapy: involves wearing a mask over the nose and mouth during sleep, delivering a continuous flow of air to maintain an open airway

  • Positional therapy: involves changing sleep positions to prevent airway obstruction

  • Lifestyle changes: such as weight loss, avoiding alcohol and sedatives, and quitting smoking

Positional therapy, on the other hand, is a non-invasive treatment option that involves sleeping in a specific position to reduce the risk of airway obstruction, such as sleeping on the side or propping up the head with pillows.

Lifestyle modifications can also play a crucial role in treating sleep apnea. Lifestyle modifications, such as maintaining a healthy weight, avoiding alcohol, and assuming specific sleep positions, can alleviate sleep apnea symptoms. Discussing all available treatment options with a healthcare provider to determine the best approach for your specific condition is vital.

Preparing for MAD Therapy

Preparing for MAD therapy involves getting started with the right device, adjusting to sleeping with a MAD, and monitoring treatment progress. A consultation with a healthcare professional typically includes an evaluation of sleep apnea, customization of the device, fitting and adjustment, instructions for use, and regular follow-up appointments.

Accommodating sleeping with a MAD may require some time and may involve becoming accustomed to the sensation of the device in the mouth, regulating the device for comfort, and tracking treatment progress. Regular follow-up appointments with a healthcare provider can provide insight into the progress of treatment and help address any issues or concerns that may arise during the course of therapy.

It is crucial to adhere to the guidance of your healthcare provider and maintain open communication throughout the treatment process.

Getting Started with Your MAD

Consult with a healthcare provider to obtain the appropriate MAD and follow their guidance for proper usage. The consultation process may involve taking alginate impressions of the teeth to ensure accurate results during the impression and custom-fitting process.

The fabrication process involves taking alginate impressions of the teeth to ensure accurate results. The MAD operates by temporarily advancing the jaw and tongue, thus reducing the obstruction in the throat.

Avoid making any adjustments during the initial week to give yourself time to get used to the device. Proper customization and fitting are essential to ensure the effectiveness of the MAD and reduce the risk of adverse effects.

Adjusting to Sleeping with a MAD

It may take some time to adjust to sleeping with a MAD, but most users report improved sleep quality and reduced snoring over time.

To accommodate sleeping with a MAD, you can:

  1. Utilize a screw to modify the position of the jaw forward.

  2. Focus on breathing through the nose.

  3. Allow time to acclimate to the sensation of having the device in your mouth while sleeping.

Keep track of your sleep quality, snoring, and other symptoms to monitor the progress of the treatment. Regular follow-up appointments with a healthcare professional can help ensure the most effective treatment outcome and address any potential issues or concerns that may arise during the course of therapy.

Summary

In summary, Mandibular Advancement Devices offer a promising solution for those suffering from sleep apnea and chronic snoring.

With various types, designs, and levels of adjustability available, MADs can provide significant benefits in terms of sleep quality, reduced snoring, and improved daytime functioning. However, it is crucial to consult with a healthcare provider to determine if a MAD is suitable for your specific condition and to understand the potential side effects and concerns associated with their use.

By exploring the world of MADs and understanding their advantages, potential side effects, and alternative treatments, you can make an informed decision about your sleep health. With proper guidance and care, a MAD may be the key to unlocking a better night’s sleep and improved overall well-being.

Frequently Asked Questions

Do mandibular advancement devices work?

Studies have shown that mandibular advancement devices (MADs) are an effective treatment for snoring and sleep apnea, with efficacy approaching up to 80% of a properly-worn CPAP device.

Do I need a prescription for a mandibular advancement device?

Yes, a prescription is required for a mandibular advancement device as it is an oral appliance used to treat Obstructive Sleep Apnea.

What are the problems with mandibular advancement devices?

Mandibular Advancement Devices can cause dry mouth, discomfort and pain in teeth and jaws, hypersalivation, stiffness or pain of masticatory muscles, occlusal change of tooth position and loosening of teeth. Long-term use may also lead to temporal mandibular joint arthritis or temporomandibular dysfunction symptoms.

Do mandibular advancement devices work?

MADs have been found to be an effective treatment option for sleep apnea, with around 65-80% of the efficacy of CPAP devices. (source)

What are the advantages of using a Mandibular Advancement Device (MAD)?

MADs offer a range of benefits, including reduced snoring and sleep apnea episodes, improved sleep quality, and enhanced daytime functioning.

References


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