Sleep apnea and snoring are two common nighttime breathing disorders caused by obstruction of the airways. While there are a variety of techniques and appliances that can be used to tackle these disorders, simple dental devices called mandibular advancement devices are some of the most popular.
In this article, I’ll walk you through everything there is to know about mandibular advacement devices, including their benefits, side effects, and cost!
What Are Mandibular Advancement Devices (MADs)?
Mandibular advacement devices (MADs), also known as mandibular advancement splints, are dental appliances designed to pull the lower jaw (mandible) forward. Like nighttime retainers, mandibular advancement devices are removal devices designed to be worn during the nighttime.
For best results, a mandibular advancement device should be custom-made for the patient by a dentist. However, it’s also possible to buy generic mandibular advancement devices, which the patient can mould to their teeth at home.
Benefits
Mandibular advancement devices are mainly used to treat sleep-related breathing disorders like sleep apnea and snoring. However, there is some evidence that MADs may be beneficial in some cases of tempormandibular joint disorder.
Sleep apnea
Sleep apnea is a common disorder in which breathing stops and starts throughout the night. While some cases of sleep apnea are neurological (central sleep apnea), most are related to physical obstruction of the airways that occurs when the tongue and soft palate relax during the night (obstructive sleep apnea).
Mandibular advancement devices are one of the most promising treatments for obstructive sleep apnea. By holding the lower jaw forward, they prevent the tongue and soft palate from relaxing into and thus restricting the airways.
Snoring
Snoring can be explained by the same mechanism as obstructive sleep apnea. As the tongue and soft palate relax during the night, they restrict the airways. The difference is that snoring involves only partial obstruction of the airways, so breathing continues (albeit with the loud noise of air trying to pass the obstruction).
As a result, snoring can also be treated with the use of a mandibular advancement device. Once again, this involves holding the lower jaw forward to prevent the tongue and soft palate from restricting the airways.
Other conditions
Until now, mandibular advancement devices have mainly been used to treat sleep apnea and snoring. However, there is some evidence that MADs may be effective in treating some cases of tempormandibular joint disorder, which is a disorder of the jaw joint.
Side Effects
Mandibular advancement devices have a number of mild side effects which are especially noticeable during the early stages of treatment. These include:
- excessive salivation
- mouth dryness
- dental and jaw discomfort
- tooth tenderness
- dental changes
However, orthotropic practicioners such as Dr. Mike Mew have postulated that the use of mandibular advancement devices can have serious adverse effects in the long term, especially as relates to the treatment of sleep apnea and snoring.
This belief is largely supported by a physics principle called Newton’s third law, which states that each action has an equal and opposite reaction. Orthotropists agree that mandibular advancement devices push the lower jaw forwards, but say that simultaneously results in pushing the maxilla (the central bone of the skull) backwards. In the long term, this may result in more soft tissue obstructing the airways.
Cost
Off-the-shelf mandibular advancement devices usually cost between $30 and $200, depending on whether they use thermoplastic “boil-and-bite” strips or an at-home moulding system.
A professionally commissioned mandibular advancement device can cost anywhere from $500 to $2,000. Although this is a serious investment for most, tailor-made mandibular advancement devices are less likely to cause discomfort.
Alternatives
Mandibular advancement devices are not the only cure for sleep apnea and snoring. In fact, there are several other alternatives, some of which are entirely free!
Sleeping on your side
The simplest solution for obstructive sleep apnea and snoring is sleeping on your side. By sleeping on your side, gravity pulls the tongue and soft palate towards your ears, instead of down your throat.
Although this technique only works in less severe cases of sleep apnea and snoring, it costs nothing and is definitely worth a try.
Mewing
Proper tongue posture, also known as mewing, is a novel approach to tackling sleep apnea and snoring. This simple technique involves training yourself to subconsciously hold your tongue against the roof of the mouth.
With enough practice, orthotropists believe that proper tongue posture can be maintained throughout the day and night. As a result, practicing proper tongue posture may prevent the tongue and soft palate from relaxing into and blocking the airways.
CPAP
A particularly effective way to treat sleep apnea is with the use of continuous positive airway pressure (CPAP) machines. These portable machines create a continuous pressure that keeps the airways open, allowing you to breathe as normal.
Summary
Mandibular advancement devices, also known as mandibular advancement stints, are dental appliances that push the lower jaw forward. They are mainly used to treat sleep apnea and snoring — both of which are caused by the tongue and soft palate restricting the airways.
While mandibular advancement devices have been proven effective, they have come under considerable criticism from orthotropic practicioners, who believe long-term use results in recession of the maxilla. Alternatives include CPAP machines, mewing, and sleeping on your side.