Mandibular Advancement Devices (MAD)
Custom-fabricated dental appliances designed to mechanically protrude the mandible, preventing the tongue from collapsing into the pharyngeal space.
Mechanism of Action
Unlike CPAP which uses air pressure, MADs use mechanical leverage. By fitting over the upper and lower arches and forcing the lower jaw forward, they tighten the soft tissue and muscles of the upper airway, increasing airway patency.
Efficacy Profile
MADs are generally considered a first-line therapy alternative to CPAP for mild to moderate OSA, and for severe OSA patients who are CPAP-intolerant. While CPAP has higher absolute efficacy (reducing AHI to <5 in more patients), long-term health outcomes (like blood pressure reduction) are often statistically similar between CPAP and MADs due to significantly higher compliance rates with dental devices.
Contraindications
- Central Sleep Apnoea (CSA).
- Inadequate dentition (lack of healthy teeth to anchor the device).
- Severe, active Temporomandibular Joint (TMJ) disorders.
- Severe periodontal disease.
Common Side Effects
- Excessive salivation.
- Transient jaw pain upon waking.
- Dry mouth.
- Tooth tenderness.
- Occlusal changes (bite shift).
- Decreased overjet and overbite.
- Chronic TMJ pain (rare but severe).
Note: Boiler-and-bite devices bought over-the-counter are not clinically recommended for OSA treatment due to lack of titratability and poor retention.
Clinical Profile
- Primary Indication Mild/Mod OSA
- Efficacy Rate ~60-70%
- Avg. Cost $1,500 - $3,000
- Lifespan 3 - 5 Years