If your dentist or sleep physician has recommended oral appliance therapy to treat your obstructive sleep apnea (OSA), you might be wondering how it works. This guide walks you through the basics so you’ll know what to expect and how to get the best results.
What Is a Mandibular Advancement Device?
A prescription for an oral appliance is provided to a qualified dental sleep provider, usually by a sleep specialist. A mandibular advancement device (MAD) is an FDA-cleared medical device. It is a patient-matched, custom-fitted oral appliance worn during sleep. The MAD gently stabilizes or moves your lower jaw (mandible) forward to help keep your airway open, reducing airway collapse and improving airflow.
Backed by decades of clinical research, MADs are one of the most common and effective treatments for mild to moderate OSA. In some cases, they may also be a successful alternative for patients with severe OSA who cannot tolerate CPAP therapy or when CPAP therapy is not recommended.
Getting Fitted for a MAD
To determine if a MAD is a good treatment option for you, the dentist will examine your teeth, jaw, and airway at your first visit. If you are a good candidate and you want to move forward with a MAD, impressions (or digital scans) of your upper and lower teeth and jaw position are taken to be sent to a dental lab or manufacturer to fabricate your custom device.
At your next appointment, the dentist will ensure the custom device fits properly, checking for comfort and stability and confirming the amount of jaw advancement needed to begin treatment. You also may be instructed on morning jaw exercises and bite alignment techniques. Your dental provider will discuss with you the steps needed to find the most effective position for your individual treatment needs.
Key Features of a High-Quality Device
While several models of MADs are available, the most effective ones share a few important features. Your dentist will help select the right design for you, but all high-quality MADs should:
- Be custom-made to fit your mouth
- Use biocompatible, medical-grade materials
- Engage both upper and lower teeth for stability
- Allow gradual, reversible adjustments in 0.5 millimeter steps
- Stay in place comfortably throughout the night
What to Expect as You Start
Oral appliance therapy can lead to better sleep and less snoring—and it’s a noninvasive alternative to CPAP. It’s quiet, portable, easy to clean and store, and custom fit for comfort and effectiveness. Most patients report high satisfaction and usage.
Your MAD will come with instructions on how to care for your device, including cleaning and storage. With proper care, your device should last 3-5 years.
Most patients adapt to their MAD within a few weeks. However, temporary side effects may include:
- Jaw, muscle, or tooth soreness
- Dry mouth or increased salivation
- Minor bite changes or tooth movement
These side effects are usually short-term and expected to improve with regular use of the MAD. Muscle and jaw exercises and follow-up adjustments as directed by your dentist should be helpful. Your dentist will monitor your progress and manage any side effects that arise.
Follow-Up Monitoring for Success
Your treatment doesn’t end when you receive your MAD—ongoing care is essential. You should return for regular visits to check fit, monitor symptoms, manage side effects, and fine-tune the settings.
A follow-up sleep study (at-home or in-lab) is recommended to confirm that your device is effectively reducing apnea events. Your dental provider will work with you to determine the best time to do this. Based on your results, your provider may adjust the appliance or your overall treatment plan.
If you have any questions about your device, comfort, or treatment progress, talk to your dentist. MADs are a powerful tool in managing sleep apnea—and your comfort and long-term success are the top priority.
Source: SleepWorld Magazine Jul/Aug 2025
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