Oral Appliances
Mandibular Advancement Device (MAO / MAD)
These devices – Mandibulary Advancement Device or Orthesis – are effective in treating snoring, mild apnea and moderate apnea. They can sometimes be used for severe apnea treatment when the CPAP therapy has failed. Their objective is to help keep the airway open during sleep.
“Universal” solutions are available in stores or online. We recommend a custom-made devices conceived by specialists, as they are more comfortable and pose less risks to your dentition.
The Advanced Mandibular Orthesis (OAM) or Mandibular Advancement Device (MAD)
These custom-made oral appliances are adjustable and tailored to your mouth and teeth. Impressions of your upper and lower teeth are required.
These flexible plastic orthoses resemble boxers’ mouthguards and are worn at night. They advance the lower jaw, tongue and adjacent oral structures and increase the vertical dimension, thus enlarging the pharyngeal space, decreasing breathing resistance, and mechanically keeping the airway open during sleep. This ensures unobstructed breathing.
Consulting a sleep specialist beforehand is essential. They will assess the likelihood of success and make sure your teeth and jaws can support the device. These devices must be conceived by sleep specialists and are an effective, non-invasive, alternative treatment for snoring and sleep apnea.
Studies have shown that oral appliances effictively treat snoring in individuals with the following characteristics:
- Non-obese
- Simple snoring
- Mild to moderate obstructive sleep apnea
- Retruded lower jaw
Insurance plans do not always cover oral appliances. Even if snoring and sleep apnea are increasingly considered to be major public health problems.
Ideal candidates for oral appliances
An orofacial and functional evaluation by a specialist or sleep medicine-qualified dentist is essential. They will ensure that you are an ideal candidate for oral appliances. This evaluation includes a complete dental exam. Indeed, your teeth and supporting structures must be strong enough to withstand the loads associated to oral appliance wear.
The use of these devices requires regular monitoring to prevent tooth mobility and temporomandibular joint dysfunction, and to asses the treatment efficiency.
A minimum of eight healthy (8) teeth on each jaw is required to support the device. Having more teeth reduces the risk of experiencing consequences associated to long-term oral appliance wear.
Potential side effects of Oral Appliances
Most patients do not experience any dental side effects. However, if the teeth are not strong enough, they will tend to gradually move which will cause a malocclusion (i.e. upper and lower teeth that no longer close together properly). This causes varying degrees of discomfort, difficult chewing, and uneven tooth wear.
The devices exert a constant pressure on all teeth throughout the night in order to reposition the lower jaw in a forward position. This therefore exerts pressure on anterior lower teeth and posterior traction on the upper teeth. Patients presenting with orthodontic problems with upper teeth that are too advanced compared to the lowers, will benefit from such a device as this may partially correct their malocclusion. However this is not the treatment goal. Inversely, others may have their malocclusion worsened by the device.
It is important to ensure that dental restorations in place are sound and that the teeth do not possess decay or fractures that need to be repaired in the near future. Dental work done once the oral appliances is conceived may alter the quality of the fit, as tooth shape will have been modified. In order to correct for this, the device will have to be adjusted or remade.
Mandibular advancement device instructions
Follow these instructions in order to make you mandibular advancement device beautiful and long lasting:
- Brush your device each morning.
- Use half a pellet of Polident or Novadet IP for 10 minutes, 2-3 times per week.
- Do not soak in a liquid or chemicals.
- Always leave the device inside the box.
The jaw must always return to its normal position in the morning (about 1 hour).
If by lunch or dinner your jaw did not return to its original position, stop wearing the device and contact your sleep specialist.
There may be temporomandibular joint (TMJ) pain the first morning because of the unusual movement. If the pain persists or increases after a few days, stop wearing the device and contact your sleep specialist.
Don’t wear the device all night on your first night. Wear it one hour before bedtime, and if it is well tolerated, wear it all night. Repeat this the next day until it is well tolerated.
If you are nauseous, remove the prosthesis and try it again the next day until it is well tolerated throughout the night.
Once the mandibular advancement device is well adjusted, a sleep test will be performed to see if the apnea is still present.
See if you are less tired during the day. If you sleep with a partner, you can ask if your snoring has decreased.
The lifespan of the device is about 3 to 5 years.