Mandibular Advancement Device (MAD) is a therapy for snoring and sleep apnea. It is also sometimes referred to as a Mandibular Repositioning Device (MRD).
According to the American Sleep Apnea Association, millions of people snore while sleeping in the United States. Snoring is not only an audible noise, but can also interrupt a person’s sleep and reduce overall performance.
Before we continue, let us discuss a little about sleep apnea…
What Is Sleep Apnea?
About 22 million people in the US have Obstructive Sleep Apnea. When the human body relaxes, so does the throat. This relaxation leads to the narrowing of the airway, which causes audible snoring noises when breathing.
Sleep apnea is a medical condition that happens when breathing is completely blocked by the walls of the throat. Most people don’t know that they have sleep apnea.
Symptoms Of Sleep Apnea
In addition to snoring, common symptoms include:
- Feeling very tired throughout the day
- Waking up unexpectedly in the evening
- Focus and memory issues
- Breathing pauses when sleeping
- Mid-morning headaches
Individuals who suspect that they may have this disorder may want to consider a sleep examination that may confirm the presence of sleep apnea. Sleep specialists will recommend potential treatment options after diagnosis.
Treatment Of Sleep Apnea
Sleep apnea treatment options include:
- Changes in lifestyles, such as shifting sleep positions, weight loss, and treatments for allergies
- Appliance with Continuous positive airway pressure (CPAP)
- Oral appliances such as MAD
The most widespread treatment for sleep apnea is CPAP.
How Does Mandibular Advancement Device Work?
Mandibular Advancement Device (MAD) is an alternative type of treatment that people should pursue. It works by moving the jaw and tongue forward briefly, preventing constriction of the throat and avoiding sleep apnea and snoring. Moving the tongue forward creates space in the airway.
Some MADs are personalised or semi-customized and fit the mouth of a specific person. Others known as Boil-and-Bite MADs are available via the counter (OTCs). They include soft materials that can make underexposure to hot water more pliable. It helps to suit the device by biting down the flexible mould.
The authors of the 2018 review explain that more research is needed to determine the efficacy of each type of Mandibular Advanced Device. It is important to note that MADs are not ideal for people who wear dentures or have severe dental problems.
Advantages Of Using Mandibular Advanced Device
The primary benefit of the Mandibular Advanced system is that it helps to suppress snoring and sleep apnea. A 2000 clinical report on the use of MADs by 22 people aged 12 to 30 months shows that these devices are beneficial for sleep apnea and snoring treatment.
Many of the study participants decided to continue using MADs. However the size of the sample was very small.
Individuals expected to benefit most from the use of MAD include:
- Those suffering from mild to severe sleep apnea
- Youthful people
- People with sleep apnea, which increases when they sleep on their side
- Those with the structure of a receding jaw (also known as a Retrognathic mandible)
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Symptom progress with MADs is less likely to be seen by the following individuals:
- Older grown-ups
- Obesity patients and those with too much fat tissue around the neck
- Those with a stiff jaw, making it hard to progress
- Individuals with dental problems, including gum disease,
- People with central sleep apnea, which is not mechanical, but a neurological disorder
Types Of Mandibular Advancement Devices
There are three types of MAD, which include:
- Boil and Bite MADs: They can be bought online and from pharmacies. The fit is accomplished by loosening the resin or silicone with hot water, then sticking it in the mouth and clamping it down to create a comfortable fit after it has been slightly cooled. A few of these devices can now be customised to the consumer.
- Semi-custom Devices: They involve the consumer taking the custom mould from their teeth. The mould is then sent out to be specially designed. It could be sent back to be patched if the device doesn’t fit properly.
- Custom Dental MADs: These devices are based on the recommendation of physicians and are customised by dentists or sleep experts. They deliver a perfect match and the potential of the experts to be perfected.
Disadvantages Of Using Mandibular Advanced Device
While Mandibular Advanced Device can help reduce the symptoms of sleep apnea and snoring, there are still some adverse reactions associated with its use. These includes:
- Discomfort around the jaw and areas of the mouth
- Tooth pain
- Over excessive drooling
- Dry mouth
- Irritated gum
The adverse effects of the use of mandibular advancement devices are usually negligible. However, they will also cause individuals to give up on the treatment with MAD.
Mandibular Advancement Device vs Continuous Positive Airway Pressure
Although Continuous Positive Airway Pressure (CPAP) is the gold standard for sleep apnea care, people cannot always remain compliant with the treatment. Eventually, around 50% of people who use CPAP therapy for sleep apnea would quit treatment.
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Research in the Journal of Thoracic Disease indicates that MADs are helpful for individuals who have mild sleep apnea or are having issues with CPAP treatment.
Overall, CPAP is more effective than MADs in the treatment of sleep apnea. However, people are more likely to use MADs more effectively, and this procedure is more economically feasible than CPAP.
Compared to CPAP, MADs are durable, take up almost no physical space in the bedroom, and do not produce noise. They also do not need electrical power. However, They are not effective for everyone.
The American Thoracic Society explains that MADs are useful for the improvement of symptoms, but they are not used for the full-time control of sleep apnea. However, they noted that CPAP is more likely to offer immediate relief from sleep apnea symptoms than MAD.
Other Treatment Options For Sleep Apnea
Besides CPAP and MADs, other treatment options for sleep apnea include:
- Weight Loss: This long-term procedure will alleviate the symptoms of sleep apnea by lowering the fat tissue around the neck.
- Smoking and Alcohol Restriction: The risk of airway blockage can be reduced over time by quitting alcohol and smoke.
- Allergy Medicines: Nasal decongestants and other OTC allergy medicines can improve airflow and help people sleep while breathing through their noses.
- Modifying Sleep Position: Individuals may attempt to change their sleeping posture and rest on their side and see if the symptoms improve. Those with a disability are more likely to show signs while sleeping on their back.
- Surgery: Sleep apnea surgery typically involves removing any excess tissue from the back of the throat to reduce congestion of the airway.
Mandibular advancement devices are an important method for treating snoring and obstructive sleep apnea. They are mild, easy-to-use, have less adverse reactions and are more cost-effective than CPAP.
But MADs are not suitable for everybody. There may be no relief from the use of such devices in people with severe sleep apnea or central sleep apnea.
People who are worried that they might have sleep apnea should see their doctor or see a sleep specialist. Sleep tests will support a diagnosis of sleep apnea. The treatment choices should then be offered by the specialist.
Frequently Asked Questions On MAD
Can a MAD Be Used With Dentures?
No, It can’t. Most of the mandibular advancement devices are fastened and will not stretch the jaw unless the fastener suits the teeth. Denture users should go for the Tongue Stabilizing Device (TSD).
Mandibular Advancement Device or a Tongue Stabilizing Device?
The use of MAD, TSD, or some other anti-snoring device is a matter of trial and error. We encourage you to contact your doctor for advice on the best option for you. Meanwhile, other sleep disorders can be checked by your health care provider or specialist.
How Much Does a Mandibular Advancement Device Cost?
Prices range from $39 to $2000 for MADs. Most of the devices that are off-the-shelf range from $75 to $150. Custom units are the most expensive, ranging from $1500 to $2000.
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How Long Does a MAD Last?
Generally, the rate of usage and frequent cleaning will affect how long a mandibular advancement device will last. You should however, expect a minimum of six months and an operating life of up to two years. Usually, you renew your MAD off-the-shelf every year and you renew your custom MADs every three years.
Do MADs Cover Health Insurance?
Some health insurance companies offer policies that provide coverage for medical sleeping devices. However, whether you are protected will depend on the form of policy and the extent of coverage. Please contact your health insurance company for an informed opinion on the use of MADs.
Can MADs be Adjusted?
More traditional and contemporary pharmacy or online-sourced solutions may include simple adjustment. The very best mandibular advancement devices give a 1.0mm or 1/16 inch increment. Custom-fitted MADs also have micro-adjustment options.
Are MADs Uncomfortable to Wear?
Not necessarily. There might be some discomfort with the implant in your mouth, but it would be highly rare for you to feel pain. If you feel discomfort in some way, you should avoid wearing the device. With the jaw being held in front of the MAD, it may take a week or so to get fully relaxed.
How Do I Keep MAD Clean?
Any build-up of bacteria or germs can be reduced by putting the MAD in hot water. Daily toothpaste brushing or mouthwashing would also keep your Mandibular Advanced Device clean.
Do I Need to Get a Professionally Fitted MAD?
The fitting will differ with the customization function. Typically, an off-the-shelf MAD or one bought online is a pretty easy device. Place the machine in hot water, let it cool down, place the MAD and the silicone in your mouth.
Most MADs deliver incremental improvements as soon as they are attached to your mouth. Professional sleeping physicians or dentists normally suit personalised MADs that have a relaxed fitting and can also be adjusted gradually.
What if Snoring Persists?
Unfortunately, there is no guarantee that the mandibular advancement devices can cure the snoring problems. MADs do not work for everyone, particularly if snoring is linked to other health issues, but for most users they do offer improvements.
Right fitting is important because it ensures that the appliance is not damaged or worn out. A shift or rise in weight and alcohol intake can also have an effect on your snoring.
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It’s best to re-evaluate moving to the next stage of anti-snoring advice if your MAD doesn’t help you avoid snoring. There are a few of them out there:
- TSDs – Tongue stabilizing devices
- Dental care appliances
- Positive airway pressure – CPAP Machines
- Bidirectional Positive Airway Pressure – BiPAP Machines
Mandibular advancement devices are an important method for treating snoring and obstructive sleep apnea. They have mild adverse reactions, are easy to use and are more cost-effective than CPAP.
Please consult your health professional before using MAD.