Snoring is an expression of airway congestion. The science calls it obstructive sleep apnea and proclaims that 2 to 7% of adults suffer from this disorder. However, there is a friendly solution available now and it is called a mandibular advancement device.
Surprisingly, this disorder has emerged as a challenge for Australians in recent decades. Considering that it affects the quality of life and health of many Australians, the concern is understandable.
What This Article Is All About?
Obstructive sleep apnea causes impairment in cognition, mood disturbances, and a significant reduction in productivity.
So, if you are sick of your partner snoring or suffer from this nuisance yourself, you have a treatment you can rely on. Mandibular advancement device is cheap and works like magic!
What Is a Mandibular Advancement Device?
A mandibular advancement device is an oral appliance that you can wear while sleeping. If you have ever worn braces or seen someone wearing them, that’s your clue. It is like a caste or mold that clothes your upper and lower teeth and mandible.
Mandibular devices are designed to increase the diameter of the upper airway by pushing soft oropharyngeal tissue and other anatomical structures. When the passage of air widens in your mouth, no vibration is produced; hence, snoring goes away.
It also effectively improves your oxygen supply during sleep. So, you do not wake up at night due to interrupted breathing, and in the morning you feel fresh and well-rested.
How does Mandibular Advancement Device Work?
The American Academy of Sleep Studies explains that mandibular advancement devices alter the positioning of your jaw, tongue, and support airway structures. The main principle can be easily divided into two maneuvers.
#1: The Jaw Maneuver
The mandibular device positions your lower jaw slightly outward and downward. It gives your mouth a bull-dog appearance and significantly increases the area of your airway. The anatomical structure particularly widened is the pharyngeal space (your throat).
The mandibular device also prevents the collapse of anatomical structures during the lying position. It does this by fixating the jaw and moving the soft palate to the side. This reduces the possibility of backward displacement of these structures due to gravity or relaxation, creating a room in each side of the air tract.
Isn’t it intriguing how repositioning of a single structure can effectively solve a complicated problem like airway blockage?
#2: The Bone Maneuver
The bone repositioned by the mandibular advancement device is the hyoid bone. It’s the prominent, ring-like bone you can feel in your throat while touching the upper part of your neck.
MAD fixes this bone in the forward direction and creates a new position for pharyngeal muscles attached to hyoid. This maneuver effectively makes your airway spacious in sideways. Hence, air can pass through your respiratory tract without interruption. Resultantly, your mouth produces no noise in the form of snoring.
Types of MAD Available in Australia
Mandibular advancement devices are divided into two main types. This classification is based on design, customization, and manufacturing material.
Each type has its benefits, cost, and efficacy. You can choose the one that matches your set of needs perfectly.
#1: Fixed Advancement MAD
These are non-adjustable mandibular devices, available over-the-counter in Australia. Their easy availability and low cost have made them one of the most popular choices for the snoring problem.
Such a device is made up of a single mouthpiece and only covers your lower denture.
It is most commonly called the “boil and bite” device. The material used in its design is thermoplastic which can be molded easily after dipping it in hot water. You can customize the device according to your denture after softening the material in the high-temperature liquid.
A study done in the UK shows that boil and bite device is effective in reducing sleep apnea. However, the possibility of falling out and lack of tolerance are two major hindrances in adherence to this option.
#2: Adjustable Advancement MAD
Adjustable mandibular advancement devices also come in single and double piece variety.
- A one-piece device, also called monobloc device, can be adjusted any time according to your comfort and prognosis of the disease. It has both upper and lower piece but they are fused to create a monobloc appliance.
It may be semi-bespoke (personalized by the patient) or bespoke (personalized by the dental expert). Since semi-bespoke is cheaper and has similar efficacy to bespoke, it is preferred as a first choice.
- A two-piece device has separate upper and lower dental plates and its construction is complicated. Although highly customized, it requires an expert to build an accurate jaw caste. This makes it an expensive choice but its adjustability is highly beneficial. The mandibular protrusion can be altered according to tolerance and efficacy so, you can control treatment prognosis with this option.
A tabulation of comparison is done to make it easy for you to choose a device suitable for your needs.
|Monobloc adjustable MAD
|Two-piece adjustable MAD
The Efficacy of Mandibular Advancement Device- What Are the Odds?
The two main goals of any treatment designed for sleep apnea are:
- The physiological improvement which includes lessening the obstruction of airway due to structural alteration
- The symptomatic improvements which include a freduction in snoring and day time sleepiness, and betterment in quality of life
Both these targets are achieved by mandibular advancement devices, making them a highly effective therapy option.
The efficacy of snoring therapy is measured by recording the extent of improvement in the Apnea-Hypopnea Index (AHI).
AHI is a yard-stick against which the severity of obstructive sleep apnea is measured. It is recorded in terms of the number of apnea events occurring per hour of sleep.
|Less than 5 per hour
|Normal or No sleep Apnea
|5-15 per hour
|Mild sleep apnea
|15-30 per hour
|Moderate sleep apnea
|Greater than 30 per hour
|Severe sleep apnea
In simple words, the greater the reduction in AHI with therapy, the more effective is the treatment.
Although mandibular advancement devices are known to be effective for mild to moderate sleep apnea, results are promising.
The studies show that MADs are capable of reducing AHI up to 72% in moderate cases. In individuals with mild sleep apnea, a 100% reduction was observed, which means AHI had become less than 5 per hour only.
Another study shows that the efficacy of MAD may even be equal to CPAP, which is still considered a gold standard for decreasing snoring.
Modulation of Mandibular Advancement Device – an Important Outcome Predictor
If you are looking for a solution that gives you control over treatment outcomes, a mandibular advancement device is the right choice for you.
You can alter the degree of jaw protrusion if you feel that the current degree isn’t helping you. Logically it makes sense that more jaw protrusion would create more space, increasing the efficiency of treatment. However, experts do not recommend overdoing it as the long term effects of this would be severe. There is also a high possibility of jaw pain and poor comfort that can reduce your compliance altogether.
The recommended advancement is 75% of the maximum degree as it produces great results without significant side effects. Research also shows that you should keep the titration in millimeters to avoid trauma and gain safe results. Over-enthusiasm can cause more damage than good.
MAD has a screw in the midline or lateral side that helps you in achieving desirable advancement.
Various Health Outcomes Achieved by MAD
Apart from an improvement in AHI, MAD has promising effects on other aspects of your health. Here are some of them:
- Improved Excessive Day Time Sleepiness
Excessive day time sleepiness (EDS) is a major problem faced by patients of sleep apnea.
If you feel sleepy the whole day, despite sleeping significant hours in the night, it is due to your apnea problem. Many Australians complain about a reduction in productivity and energy levels due to this issue. However, MAD solves your problem in minimum possible time and least invasive way. Not only does it improve sleep quality, but it also massively decreases EDS.
Another benefit of MAD is that it reduces your sleep onset time. It is always frustrating being in bed for hours and trying to sleep. So, MAD decreases the time your brain takes in getting from wakefulness to a sleep mode.
- Calming Effect in Hypertensive Patients
Since the mandibular advancement device has a calming effect on your sleep, it soothes your blood pressure levels. There is evidence that MAD improves your systolic and diastolic BP and may lead to betterment in hypertension. However, this is strictly for those who suffer from hypertension due to sleeping problems.
- Significantly Better Quality of Life
As MAD has shown high efficacy in managing sleep apnea, an improvement in the quality of life is logical. A goodnight’s sleep without interruption in oxygenation increases your cognitive function, motivation levels and, focus. These indicators ensure that your life quality can improve dramatically with MAD.
Short-term side-effects of MAD
Like any other therapeutic option, MAD carries risks but luckily, they are minimal.
Short-term side-effects are those which appear during the acclimatization process. It usually takes six weeks to get used to this device.
Such problems are due to the inability to seal your lips or the presence of a foreign body in your mouth.
- Dry mouth
- Joint discomfort
- Gingival pain
Long-term Side-effects of MAD
Wearing a mandibular advancement device for more than six months starts the onset of serious side-effects. These mainly include dental changes and alteration in jaws.
- Decreased overbite
- Inward movement of lower incisors
- The outward inclination of upper incisors
Who Cannot Use MAD?
MAD is an oral device and you have to wear it during the night. Although it is suitable for most individuals, there are some documented contraindications. These are the people who should avoid MAD:
- People with periodontal disease
- People with temporomandibular joint (lower jaw) disorders
- Those who have inadequate teeth for retention (older people)
- Individuals with a highly active gag reflex
Who Can Expect Better Treatment Outcomes With MAD?
MAD works successfully for the majority population but some factors escalate its effectiveness. These include:
- Low body mass index
- Younger age
- Female gender
- Small neck circumference
- Low AHI
- A low-set bone of hyoid
- Small-sized uvula
Are You an Ideal Candidate for Mandibular Advancement Device?
There are many other treatment options available in Australia for apnea and its resultant snoring. So, how can you conclude if you are an ideal candidate for a mandibular advancement device?
This is a checklist designed to help you find out if MAD is the right option for you. If your answer is “yes” for most of these questions, you need a MAD.
- Have you tried tongue stabilizers and felt no improvement?
- Do you suffer from mild to moderate sleep apnea?
- Do you find CPAP excessively invasive and difficult to adhere to?
- Are you scared of surgery?
- Are you a diabetic and at risk of delayed wound healing?
- Do you need a less invasive solution for your sleep apnea?
- Do you like your treatment to be adjustable to achieve desired results?
- Do you want your device to be designed according to your denture?
- Do you want a cost-effective solution for the snoring problem?
- Do you prefer customizing your device without involving a dental expert?
The Final Verdict
Although CPAP is considered a superior treatment for snoring, the mandibular advancement device brings a lot of benefits to the table. It has a wide variety of designs available and gives you the choice to control the intensity of treatment.
Additionally, the efficacy of the mandibular advancement device is well-documented and even comparable to CPAP. All these features make mandibular advancement devices a popular choice among Australians. You can pick the design that suits your needs and get rid of your sleep troubles without any doubt.