Oral Appliance Therapy
Custom dental devices that treat obstructive sleep apnea and snoring by repositioning the jaw to maintain an open airway during sleep.
What is Oral Appliance Therapy?
Oral appliance therapy (OAT) uses custom-fitted dental devices worn during sleep to treat obstructive sleep apnea (OSA) and snoring. The most common type, mandibular advancement devices (MADs), work by holding the lower jaw forward, which enlarges the airway and prevents collapse. OAT is an effective alternative for patients with mild to moderate OSA, those who can't tolerate CPAP, and as adjunct therapy. Custom devices fitted by trained dentists are far more effective than over-the-counter alternatives.
How It Works
Mandibular advancement devices hold the lower jaw in a forward and sometimes downward position, which pulls the tongue base forward and tenses soft palate muscles. This enlarges the pharyngeal airway, reduces tissue collapse, and decreases the vibration that causes snoring. The devices are adjustable, allowing titration to find the optimal jaw position.
Who Is It For?
OAT is recommended for patients with mild to moderate OSA who prefer it to CPAP, patients with any severity OSA who cannot tolerate or refuse CPAP, primary snorers, and as combination therapy with CPAP in some cases. Good candidates have adequate dentition (enough healthy teeth), can protrude their jaw forward, and don't have significant TMJ disorders.
Benefits
Effective Alternative to CPAP
For mild-moderate OSA, OAT can achieve similar clinical outcomes to CPAP, particularly when CPAP adherence is poor.
Better Tolerated by Many
Many patients find oral appliances more comfortable and easier to use than CPAP, leading to better adherence.
Portable and Quiet
Oral appliances are small, silent, don't require electricity, and are easy to travel with.
No Equipment Maintenance
Unlike CPAP, oral appliances don't require filters, humidifiers, or complex cleaning routines.
Effective for Snoring
OAT very effectively reduces snoring, benefiting patients and their bed partners.
Side Effects & Considerations
Most side effects are minor and can often be resolved with simple adjustments.
Jaw Discomfort
TMJ pain, jaw muscle soreness, and bite changes are common, especially initially. Most improve with time.
Tooth and Bite Changes
Long-term use can cause teeth to shift and bite alignment to change. Regular dental monitoring is important.
Excessive Salivation or Dry Mouth
Some patients experience increased salivation initially; others have dry mouth.
Not Suitable for Everyone
Patients with inadequate dentition, severe TMJ problems, or severe OSA may not be good candidates.
Less Effective for Severe OSA
While OAT can work for severe OSA, it's generally less effective than CPAP for this population.
Variations & Types
Mandibular Advancement Devices (MAD)
Most common type, holding the lower jaw forward. Available in many designs from various manufacturers.
Tongue Retaining Devices (TRD)
Hold the tongue forward directly using suction. Option for patients with inadequate dentition.
Custom vs. Over-the-Counter
Custom devices fitted by dentists are far more effective and comfortable than boil-and-bite OTC devices.
Titratable vs. Fixed
Most modern devices are adjustable (titratable), allowing optimization of jaw position. Fixed devices cannot be adjusted.
Tips for Success
See a Qualified Dentist
Work with a dentist trained in dental sleep medicine. They have expertise in device selection, fitting, and management of side effects.
Get a Sleep Study First
Diagnosis of OSA severity helps determine if OAT is appropriate and provides a baseline for measuring treatment success.
Follow Up with Sleep Testing
After titration, a follow-up sleep study confirms the appliance is adequately controlling your OSA. Don't assume it's working without testing.
Wear It Every Night
Like CPAP, oral appliances only work when worn. Consistent nightly use is essential for benefit.
Report Jaw Pain Early
If you develop significant jaw pain, report it promptly. Adjustments can often resolve the problem before it worsens.
Do Morning Jaw Exercises
Your dentist will likely prescribe exercises to do each morning to counteract the effects of wearing the appliance and maintain bite alignment.
Additional Resources
Find Providers
Search our directory for sleep clinics that offer oral appliance therapy.
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