Mandibular Advancement Devices for Obstructive Sleep Apnea: An Informative Guide

Introduction and Terminology of the Procedure

Obstructive sleep apnea (OSA) is a prevalent condition that affects countless individuals across the United States. One effective treatment for this condition is the use of Mandibular Advancement Devices (MADs). MADs are dental appliances that gently shift the lower jaw (or mandible) forward, helping to open up the airway and reduce the instances of sleep apnea. According to the American Academy of Sleep Medicine, MADs are used by tens of thousands of people across the country as a non-invasive, patient-friendly method to combat sleep apnea.

Indications for Mandibular Advancement Devices

Mandibular Advancement Devices are indicated for the treatment of OSA in several situations. If you identify with any of the following circumstances, a MAD may be an effective treatment option for you:

• You’ve been diagnosed with mild to moderate OSA
• Continuous positive airway pressure (CPAP) therapy has failed, or you’ve found it hard to comply with
• You’re unable or unwilling to undergo surgical procedures for OSA
• You experience positional OSA (your sleep apnea is significantly worse when you’re on your back)
• Your sleep apnea is primarily due to a lower jaw that’s set back, causing a narrow airway
• You experience snoring that’s disturbing to others in your household

The ultimate decision regarding the use of MADs should be taken after thorough discussion with your healthcare provider, considering your individual health condition, lifestyle, and comfort. Our telemedicine practice can provide comprehensive consultations to help you make an informed decision.

Pre-Op Preparation

Prior to getting your custom-made MAD, there are few things to prepare for:

• You might need a dental check-up to ensure that your teeth and gums are healthy enough for a dental appliance.
• No fasting or specific medication adjustments are usually needed, but it’s important to discuss any medications you’re currently taking with your doctor.
• Pre-clearance authorizations might be necessary, depending on your insurance provider.
• Consider transportation and any necessary work or school notes, as your fitting appointment may take some time.

Remember, these are general guidelines and your doctor might have specific instructions for you. It’s essential to ask your doctor about the exact pre-operative preparations suitable for your condition. For assistance with pre-operative clearances or ordering pre-op labs and imaging, our telemedicine primary care practice is readily available to help.

Procedure Technique for Mandibular Advancement Devices

If you and your healthcare provider have decided to proceed with a Mandibular Advancement Device (MAD) for your Obstructive Sleep Apnea, you may be wondering what to expect during the process. While every individual’s experience can vary slightly, here are the general steps involved in obtaining and using a MAD:

Initial Consultation

The process begins with an initial consultation with your healthcare provider or a dental specialist skilled in sleep medicine. During this consultation, they’ll examine your teeth, jaw, and airway to determine if a MAD will be effective and comfortable for you.

Impressions and Molds

If a MAD is determined to be a good fit for your needs, the next step involves creating an impression of your teeth. This is done using a dental putty that hardens around your teeth, capturing their exact shape. These impressions are then used to create plaster molds, which serve as the basis for your custom MAD.

Device Construction

The molds of your teeth are sent to a dental laboratory, where your custom MAD will be constructed. The device is usually made of medical-grade plastic or acrylic and is built to last for several years with proper care.

Fitting Appointment

Once your MAD is ready, you’ll have a fitting appointment. During this session, your healthcare provider will check the fit of the device in your mouth, making sure it’s comfortable and effective. They’ll also instruct you on how to insert and remove the device, how to clean it, and what to do if you experience any discomfort.

Adjustments

Most MADs are adjustable, meaning they can be fine-tuned to provide the best possible results for your specific needs. At the fitting appointment, your healthcare provider will adjust the device to optimally position your lower jaw. They’ll do this by slowly moving the mandible forward until your airway is maximally open. However, the jaw position should still be comfortable for you.

Home Trial

After the fitting and adjustments, you’ll take the MAD home to use while you sleep. It’s important to use the device every time you sleep, even during naps, to get the best possible benefit.

Follow-up Visits

After you’ve started using your MAD, you’ll have follow-up visits with your healthcare provider to check on your progress. During these visits, they’ll ask about your experience using the device, including any discomfort or side effects you may be experiencing. They’ll also check the condition and fit of the device, making adjustments as needed.

Remember, the goal of a MAD is to alleviate your Obstructive Sleep Apnea symptoms, so it’s crucial to keep your healthcare provider informed about your experience. With good communication and regular follow-ups, your MAD can offer a non-invasive, effective solution for your sleep apnea, leading to better sleep and improved overall health.

Duration of Mandibular Advancement Devices Procedure

Acquiring a Mandibular Advancement Device (MAD) usually involves two office visits – the initial consultation and the fitting session. Each of these appointments typically takes about an hour, but times may vary depending on the individual case and any necessary adjustments.

Post-Op Recovery from Mandibular Advancement Devices

After the fitting of your MAD, there’s generally no recovery time necessary – you can return to your regular activities immediately. The device is designed to be worn while sleeping, so any adjustment period primarily involves getting used to wearing the appliance at night.

You’ll likely have follow-up appointments to ensure the device is working properly and to make any necessary adjustments. These visits can be scheduled at your convenience, and our practice offers same-day appointments until 9 pm on weekdays and 5 pm on weekends.

As for lifestyle changes, the most significant is consistently using the MAD every time you sleep. There’s no specific rehab or physical therapy required, but maintaining good oral hygiene and regular cleaning of the device is crucial. You won’t need to take any time off work specifically for the procedure. Full adjustment to the device varies among individuals, but most patients get used to their MAD within a few weeks.

Effectiveness of Mandibular Advancement Devices

MADs have been shown to be an effective treatment for Obstructive Sleep Apnea (OSA). Studies indicate that these devices can significantly reduce apnea episodes for individuals with mild to moderate OSA. For instance, a research review in the Journal of Dental Sleep Medicine showed that MADs reduced sleep apnea severity by around 50%.

The effectiveness of a MAD can be influenced by several factors. For example, individuals with a lower body mass index (BMI) tend to have better outcomes. The device is also more effective for those who sleep on their back or have positional OSA.

On the other hand, there are situations that might lower the effectiveness of the device. This includes severe OSA, obesity, or having a large neck circumference. Despite this, even for those patients, MADs can still provide some level of symptom relief and improve the quality of sleep.

Remember, the effectiveness of MADs is also linked to consistent use. Wearing the device every time you sleep is essential for it to be effective in treating OSA. Regular follow-ups with your healthcare provider can help ensure the device is properly adjusted and providing the maximum possible benefit.

Adverse Events with Mandibular Advancement Devices

Mandibular Advancement Devices (MADs) are generally safe, but like any treatment, there can be side effects. Adverse events include excessive salivation (15-20%), which is caused by having a foreign object in the mouth; temporomandibular joint discomfort (25-50%), due to the pressure applied on the jaw joint; and dental discomfort (20-40%), mainly due to pressure applied on the teeth. There might be minor changes in dental occlusion (<1%) which are mostly reversible. These are all usually temporary and often lessen as you adjust to the device. Mortality from the procedure is negligible as it is non-invasive and performed under controlled, non-surgical conditions.

Alternatives to Mandibular Advancement Devices

If a MAD isn’t right for you, there are other treatments for Obstructive Sleep Apnea (OSA). These include lifestyle changes like weight loss and positional therapy; Continuous Positive Airway Pressure (CPAP) therapy, which provides a steady stream of pressurized air to keep your airways open while you sleep; and surgical options, such as uvulopalatopharyngoplasty or maxillomandibular advancement, if non-surgical options have failed or are inappropriate. Consult with your healthcare provider to determine the best treatment option for you.

Experimental or Emerging Technologies

Emerging treatments for OSA include hypoglossal nerve stimulation, a surgical treatment that uses electrical pulses to stimulate the tongue muscles, preventing them from blocking the airway during sleep. This is still in experimental stages, and more research is needed to determine its long-term effectiveness and safety.

Conclusion

For individuals with mild to moderate Obstructive Sleep Apnea, a Mandibular Advancement Device can be an effective and non-invasive treatment option. While there are potential side effects, these are typically minor and temporary. If a MAD is not suitable or effective, there are several other treatment alternatives. New treatments are also in development, offering hope for even more effective future therapies. Always consult with your healthcare provider to choose the best treatment for your individual circumstances.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.