Mandibular Advancement Device (MAD)- An Introduction

Definition

A Mandibular Advancement Device (MAD) is a dental appliance, similar to a gumshield which are used to cure mild to moderate sleep apnea and snoring.

I think that it is fair to say that most MADs are bought as an anti snoring device.

There is credible evidence to suggest that they can successfully treat mild forms of Obstructive Sleep Apnea (OSA).

Snoring has a variety of causes and MADs tend to only work for people whose snoring is caused by a “vibrating tongue”.

Sleep apnea and snoring are caused by a narrowing at the back of the throat, which reduces the flow of air.

The “mandible” is the lower jaw and “advancement” means move forward.

And so MADs physically move the lower jaw forward so that in order to maintain an unrestricted airway.

History

The first MAD was apparently used in the early 1980’s. It was created in response to a patient who refused to have a tracheotomy as a solution for his OSA.

An oral surgeon suggested that instead a mouthpiece should be created, to be worn at night, that held his lower jaw in a forward position, in order to reduce any restriction the airway at the back of his throat.

Of course the device was not known as a MAD back then but as a Nocturnal Airway Patency Appliance (NAPA.)

Physical Description

MADs consist of two gum shield-like devices, joined at the back, which fit over both the upper and lower teeth (http://www.tsft.nhs.uk/media/44690/mandibular-advancement-device-mad-.pdf)

Add lots of photos showing variety of designs and styles.

Also Known As

MADs are known by a variety of different names. They include; mandibular splint or mandibular advancement splint (MAS), sleep apnea oral appliances, oral airway dilators and sleep apnea mouth guards (Wikipedia) or Jaw Advancing Device (JAD) (sleepassociation.org) or mandibular repositioning splint (MRS).

Availability & Types

They are very popular devices and there are dozens of different types and styles that are available to buy. There are two types of MADs- custom fit and over the counter.

Custom fit

Custom fit MADs are the expensive option. It is thought on average that a device will cost about $2000.

You will be required to visit a dentist or orthodontist on several occasions in order that you can be assessed for the suitability of a device, have “plaster” impressions made of your jaw, have the device built and then fitted and adjusted.

It is a long winded but thorough process.  The good news is that most medical insurances and Medicare will cover these expenses.

Over the Counter

If the custom made approach sounds too expensive and a bit too much bother, MADs that can be bought online and in shops for about $70.

The huge difference in cost between the two types of devices can be accounted for because over the counter MADs require the buyer to self assess that a MAD is the right device to fix their snoring.

Then the buyer needs to fit the device themselves using a boil and bite technique, which is carried out by the user usually at home.

The Boil and Bite Technique involves 3 different steps.

*1 Boil a cup of water and place the device in it for 1 minute.

*2 Place your device in a cup of water (that is at room temperature) for 3 seconds.

*3 Place the device in your mouth and bite it to create a mold of your mouth

Importantly “over the counter” devices do not involve any visits to the dentist or orthodontist.

Why use a MAD?

As described earlier, the origins of MADs came out of a person’s intolerance of the Continuous Positive Airway Pressure (CPAP) treatment, which requires quite a bit of equipment- some of it uncomfortable. 

CPAP is a treatment that involves 3 elements- a mask that fits over the nose or the nose and mouth, a tube and a ventilator. The ventilator creates a flow of air along the tube and into the mask.

A MAD is obviously smaller and less cumbersome.

MAD Side Effects

A MAD does have quite a few side effects although most of these are temporary and will not last more than a couple of weeks or so. These include; dry mouth, tooth pain, gum pain, jaw pain, excess saliva production and temporo mandibular joint (TMJ)pain. The TMJ is the joint where the upper and lower jaws meet.

In the long term, a very small percentage of users will find a change in their “bite”- where the upper and lower jaws rest on one another. Normally this is less than 1mm and will return to normal when a user stops wearing a device.

Do MADs Work?

Yes. A study in 2015 that looked at 51 clinical trials that had involved MADs showed that they were effective in reducing snoring.

Myths about MADs

I can only get a MAD by visiting my dentist.

MADs cost hundreds of dollars

Once I have worn a MAD, I can’t get a refund

 

MADs don’t cure OSA.

 

MADs have long term side effects

Leave a Reply

Your email address will not be published. Required fields are marked *