Usage and Mechanism of Action
- Mandibular advancement splints are custom-made medical devices used to treat sleep-related breathing disorders such as obstructive sleep apnea (OSA), snoring, and TMJ disorders.
- They are also known as mandibular advancement devices, sleep apnea oral appliances, oral airway dilators, and sleep apnea mouth guards.
- The American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM) recommend their use for certain patients.
- These devices move the lower jaw forward slightly, tightening the soft tissue and muscles of the upper airway, preventing obstruction during sleep.
- They also prevent the tissues of the upper airway from vibrating, which causes snoring.
- Oral devices have been shown to improve polysomnographic indexes of sleep apnea, sleepiness, blood pressure, neuropsychological functioning, and quality of life.

Effectiveness
- Mandibular advancement splints are widely used in the United States and are beginning to be used in the UK.
- They are considered a good therapy choice for patients with snoring or mild to moderate sleep apnea.
- Evidence suggests that oral devices are equally effective as continuous positive airway pressure (CPAP) devices in lowering blood pressure.
- A study showed that CPAP and mandibular advancement splints are effective in treating sleep-disordered breathing.
- Mandibular advancement splints are generally more successful in treating mild and moderate sleep apnea compared to severe sleep apnea.

Drawbacks and Side Effects
- Some patients discontinue use of mandibular advancement splints due to discomfort, lack of efficacy, or switching to CPAP.
- Long-term use of these devices can lead to permanent changes in how the upper and lower teeth meet.
- Side effects include dry mouth, tooth pain, dental discomfort, and jaw pain.
- Improperly fitted devices may cause teeth to shift over time.
- The high cost of prescription devices has led to the proliferation of lower-cost non-prescription devices that may be unproven and potentially dangerous.

Comparison and Adherence
- Mandibular advancement splints are considered an alternative to CPAP in non-compliant patients with severe obstructive sleep apnea.
- Adherence to oral appliance therapy is associated with patient reservations regarding the effects of the device on teeth, lack of efficacy, and discomfort.
- Some patients find mandibular advancement splints less bothersome than CPAP masks, leading to better compliance.
- Some health plans in the US do not cover the costs of mandibular advancement splints.

Factors Affecting Adherence and Insurance Coverage
- Factors affecting adherence to oral appliance therapy in severe sleep apnea.
- Insurance coverage and expenses for managing a sleep disorder long-term.