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.
A mandibi splint or mandibi advancement splint is a prescription custom-made medical device worn in the mouth used to treat sleep-related breathing disorders including: obstructive sleep apnea (OSA), snoring, and TMJ disorders. These devices are also known as mandibular advancement devices, sleep apnea oral appliances, oral airway dilators, and sleep apnea mouth guards.
| Mandibular advancement splint | |
|---|---|
 A mandibular advancement splint for treatment of sleep apnea | |
| Other names | MAS |
The American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM) recommend that sleep physicians should prescribe sleep apnea oral appliances for adult patients who need treatment for their primary snoring (without obstructive sleep apnea) rather than no treatment and for patients who have obstructive sleep apnea but are intolerant to CPAP therapy or otherwise prefer alternate therapy.
Vanderveken et al (2008) researched prescription custom-made splints head-to-head with thermoplastic over-the-counter splints: "Our results suggest that the thermoplastic device cannot be recommended as a therapeutic option nor can it be used as a screening tool to find good candidates for mandibular advancement therapy."
