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.