What is a Mandibular Advancement Device?

Mandibular advancement devices (MADs) are anti-snoring mouthpieces designed to physically move the jaw forward and expand the airway. MADs typically consist of trays with moldable thermoplastic to fit your upper and lower teeth, and mechanisms such as hinges or elastic bands to adjust the advancement level. For people with obstructive sleep apnea (OSA), MADs can be a more comfortable and less invasive treatment option than CPAP therapy.

You can purchase boil-and-bite MADs over the counter and customize them at home by softening the thermoplastic with hot water. Other MADs are customized in labs using impressions of your teeth, and some of these models require a prescription. We’ll provide a detailed look at how MADs work, who they’re best suited for, and how to obtain them.

How Do Mandibular Advancement Devices Work?

MADs physically advance your lower jaw forward to widen your breathing passages and promote more air circulation. Snoring often occurs because the airway is too narrow and tissue vibrates when air passes through during inhalation and exhalation. By expanding the airway, MADs can help prevent these vibrations from occurring.

Most MADs are adjustable, allowing you to change the advancement level of your lower jaw in 1-millimeter increments. Adjustment mechanisms vary by device. Some feature elastic bands with different lengths and strength levels, while others have screws, hinges, and other types of metal hardware.

Snoring is considered a major symptom of OSA. Boil-and-bite MADs can curb snoring, but they may not be ideal for OSA treatment. Custom-fit MADs that require a prescription may be more effective for reducing snoring and treating mild and moderate cases of OSA. Some MADs in the latter category have been cleared by the Food and Drug Administration (FDA) or FDA-approved for people with OSA.

MAD vs. CPAP

CPAP therapy involves a machine that captures outside air and pressurizes it. Sleepers receive the air through a face mask, which connects to the machine with a thin tube. CPAP masks and machines require a prescription. Standard CPAP machines pressurize air to a single prescribed level, while BiPAP and APAP machines fluctuate between pressure levels depending on the sleeper’s breathing patterns.

CPAP therapy has proven highly effective at treating OSA, but it has some major downsides. Many people find the masks and pressurized air delivery uncomfortable, the machines can be somewhat loud, and investing in the necessary equipment can be expensive. MADs may be a more comfortable and less disruptive option for people with OSA, provided their doctor gives approval.

Types of Mandibular Advancement Devices

Every MAD is unique, but most models sold today fall into one of three categories. These include over-the-counter and prescription options. Consult with your doctor or dentist if you aren’t sure which type of MAD will best meet your needs.

  • Boil-and-bite: Boil-and-bite MADs feature moldable thermoplastic on the upper and lower trays. You can customize them at home by softening the thermoplastic with hot water and biting into the material. Most of these MADs don’t require a prescription.
  • Semi-custom: With semi-custom MADs, you’ll receive a kit in the mail for making dental impressions at home. You’ll send these impressions to the manufacturer’s lab, where they are used to create a customized mouthpiece. If the device doesn’t fit properly, you can ask for a new impression kit. A prescription is not required for most semi-custom MADs.
  • Custom: Custom MADs require a prescription. Your dentist takes impressions of your upper and lower teeth, then sends them to a lab to create a customized mouthpiece. Custom MADs are typically best for people who snore due to OSA.

Most MADs are adjustable using mechanisms on the right and left sides, but some are designed with fixed advancement levels.

Fixed Advancement MAD
Adjustable Advancement

A fixed advancement MAD cannot be manually adjusted. If your required or preferred advancement level changes, you’ll need to arrange for a new mouthpiece.

Adjustable MADs allow you to move your lower jack back or forward using mechanisms on the right and left sides. These mechanisms include screws, hinges, and elastic bands.

How Much Does a MAD Cost?

Boil-and-bite mouthpieces typically cost less than $100, while semi-custom devices are usually between $75 and $150. Costs for custom appliances vary by model and provider, but you should expect to pay at least a few hundred dollars.

Does Health Insurance Cover MADs?

Your health insurance may cover all or some of the cost of an over-the-counter MAD, but this depends on your provider. Custom-fit MADs are fully or mostly covered under most insurance plans, and many are also eligible for Medicare reimbursement.

Using a Mandibular Advancement Device

Many people prefer the customized design and adjustable advancement level of MADs compared to one-size-fits-all mouthpieces. Your MAD may cause discomfort the first few nights you wear it. However, most sleepers eventually acclimate to their device after regular use. 

Boil-and-bite devices are the most affordable option. However, if you need more precise customization, you may want to consider a semi-custom or custom appliance instead. Your doctor or dentist can offer helpful tips for determining which device will work best for you.

Are There Any Side Effects?

Immediate side effects from using a MAD may include dry mouth, jaw pain and stiffness, and excessive drooling. These side effects usually taper off with continued use. An adjustment period of three to seven nights is typical, though some people need more than a week to feel comfortable sleeping with their MAD. 

Who Should Use a MAD?

A boil-and-bite MAD is best suited to people who want to stop snoring but have not necessarily been diagnosed with OSA. Semi-custom and custom MADs may be better for people with OSA, especially if they haven’t responded well to CPAP therapy. People should avoid MADs if they have central sleep apnea (CSA), dentures, dental implants, periodontal disease, braces, and conditions that cause jaw pain such as TMJ.

Other Alternatives for Snoring and Sleep Apnea

Many people effectively reduce their snoring with MADs, but these devices aren’t the only options for individuals who snore. Consult with your doctor about your best options for snoring treatment. Alternatives to MADs include: 

  • Tongue-retaining devices
  • CPAP, BiPAP, or APAP therapy
  • Switching from back to side or stomach sleeping
  • Smoking cessation
  • Avoiding alcohol before bed
  • Losing weight