Oral Appliance Therapy for Snoring: How Mandibular Advancement Devices Work and Who They Help

Snoring isn’t just annoying-it can be a sign your airway is collapsing while you sleep. If you’ve tried nasal strips, pillow adjustments, or even sleeping on your side with no real change, you might be wondering: is there something more effective? Mandibular advancement devices (MADs) are one of the most proven, non-invasive solutions for snoring-and they’re growing in popularity fast. Unlike CPAP machines, they don’t require masks, hoses, or air pressure. Instead, they gently move your lower jaw forward to keep your airway open. For many people, this means quieter nights, better sleep, and fewer complaints from their partner.

How Mandibular Advancement Devices Actually Work

Mandibular advancement devices are custom-fitted oral appliances, similar to mouthguards, that hold your lower jaw slightly forward during sleep. This forward position prevents the soft tissues in your throat-like the tongue and uvula-from collapsing backward and vibrating, which is what causes snoring. The science behind it is straightforward: when your jaw moves forward, your airway opens up. Studies show that even a 5-10mm shift can make a big difference.

Most prescription MADs are made from semi-rigid acrylic with titanium connectors, designed to last for years. They’re adjustable, letting your dentist fine-tune the jaw position in small 0.5mm increments. Over-the-counter versions exist too-made from thermoplastic that you boil and bite into-but they’re less precise and often less effective. A 2015 meta-analysis found custom devices reduced snoring by 72.3%, while over-the-counter ones only hit 48.6%.

These devices don’t cure snoring-they manage it. If you stop wearing them, snoring typically returns within two days. But for people who can’t tolerate CPAP, or who have mild-to-moderate sleep apnea, MADs offer a practical, portable alternative. They weigh less than an ounce, fit in a small case, and work anywhere-even on a plane or in a hotel.

Who Benefits Most from Oral Appliance Therapy?

Not everyone who snores is a good candidate. MADs work best for people with:

• Primary snoring (no sleep apnea), or mild-to-moderate obstructive sleep apnea
• At least 6-8 natural teeth in both upper and lower jaws
• Healthy temporomandibular joints (TMJ)-no severe arthritis or joint pain
• No advanced gum disease or loose teeth

Patients with severe anatomical blockages-like those with Mallampati Class IV airways (where the throat is very narrow)-often don’t benefit. In fact, studies show failure rates hit nearly 40% in these cases. That’s why a sleep study (either at home or in a lab) is required before getting a MAD. You need to rule out severe sleep apnea, which might need CPAP or surgery instead.

People who travel often, work irregular hours, or dislike the bulk and noise of CPAP machines tend to do very well with MADs. One Reddit user reported his wife’s snoring dropped from 65dB to 38dB after using a custom device-loud enough to wake her up, but quiet enough to sleep through.

Effectiveness Compared to Other Treatments

How do MADs stack up against other options? Here’s what the data says:

CPAP is still the gold standard for stopping snoring completely-but most people can’t stick with it. About half of users quit within a year. MADs, on the other hand, have much higher long-term use rates. That’s why the American Academy of Sleep Medicine recommends them as a first-line treatment for mild-to-moderate sleep apnea and primary snoring.

Side Effects and Long-Term Risks

There’s no such thing as a perfect solution, and MADs come with trade-offs. The most common issues during the first few weeks are:

• Morning jaw pain or soreness (reported by 68% of users)
• Excessive saliva production
• Tooth discomfort or pressure

Most of these fade after 2-4 weeks. Dentists often recommend wearing the device for an hour or two during the day to get used to it before sleeping with it. Warm water soaks can help soften thermoplastic components during adjustments.

The bigger concern is long-term dental changes. About 25% of people who use MADs for five or more years develop permanent shifts in their bite. Some need orthodontic work later. A 2023 study from SUNY warned that these changes can be irreversible. That’s why regular dental check-ups every six months are non-negotiable. Your dentist needs to monitor your teeth, gums, and jaw joint.

It’s also important to clean the device daily. Left uncleaned, bacteria and plaque can build up, leading to bad breath or even gum infections. Most users rinse theirs with water after each use and soak them weekly in a denture cleaner.

The Process: From Diagnosis to Daily Use

Getting a MAD isn’t as simple as ordering one online. Here’s what the real process looks like:

1. Sleep study: Get a home sleep test or in-lab polysomnography to confirm snoring isn’t caused by severe sleep apnea.
2. Dental evaluation: Your dentist checks your teeth, gums, jaw joints, and bite. If you have missing teeth or severe periodontal disease, you may not qualify.
3. Dental impressions: A custom mold is made-either using traditional putty or digital scanning. Digital scans are 23% more accurate, according to a 2022 study.
4. Device fabrication: The appliance is made in a lab and usually ready in 2-3 weeks.
5. Titration phase: You start with minimal jaw advancement and increase it by 1mm every 3-5 days over 4-6 weeks until snoring stops or you hit your max comfortable position.
6. Follow-ups: You’ll need 2-3 visits over the first few months to adjust fit and check for side effects.

Most people are using the device consistently by day 30. The first week is the hardest-many report feeling like they’re wearing a mouthful of plastic. But after that, it becomes routine.

Cost, Insurance, and Market Trends

Custom MADs cost between $1,800 and $2,500. Over-the-counter versions run $50-$100-but they’re far less effective and often cause more discomfort. Only about 38% of U.S. private insurance plans cover MADs, meaning most people pay out of pocket.

That’s changing. The global market for oral appliances is expected to grow from $1.28 billion in 2022 to $2.41 billion by 2030. More insurers are starting to recognize the long-term savings: people who snore less sleep better, have fewer accidents, and visit doctors less often. Some employers now offer sleep health benefits that include MAD coverage.

Leading brands include SomnoDent MAS, TAP 3, and the newer SomnoDent EVO 3, which has a built-in sensor that connects to an app to track usage and snoring levels. In 2024, a new AI-powered device from Sleep Solutions Inc. will launch, using algorithms to recommend optimal jaw settings based on your breathing patterns.

Is It Worth It?

If you snore loudly, wake up tired, or have a partner who’s had enough-then yes, it’s worth exploring. MADs aren’t magic. They require commitment, dental visits, and ongoing care. But for the right person, they’re life-changing.

Think about it: if you’re paying $2,000 for a device that lets you sleep through the night without waking yourself or your partner, and you use it for five years, that’s less than $400 a year. Compare that to the cost of lost sleep, daytime fatigue, relationship strain, or even the long-term health risks of untreated sleep apnea.

The key is choosing the right path: get evaluated properly, avoid cheap knockoffs, and work with a dentist trained in sleep medicine. Don’t just buy one online and hope for the best. The difference between a custom device and an over-the-counter one isn’t just price-it’s effectiveness, comfort, and safety.

Snoring doesn’t have to be normal. You don’t have to live with it. And you don’t have to use a CPAP machine to get relief. For thousands of people, the answer has been simpler-and quieter-than they ever expected.