Doctors consider positive airway pressure (PAP) therapy the most effective treatment for obstructive sleep apnea (OSA). But it may not be the best choice for you. An oral and dental appliance, also called a mouthpiece, might be another option.
Some people use both appliances and PAP to treat their OSA. For example, you might use PAP at home and a mouthpiece when you’re on vacation or traveling for work. Here’s more information about the pros and cons of each.
What Are Oral and Dental Appliances for Sleep Apnea?
These devices help keep your airway open by positioning the jaw and tongue a certain way. The goal is to make it easier for you to breathe while asleep. There are three main types:
Mandibular advancement devices (MADs). Also called mandibular advancement splints, mandibular advancement appliances, or mandibular repositioning appliances, they fit over your teeth and pull your bottom jaw forward. This also pulls your tongue forward to make space in your throat to breathe.
Mouthguards. A less expensive appliance, these also pull your lower jaw forward. Just not as much as MADs. You can buy them over the counter or get one custom made for your mouth.
Tongue-stabilizing devices (TSDs). These use suction to pull your tongue forward. You aren’t likely to try a TSD unless there’s a reason you can’t put an appliance over your teeth.
Do Oral and Dental Appliances Work for Sleep Apnea?
An appliance may be a good substitute for or addition to PAP if you have mild to moderate OSA. Research shows many people struggle to stick with PAP therapy. Only 17% to 60% consistently use their mask.
Doctors measure OSA based on how many obstructive respiratory events occur each hour you’re asleep. In other words, the number of times you stop breathing. Studies to measure how well appliances work are based on whether they can cut the number of events in half at least. Research suggests they work well for about 7 in 10 people. But they don’t stop breathing events completely.
Pros and Cons of Oral and Dental Appliances
Size and cost are two benefits of using appliances to treat OSA. But there are drawbacks: mainly the fact that they don’t work for everyone. Let’s take a closer look.
Portable. Oral and dental appliances are small and easy to travel with.
Customizable. Although over-the-counter “boil and bite” appliances are available, research shows custom devices are best. Your dentist will do a 3D scan of your teeth or make an impression of them. That information is sent to a company that makes oral and dental appliances. Once your device is ready, you’ll go back to the dentist. They’ll check the fit and make sure it’ll stay put while you snooze.
Cost-effective. Appliances often cost considerably less than PAP machines. Most insurance plans will cover the entire cost or at least part of it. But you may need to provide proof of your OSA diagnosis first. Call your insurance provider first to find out what’s covered.
Mandibular advancement devices (MADs) have also been shown to help with:
- Daytime sleepiness
- Brain fog
- High blood pressure
- Your risk for a life-threatening heart event
Other pros and cons of using an oral appliance include:
No sound. Some PAP machines can be a bit noisy.
Saves energy (and money). Unlike PAP machines, appliances don’t need electricity to function. They also don’t have multiple parts that must be replaced over time, such as a hose and filters.
No setup required. All you have to do is put the appliance on.
May not work as well as PAP. Appliance therapy is becoming a more common treatment for OSA. But it doesn’t work for everyone. An analysis of people treated with oral and dental appliances from 2000 to 2013 found that 1 in 3 people saw little to no improvement in their symptoms.
MADs likely won’t work if you have a severe form of OSA. For example, doctors don’t usually suggest them for people with central sleep apnea. That’s because signaling issues in your brain trigger this form of the condition, so appliances won’t help. And treatments that work in adults may not be a good fit for children with OSA.
Might cause side effects. These can be short-term, lasting a couple of weeks. Or they may go on longer. They include:
- Jaw, tooth, and temporomandibular joint (TMJ) pain
- Dry mouth
- Gum soreness
You might salivate more (make extra spit) when wearing the device. In rare cases, some side effects stick around. These include:
Bite changes. Limited research suggests MADs can lead to changes in your teeth and jaw structure over time. They may slightly tilt your lower front teeth and jaw forward, along with other shifts. More high-quality studies are needed to better understand this potential side effect.
Dental issues. MADs can loosen work, like bridges and crowns, in some people. It’s important to see your dentist regularly so they can look for changes in your teeth, jaw, and other parts of your mouth. They’ll also check your appliance to make sure it’s still in good condition. Try to remember to take it with you to every dental appointment.
When to Consider an Oral and Dental Appliance for Sleep Apnea
You’re more likely to benefit from an appliance if you:
- Have mild to moderate OSA
- Are younger or a child
- Are female or were assigned female at birth
- Are at a healthy weight or have a low body mass index
- Know you won’t use your CPAP machine consistently
Questions to Ask Your Doctor About Oral and Dental Appliances for Sleep Apnea
Consider asking your doctor, dentist, and health insurance provider these questions to help you decide if an appliance for OSA might be a good idea:
- Will an oral and dental appliance work for me? Why or why not?
- Should I have an oral and dental appliance as a backup when I’m traveling or can’t do PAP therapy?
- Can you refer me to a dentist to get a custom oral and dental appliance?
- How much does an oral and dental appliance cost?
- Is an oral and dental appliance covered by my health insurance?
- How long will it take to get an oral and dental appliance?
- How will I know it’s working?
- Do I still need PAP therapy if I have an oral and dental appliance?
- How often would I need to replace my oral and dental appliance?
- Which oral and dental appliance do you recommend for my sleep apnea?
Show Sources
Photo Credit: Medicimage/Science Source
SOURCES:
Journal of Clinical Sleep Medicine: “Oral Appliance Treatment Response and Polysomnographic Phenotypes of Obstructive Sleep Apnea.”
Northwell Health: “Find relief from sleep apnea with oral appliance therapy.”
American Dental Association: “Sleep Apnea (Obstructive).”
Harvard Health Publishing: “Dental appliances for sleep apnea: Do they work?”
Cleveland Clinic: “Sleep Apnea,” “Oral Appliances for Sleep Apnea.”
Cleveland Clinic Journal of Medicine: “Treatments for obstructive sleep apnea: CPAP and beyond.”
The TMJ Association: “TMJ Basics.”
SleepApnea.org: “Oral Appliances for Sleep Apnea.”
Healthcare: “Oral Appliances in Obstructive Sleep Apnea.”
Journal of Personalized Medicine: “Dental and Skeletal Side Effects of Oral Appliances Used for the Treatment of Obstructive Sleep Apnea and Snoring in Adult Patients—A Systematic Review and Meta-Analysis.”
UC Health: “Overnight cure for poor sleep: the benefits of CPAP.”
