Sleep Apnea Timeline: Oral Appliance
An oral appliance (mandibular advancement device) is a custom mouthpiece, made by a dentist, that holds the lower jaw slightly forward during sleep. Moving the jaw brings the tongue forward and opens the airway behind it.
This page is one of seven treatment-track timelines for adult obstructive sleep apnea. The sleep study, how a track is chosen and how to read the outcomes row are covered on the sleep apnea treatment timelines page.
Teal words in the timeline are links. On a phone, swipe sideways to see the whole graphic.
Who follows this track
Oral appliances are used for snoring and for sleep apnea in people who cannot use CPAP or prefer not to. They lower the AHI less than CPAP on average but are often worn more hours a night, so the overall benefit can be similar. They work best with mild or moderate sleep apnea and need enough healthy teeth to hold the device. The appliance should be custom-made and adjustable, fitted by a dentist trained in sleep medicine (see sleep dentists in Bloomington-Normal), and checked with a sleep test. Over-the-counter "boil and bite" mouthguards are not the same device.
Fitting and adjustment (weeks 1 to 20)
Weeks 1 to 4 after diagnosis: referral to the dentist, an exam of the teeth, gums and jaw joints, X-rays, and molds or digital scans.
About 2 to 6 weeks later: the appliance is delivered, set with the jaw only partly forward.
Over the next 1 to 12 weeks: the jaw is moved forward in small steps, often by the person at home using a small key or screw, until snoring and symptoms improve or discomfort limits further movement.
About 2 to 4 months after delivery: a sleep test with the appliance in place shows how well it controls the sleep apnea, because how a person feels cannot confirm this on its own.
Side effects
In the first weeks: sore teeth, jaw stiffness, extra saliva or dry mouth are common; most of these ease by about 3 months.
Over time: excess saliva in about 1 in 3, a change in the bite in about 3 in 10, and jaw muscle pain in about 1 in 4 (see TMJ problems).
The front teeth slowly shift, by about 1 millimeter on average, and the change continues over years of use. Morning jaw exercises or a small morning repositioning piece help the bite settle each day. The jawbone itself does not change.
In short trials, about 7 in 100 stopped because of side effects.
Outcomes on this track
Breathing (AHI): in a large study of people averaging 23 events an hour, the AHI fell to 10, about half. The AHI fell below 5 in about 1 in 3, below 10 in about 2 in 3, and by at least half in about 6 in 10. In a head-to-head trial, the AHI was 4.5 on CPAP and 11 on an appliance, from 26.
Sleepiness: the Epworth score averaged about 2 points lower than without treatment, and about 4 points lower with use beyond 1 year. In people with severe sleep apnea, effects on sleepiness and quality of life were similar to CPAP even though CPAP lowered the AHI more.
Daily life: in the head-to-head trial, sleep-related quality of life improved by similar amounts with the appliance and with CPAP.
Use: about 8 in 10 were regular users at 1 month and about 2 in 3 at 6 months to 1 year in some studies; in another, 83 percent were still using it at 1 year, about 6.4 hours a night. In trials comparing the two, the appliance was worn about half an hour to an hour longer each night than CPAP, and over half of people chose to alternate between them.
Long term: the lower AHI holds up beyond 5 years in studies that followed people that long.
These are averages from groups of people, not a prediction for any one person.
Check-ups and long-term care
Dental check of the teeth, bite and jaw joints at least once a year, because changes build slowly.
Sleep doctor visits, with a repeat sleep test if symptoms return or weight changes.
The appliance is relined or replaced every few years as it wears.
Some people combine an appliance with positional therapy or weight loss, or use it as a travel alternative to CPAP.
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