What Lies Beyond Traditional Mandibular Advancement Devices (MADs)

December 15, 2021

According to Reuters Health, as many as 37 percent of adults in the Americas suffer from obstructive sleep apnea (OSA), a condition in which the individual repeatedly stops breathing throughout the night. This disruption not only causes a temporary lapse in breathing and sleep but also oxygen deprivation to the heart, brain, and other organs. Over time, this condition leads to morning headaches, exhaustion, difficulty concentrating, moodiness, and more. And high blood pressure, diabetes, heart disease, Alzheimer’s, and dementia are just some of the associated comorbidities. One report by Red Deer Dental Clinic even shares that oxygen starvation from OSA can shorten an individual’s lifespan by 12–15 years. This is shocking and highly concerning for individuals globally.

The sleep apnea epidemic needs to be stopped, and it’s the responsibility of dental professionals, in collaboration with their healthcare professionals, to initiate a conversation with patients, conduct sleep tests on suspected sufferers, and get them on an effective treatment plan. While some individuals may find a CPAP tolerable, many do not. The only other widely accepted nonsurgical option for the past decade was a mandibular advancement device (MAD). That said, this therapy, too, causes many unwanted side effects.

So, the question is this: What lies beyond traditional mandibular advancement devices? Here’s the 101.

The 101 on MAD

Mandibular advancement devices (MADs) are custom-fitted oral appliances that fit in the mouth like a guard or retainer. It maintains the airway by putting the lower jaw forward to keep the soft tissue and tongue from falling back and obstructing the airway. For many years, this was the therapy of choice for individuals who weren’t compliant with the traditional CPAP machine and wanted something more nonintrusive and easy to travel with. While the MAD allows for a more-natural sleeping experience without the dry, itchy nose, it still poses many challenges.

For one, the most commonly reported side effect of the MAD is excess salivation. This usually subsides with time but can be uncomfortable to users during the adjustment period. Secondly, some patients report tenderness along the gum tissue where the device touches and, in some cases, loose teeth. Finally, some users report jaw stiffness or pain, especially over time, as the device pushes the lower jaw into an unnatural position during sleep.

The most common long-term side effect in users is bite changes. This feeling that the bite is incorrect or the teeth don’t quite line up is due to the sustained contraction of the lateral pterygoid muscles during the use of the MAD. While some feel a return to usual alignment a short time after removing the device, others notice issues that progress into the daytime. Dentalcare.com shares that “some MAD products come with a bite tab or an acrylic bite pad (sometimes referred to as morning repositioner) that can be worn for 5-10 minutes upon wakening to facilitate in ‘resetting the bite.’”

Before beginning use of a MAD device, dentists should discuss the possibility of a bite change with their patients. While this can be upsetting or concerning for some, the long-term side effects and comorbidities of untreated OSA are far, far worse for our health and wellness.

The Vivos Treatment

Thankfully, our dental and healthcare professionals have been hard at work, researching new therapies and long-term solutions to treat individuals with OSA better than traditional options.

One promising avenue that has emerged is using oral appliances to tackle the root cause of the problem by solving the underdeveloped anatomy of the airway. We’re talking about The Vivos Treatment.

The Vivos Treatment is a noninvasive, easy-to-implement, cost-effective solution that addresses the root cause of OSA. Vivos Therapeutics, Inc. is an FDA Specifications Developer for a series of Class I and Class II medical devices used for adjunctive therapies during treatment. From educating patients on OSA to at-home sleep tests, AI reports, imaging, and more, Vivos offers providers and patients a comprehensive therapy program with support from beginning to end.

Treatment of OSA begins only after proper diagnosis by a healthcare provider. Vivos Integrated Providers (VIPs) carry this out using a simple, noninvasive, at-home sleep ring known as the VivoScore device. VivoScore, powered by SleepImage, is a cloud-based sleep evaluation, diagnostic, and management system using a single-sensor technology with automated output cleared by the FDA for children and adults and found to be comparable to polysomnography (PSG) to aid clinical diagnosis of OSA. It is an effective tool for screening patients for sleep quality and providing healthcare practitioners with the necessary data for addressing and monitoring sleep disorders. After diagnosis, VIPs can discuss the many treatment options and collaborate to determine the best plan based on the patient’s wants and needs. This often includes the mmRNA device (modified mandibular Repositioning Nighttime Appliance), a 501(k) FDA-cleared device used to treat mild to moderate OSA.

The mmRNA device works to encourage gentle pressure and positioning of the mandible to open the airway, promote natural suction of the tongue, and promote proper nasal breathing. This positive change not only leads to improved sleep, but the benefits extend into the daytime. The device is worn for 12 to 24 months for patients to see the full benefits. After this time, most patients don’t require further intervention.

For more information on The Vivos Treatment and alternative therapies for OSA, please visit us at vivoslife.com.