Mandibular advancement orthosis: prescription, mechanism and side effects

Important points	Summary
What is a mandibular advancement orthosis?	A mandibular advancement orthosis (MAO) is a medical device used to treat obstructive sleep apnea and snoring by holding the lower jaw in an advanced position during sleep.
Composition and materials	OAMs are custom-made from dental impressions and are made of resin or plastic, sometimes reinforced with biocompatible materials such as acrylic.
Mechanism of action	The forward movement of the lower jaw prevents the soft tissues of the upper airway from collapsing, thus reducing snoring and sleep apnea.
When is a mandibular advancement orthosis prescribed?	OAMs are prescribed to treat mild to moderate obstructive sleep apnea, severe snoring without apnea, or as an adjunct to other treatments such as CPAP.
Advantages and efficacy of mandibular advancement orthoses	AMOs improve sleep quality, reduce snoring and fatigue, and represent an effective alternative to continuous positive airway pressure (CPAP) devices.
How to obtain a mandibular advancement orthosis	A sleep specialist should be consulted for a diagnosis, followed by a dentist or orthodontist for dental impressions and orthotic fitting.
Side effects and precautions for use	Side effects may include dental or jaw pain and excessive salivation. Regular follow-up is recommended to adjust the orthosis if necessary.
FAQ on mandibular advancement orthoses	The cost of an OAM varies between €600 and €900 in France and between $1,000 and $3,000 in the United States. They may be reimbursed by the Assurance Maladie under certain conditions.

What is a mandibular advancement orthosis?

A mandibular advancement orthosis (MAO) is a medical device designed to treat nocturnal breathing disorders such as:

💊 obstructive sleep apnea,

💊 snoring.

This device takes the form of dental splints that hold the lower jaw in an advanced position during sleep.

By advancing the mandible, the OAM frees the upper airway, facilitating the passage of air and reducing the obstructions that cause snoring and sleep apnea.

Composition and materials

Mandibular advancement braces are usually custom-made from dental impressions.

They consist of resin or plastic gutters, sometimes reinforced with biocompatible materials such as acrylic.

Some orthotics use advanced technologies such as CadCam for a precise fit and optimal comfort.

⚠ The materials used must be hypoallergenic and free from harmful substances to guarantee patient safety and well-being.

Mechanism of action

The mechanism of action of the mandibular advancement orthosis is based on the forward displacement of the lower jaw.

This movement creates tension that prevents the soft tissues of the upper airways from collapsing and vibrating, which is often the cause of snoring.

By keeping the airways open, OAM allows better air circulation, reducing apnea episodes and improving sleep quality.

When is a mandibular advancement orthosis prescribed?

Symptoms of sleep apnea

The main symptoms of obstructive sleep apnea are:

💊 loud snoring,

💊 respiratory pauses observed by those around you,

💊 excessive daytime sleepiness,

💊 morning headaches,

💊 concentration and mood disorders.

Other signs include:

💊 nocturia (the need to urinate at night),

💊 bruxism or restless sleep may also be present.

In the long term, untreated apnea increases risk :

💊 hypertension,

💊 cardiovascular disease,

💊 stroke and diabetes.

Other indications

Although less frequent, a mandibular advancement orthosis may also be indicated in certain cases of severe snoring without apnea.

It can also be prescribed as a complement to other treatments such as continuous positive airway pressure (CPAP) in patients suffering from moderate to severe apnea and with poor compliance with CPAP alone.

Advantages and effectiveness of mandibular advancement orthoses

Improved sleep quality

One of the main benefits of OAM is the significant improvement in sleep quality.

By keeping the airways open, these devices reduce nocturnal interruptions caused by apneas and micro-awakenings.

Patients often report deeper, more restorative sleep, resulting in improved alertness and reduced daytime sleepiness.

In other words, you wake up refreshed and ready to face the day.

Reduces snoring and fatigue

OAMs are also highly effective in reducing snoring, a problem that is often embarrassing for both the patient and those around him/her.

By moving the lower jaw forward, the brace prevents the tongue from blocking the airway, reducing the soft palate vibrations that cause snoring.

Less snoring also means less fatigue, as sleep is less disrupted.

Alternative to ventilators

For patients who cannot tolerate continuous positive airway pressure (CPAP), OAMs offer an effective alternative.

▶  CPAP, while very effective, can be uncomfortable and cumbersome, especially for those who travel frequently.

▶  OAMs, on the other hand, are discreet, easy to carry and use.

How do I get a mandibular advancement orthosis?

Consultation with a specialist

The first step is to consult a sleep specialist, such as:

💊 a pulmonologist,

💊 an ENT specialist,

💊 a cardiologist.

This specialist will carry out a complete diagnosis of your state of health and sleep disorders, often using a ventilatory polygraphy or polysomnography.

If your diagnosis confirms mild-to-moderate obstructive sleep apnea (OSA), or if you cannot tolerate continuous positive airway pressure (CPAP), your doctor may prescribe an OAM.

Dental impressions

Once you've obtained a prescription, you'll need to make an appointment with a dentist or orthodontist specializing in sleep disorders.

During this consultation, the practitioner will assess your oral condition to ensure that there are no contraindications to the use of the brace.

Next, he will take precise impressions of your dental arches, often using special materials or 3D scanning technologies.

Adjusting and wearing the orthosis

Once the brace has been fabricated, which may take a few weeks, you'll return to the dentist for the initial fitting.

The practitioner will adjust the brace so that it holds the lower jaw comfortably and effectively in the forward position.

Several follow-up appointments will be necessary to fine-tune the adjustments and ensure that the orthosis is working properly without causing discomfort.

Side effects and precautions for use

Dental or jaw pain

One of the most frequent side effects is the appearance of pain in the:

💊 teeth,

💊 gums,

💊 of the jaw joint (TMJ).

These pains are generally caused by the pressure exerted by the brace on the dental arches and masticatory muscles.

They are often transient and disappear after a period of adaptation but may persist in some patients.

A follow-up visit to your dentist or orthodontist is recommended to adjust the brace if necessary.

Excessive salivation

The presence of the brace in the mouth can stimulate excessive saliva production, especially during the first few weeks of use.

This hypersalivation is generally temporary and diminishes as your body becomes accustomed to the device.

You can use a glass of water nearby to facilitate swallowing if necessary.

Precautions for use

Before prescribing a mandibular advancement orthosis, your doctor or dentist will carry out a thorough examination to ensure that there are no contraindications.

A sufficient number of healthy teeth, the absence of severe periodontal problems and a functional temporomandibular joint are essential.

In addition, regular monitoring is recommended to detect and promptly treat any persistent side effects. Don't hesitate to report any discomfort or changes to your practitioner.

Mandibular advancement orthoses FAQ

Q. How much does a mandibular advancement orthosis cost?

1. The cost of a mandibular advancement orthosis varies according to several factors, including the type of orthosis and the practitioner.

▶ Typically, the price is between €600 and €900 for a custom-made orthosis in France.

▶ In the United States, costs can vary from $1,000 to $3,000.

Q. Is the orthosis reimbursed by the Health Maladie?

1. Yes, the mandibular advancement orthosis can be reimbursed by the Health Insurance, under certain conditions.

Q. How long does a mandibular orthosis last?

1. The lifespan of a mandibular advancement orthosis depends on its use and maintenance.

On average, a custom-made orthosis has a lifespan of 2 to 5 years. We recommend that you have your orthosis checked regularly by a professional to ensure that it is in good condition and effective.

Q. Can the orthosis be worn permanently or only at night?

ndibular advancement orthosis is designed to be worn only at night. It holds the lower jaw in a forward position to clear the airway and reduce sleep apnea and snoring. Wearing it all the time is not recommended, as it could lead to pain or joint problems.