Mandibular Advancement Device

Discover the best dental devices for sleep apnea sufferers

With a market full of dental devices, and most of them with false statements, how can you find the best mandibular advancement device that can treat obstructive sleep apnea the same or even better than CPAP?

This article reveals the top oral devices that can lower your apnea events to the point where you can finally get the true refreshing sleep.

It will also cover important tips on dental devices that can help you make the best decisions before starting your expensive acquisition.

• What is Obstructive Sleep Apnea?
• CPAP Guide For Patients with Sleep Apnea
  

What Is The Best Mandibular Device?

There are lots of mandibular appliances available on the market.

The best of them are customizable for your mouth, so you'll get the best comfort with the best results.

You can't go wrong with any of the following mandibular devices. However, you can fail in your sleep apnea treatment if you choose the wrong dentist to fit your chosen dental appliance.

Please take your pick:

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Thornton Adjustable Positioner - TAP 3

Nothing beats the TAP3 in terms of reducing even the severe sleep apnea cases. It's brother (or sister), TAP3 Elite, is the most advanced MAD at this time.

You may wonder why do I think that TAP3 is the best dental device?

Analyzing the clinical studies (1-7), the researchers come to the same conclusion - TAP 3 dental device ticks all the standards for an effective sleep apnea treatment.

These standards are described in the following table:

How The TAP Appliance Device Work?

The TAP works under a simple principle:

• it holds the jaw forward of the upper teeth while you wear it (during sleep).

Since the tongue is attached to the jaw at the chin, this has a way of holding the tongue out of the airway (airway will be more open), by as many as several millimeters.

Now, you will think that several millimeters are not enough to open your airway to breathe normally.

However, according to math, the area of a circle (your airway is a circle) is pi R squared, meaning that 1 mm would turn into 3.14 mm in area.

Considering the high sensitivity of the device, a dentist needs to adjust the TAP very slowly, to prevent temporomandibular joint dysfunction and pain.

However, to prevent pain from wearing the dental device during the night, you can practice special jaw flexing exercises. Your dentist should teach you how to do them.

This short clip demonstrates how the TAP 3 appliance works:

As you probably noticed in the video, the mandibular device pushes the chin and the tongue forward, to create space in your upper airway for breathing in sleep.

TAP appliance Review from patients

A good review from a patient who tests the TAP 3 appliance is extremely valuable to understand if the device is right for you:

5 Reasons to Choose TAP 3 Appliance

There are solid reasons why this mandibular advancement device is considered the best in it's class for treating obstructive sleep apnea:

1. TAP 3 is one of the few dental devices that treats severe OSA (7).
   
2. It has the most numerous successful treatment cases for severe OSA compared to any other MAD. According to a study made by Aarnoud Hoekema (1), the device had slightly better results than CPAP in treating mild to moderate OSA (84% compared with 80%), but less effective in severe cases (69.2% vs 85.2%).
3. Another study (2) shows that "no significant difference was found between oral appliance therapy and CPAP in treating mild to severe OSAS in a 2-year follow-up". However, the results of this study recommends CPAP as treatment of first choice in severe cases.
4. One follow up study (3) demonstrated that 21 out of 25 patients with mild to moderate OSA have been completely treated with the mandibular advancement device.
5. TAP 3 is a custom made and robust dental device, built from thermoplastic sheet and adjusted in the mouth with acrylic padding.
   

The Downside of TAP 3 Appliance

The studies made by Aarnoud Hoekema has the best rate of success possible until that date. However, Dr. Hoekema is a specially trained  sleep dentist. Maybe one of the best in its class.

A good sleep dentist may be difficult to find in your area.

A dentist without experience or without much knowledge, can ruin your chance to have a similar rate of success with the clinical study.

You Need to Find an Expert in Sleep Dentistry

If you think that any dentist can fit a dental device so you can sleep better, you are wrong.  It's not easy to become a good and experienced sleep dentist.

Sleep dental medicine is a separate specialty from standard dentistry. Even now, in 2015, you can barely find clinical training in the area of dental sleep medicine.

In addition, these courses are very expensive, starting from hundreds of dolars for only 8 hours of training, up to $5000 for 4 days of training.

So, imagine that only a few dentists become experts in dental sleep medicine.

How to Find a Specialist in Dental Devices for Sleep Apnea

As you already know, it's not easy to find a dentist trained in sleep medicine. And if you live far away from the big cities, the challenge can become more difficult.

Let's find out how to get in touch with a sleep certified dentist.

Talk With Your General Dentist

If you have a dentist in your area, you can contact him for advice. He may be able to provide a dental appliance, but only if he is suitable trained.

Alternately, the general dentist can help you with information about specialists in mandibular devices for sleep apnea.

Ask Your GP, ENT or Sleep Doctor

You can obtain a referral from your family doctor to a dental sleep specialist who will asses your sleep apnea. He will advise on the the appropriate way to get the best treatment.

A visit to a sleep trained ENT (ears-nose-throat) doctor can also recommend a sleep approved doctor.

A call to your local sleep center can also reveal some good dental sleep medicine dentists.

Keep in mind that most dentists prefer that you have tried CPAP therapy before committing to a dental device.

Search Online for a Sleep Certified Dentist

In you live in United Kingdom, you can search for dentists with special interests in mandibular advancement devices at British Society of Dental Sleep Medicine

If you live in United States, look on The American Academy of Dental Sleep Medicine website and use their "Find an ABDSM Certified Dentis" feature for your area.

To find more information about how to find a good specialist in dental devices for sleep apnea, you can ask Dr. Mark Burhenne from his site Ask the Dentist.

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Now, let's see if there are other dental devices similar in efficacy to TAP 3.

Best 5 Alternatives to TAP 3 Dental Device

1. MyTAP

MyTAP is a new mandibular advancement device introduced on the market in October 2013.

It is approved by FDA, and it can treat mild to moderate OSA. It can be useful for patients with severe sleep apnea, only if they can't tolerate CPAP therapy.

It is not allowed (by FDA) to declare that a dental device treats severe OSA. However, as mentioned earlier, clinical studies demonstrated that customized MADs can treat even severe OSA.

What makes MyTAP so special is that it's  almost identical with TAP 3 device but a lot cheaper. It was created so that everyone with OSA can afford one, even those without insurance coverage.

MyTAP is cheaper than the best mandibular device in the world TAP 3, because it has only plastic components. Although the material used in MyTAP is not as strong as TAP3, the warranty for this device is one year.

Another good argument to choose My TAP: it can be fitted in 15 minutes in dentist office. Your dentist doesn't need to take bite records or to wait for dental models from the lab, which may take days or even weeks.

Bottom line... The molding and fitting is done in your dentist office, and you can start the OSA treatment in the same day. Isn't it exciting?

Unfortunately, I didn't find clinical studies that can prove how effective is MyTAP, because the device is fairly new on the market. Otherwise, I would probably name this dental device the best in the world.

Anyway, it's highly recommended by Sleep Apnea Guide!

Here is a video demonstration of MyTAP device:

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2. Somnodent

Somnodent is different than TAP3. With this dental device you can open your jaw, talk, or drink, which is improving your comfort.

TAP3 keeps your mouth shut while you sleep, but with Somnodent you get a lot of freedom.

Before jumping to conclusion and choose Somnodent, there is something you should know: clinical studies demonstrated that sleeping with your mouth open can increase the chance to stop breathing during sleep (apnea events) (6).

That's why people who snore usually sleep with their mouth open.

Furthermore, it's more difficult to adjust Somnodent which has to be bilateral adjusted, compared with TAP3, where you only use one removable hex key.

This video explains more about how to adjust the device:

In practice, it seems that dentists prefer to use Somnodent for their patients over the TAP 3. That's because the device is so much easier to fit inside the patient's mouth.

It takes effort and talent to place the TAP properly. But it can be done.

Nevertheless, Somnodent is almost as good as TAP, so it's highly recommended.

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3. Silent Nite® SL

Silent Nite is not designed to be so strong as TAP 3, but the price is more acceptable ( under $500).

This means if this device breaks down during your OSA treatment, you'll have to choose Somnodent or TAP 3, which are more expensive (around $1200 to $1500).

Silent Nite is usually recommended for snoring and mild sleep apnea. For moderate and severe cases it's better to use TAP.

The adjustable arms that you'll see in the video can brake very easily and are expensive to replace. It's also possible that your device may not last you more than a year.

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4. Narval CC

Narval CC dental device is designed by ResMed with CAD/CAM technology, which helps creating a more customizable appliance that can minimize jaw stress and dental side effects.

The Narval oral appliance is intended to reduce or alleviate snoring and mild to moderate obstructive sleep apnea (OSA) in adults.

ResMed provides an upper and lower splint and a full set of connecting rods which are attached to these splints. They are designed to hold your lower jaw forward, to prevent the airway obstruction during sleep.

ResMed also offers replacements free of charge in case the rods start to stretch.

In order to keep the Narval CC in good conditions for a long time, it's recommended that you clean the device every day according to ResMed's instructions.

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5. Herbst Appliance

The Herbst Appliance is initially used as an orthodontic device for dental corrections.

With some modification, it can be used to treat mild to moderate obstructive sleep apnea.

It allows you to open your mouth, to speak or drink. It also has a strong built. Studies have demonstrated that Herbst Appliance is effective in improving OSA (9).

It is adjustable only by the dentist, compared with TAP 3 which can be also adjusted by the patient.

This video explains how the Herbst Appliance can be adjusted:

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6. Somnowell

Somnowell is a dental device built with quality materials (gold, chrome, cobalt) that are far more hygienic and last longer than the plastic devices.

The inventor (professor and specialist orthodontist Simon Ash) designed the device to be more discreet in the mouth, compared with the bulky versions from other manufacturers.

Here is a short video where the inventor describes his dental device:

The rate of success for Somnowell is over 90% and is the best mandibular advancement device in UK.

The price can start from £1000 but it can go up to £1400, considering the materials used to create the device.

Moreover, everything needs to fit perfectly on your teeth. There are a lot of steps to build the device, starting from dental measurements, to construction, to rechecking the device during treatment.

In this video, dr. Paul Moore  explains more details about Somnowell MAD:

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Other Mandibular Advancement Devices

• Klearway
• O2 OASYS
• Nocturnal Airway Patency Appliance
• IST®-Appliance

Where Can I Buy a MAD for Sleep Apnea?

There are several ways to obtain a dental device. You can go online and buy cheap appliances, but they have poor fit and without any positive results.

Unfortunately, you can't buy online TAP 3 or any other device discussed previously, because it's a very customized device, that needs a trained dentist to make the molds, establish the bite baseline, setting the initial advancement, etc.

So how do you find a TAP 3 or another good mandibular advancement device for sleep apnea? The short answer is: find a sleep certified dentist.

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How Much a MAD Costs?

The best mandibular advancement devices are very, very expensive. This is because there are lots of steps in fitting one, with expensive materials, with trained specialists and everything takes a lot of time.

The fitting of the appliance requires an impression of your teeth to be taken before the appliance is customized to your jaw.

The dentist then will adjust the device to get the desired advancement possible of your jaw without causing discomfort.

The adjustment is made in small steps, in the following weeks.

In the end, the whole process may take a couple of weeks, hence the reason for such a high price: from $450 (check myTAP device for more info) to $2000.

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Top 5 Cheap Mandibular Advancement Devices

There are cheaper mandibular appliances that can be purchased over the counter or from internet. However, I can't recommend them for treating sleep apnea, since they've been proved to be inefficient.

The generic devices found on internet are not really intended to treat obstructive sleep apnea, but only snoring.

However, reading through plenty of reviews, I found people with sleep apnea who slept better after using a cheap mandibular advancement device.

In other words, these device may help your very mild OSA, but for moderate or severe OSA, they don't work (5).

Considering that you acknowledged that the cheap dental devices may not work in your case, here are the top 5 MAD that can be bought online:

1. SnoreRX

• SnoreRX is a custom fit impression, designed to avoid tooth movement.
  
• Microadjustments by 1mm, which insure an increased effectiveness in treating OSA.
  
• It's approved by FDA (according to the website statement).
• The website mention that SnoreRX treats only snoring.
  
• Some review page on their website mention about people being treated from sleep apnea. However, you should understand that this device was approved by FDA only for treating snoring.
  
• The device is made in USA.
  

Here is a video explaining how to use SnoreRX:

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2. ZQuiet

ZQuiet is a new mandibular advancement device that is:

• it's regulated by the FDA.
• it's built from soft materials to improve your comfort during sleep.
• the reviews doesn't mention about treating sleep apnea.

Here is a video explaining how to use ZQuiet:

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3. SleepGuard

SleepGuard is a mandibular advancement device that is:

• approved by NHS (National Health Service UK) for treating snoring.
• it's the best cheap mandibular advancement device in UK.
• the online reviews are surprisingly positive.
  
• SleepGuard is recommended by British Snoring & Sleep Apnoea Association.
• I also discovered reviews on Amazon UK where buyers used the product successfully to treat their sleep apnea. 
• SleepGuard is made in UK.
  

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4. VitalSleep Snoring Mouthguard

VitalSleep is a mandibular advancement device that is:

• approved by FDA to treat snoring.
• completely customizable by using hot water (less than 5 minutes).
  
• you can apply microadjustments (up to 7 mm) with a hex key.
• it doesn't contain BPA, or other toxic chemicals.
• Although VitalSleep is a device specifically designed to treat snoring, there are plenty of positive reviews from buyers with sleep apnea. Please read the testimonial page from  vitalsleep.com before buying the product.

Here is a review of VitalSleep mandibular advancement device:

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References

1. Oral-appliance therapy obstructive sleep apnea-hypopnea syndrome : a clinical study on therapeutic outcome -  http://dissertations.ub.rug.nl/faculties/medicine/2007/a.hoekema/
2. Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow-up. - http://www.ncbi.nlm.nih.gov/pubmed/23997361
3. Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy - http://erj.ersjournals.com/content/39/5/1241.full
4. Management of Snoring & Sleep Apnoea in Dental Practice Introductory Course - http://www.sleepsociety.org.uk/event/management-of-snoring-sleep-apnoea-in-dental-practice-introductory-course/
5. Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea - https://advancedbrainmonitoring.app.box.com/s/hjma0yqals7pjn8s11y4
6. Effects of mouth opening on upper airway collapsibility in normal sleeping subjects. - http://www.ncbi.nlm.nih.gov/pubmed/8542125
   
7.  Why Choose the TAP®? - http://tapintosleep.com/why-choose-the-tap/
8. American Sleep Apnea Association Forum - http://www.apneasupport.org/topic35215.html
9. Efficacy of a Herbst mandibular advancement device in obstructive sleep apnea - http://www.ncbi.nlm.nih.gov/pubmed/8143054
10. Somnowell Follow Up Study - http://www.somnowell.com/research
    

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