What Is a Mandibular Advancement Device — And Should You Be Using One?

A mandibular advancement device (MAD) is a custom-made oral appliance used primarily to treat snoring and mild to moderate obstructive sleep apnea (OSA). Despite its dental appearance, its purpose extends far beyond just protecting your teeth — it directly influences your airway, your sleep quality, and ultimately your overall health.

Let’s break it down.

When you fall asleep, the muscles in your throat and tongue naturally relax. For some people, especially those with narrow airways, excess soft tissue, or certain anatomical structures, this relaxation can lead to partial or full blockage of the airway during sleep. This is what causes obstructive sleep apnea — a condition where breathing is briefly and repeatedly interrupted. In lighter cases, this same issue results in loud snoring, caused by the vibration of relaxed tissues in a partially narrowed airway.

This is where the mandibular advancement device comes in.

The device fits over your upper and lower teeth like a mouthguard, but it’s designed to reposition the lower jaw slightly forward while you sleep. By advancing the mandible, the MAD also moves the tongue and surrounding soft tissues forward, which helps to keep the airway open — especially in the back of the throat near the oropharynx and the base of the tongue. The result? Less tissue collapse, fewer obstructions, and smoother, quieter breathing.

Patients who benefit from MADs often report:

• Reduced or eliminated snoring
• Fewer nighttime awakenings
• Improved daytime energy
• Less morning grogginess or dry mouth
• Improved sleep quality for both the patient and their partner

While it may seem like a simple plastic device, a professionally designed MAD is highly technical. Many feature adjustable hinges, precision-fit trays, and calibration systems to allow your dentist to gradually increase mandibular advancement over time. The goal is to find the “sweet spot” — just enough forward positioning to open the airway, but not so much that it causes jaw discomfort.

These devices are especially helpful for patients who cannot tolerate CPAP machines (Continuous Positive Airway Pressure), which are traditionally used for more severe cases of sleep apnea. CPAP therapy uses a mask and pressurized air to keep the airway open. While it’s considered the gold standard, many patients find the mask uncomfortable, noisy, or inconvenient. For those with mild to moderate sleep apnea or simple snoring, a MAD is often a more user-friendly and portable solution.

However, it’s important to remember that MADs are not over-the-counter mouthguards. Store-bought options often lack the precision and adjustability required to be both effective and safe. Poorly fitted devices can lead to jaw pain, bite changes, or worsening of temporomandibular joint (TMJ) issues. That’s why dental supervision — ideally in collaboration with a sleep specialist — is essential for proper diagnosis, fitting, and follow-up.

In summary, a mandibular advancement device works by gently repositioning the jaw forward to reduce airway collapse during sleep. It’s a non-invasive, effective treatment for the right patient — but only when used correctly and under guidance.

Not all snoring is created equal, and not everyone with sleep issues is a candidate for a mandibular advancement device (MAD). While this device has helped countless people sleep better and breathe easier, it’s not a universal solution. Knowing whether you’re a good candidate — or if you should avoid it altogether — is essential before moving forward with treatment.

Let’s start with the ideal candidate.

A MAD is best suited for people who:

• Have mild to moderate obstructive sleep apnea (OSA) as confirmed by a sleep study
• Suffer from chronic or disruptive snoring without underlying TMJ issues
• Are unable or unwilling to tolerate a CPAP machine
• Have stable jaw joints and a healthy dentition (no significant missing teeth or dental mobility)
• Do not have bruxism (severe grinding) that might damage the device or aggravate the jaw

These individuals typically benefit from the simplicity and comfort of MAD therapy. For those with mild OSA, a properly fitted MAD can reduce apnea-hypopnea index (AHI) scores and dramatically improve sleep quality. It’s also a more discreet and travel-friendly option compared to CPAP.

Now, let’s talk about who shouldn’t use a MAD — or should proceed with extreme caution.

A MAD may not be appropriate if you:

• Have severe OSA (an AHI score over 30) that requires CPAP therapy or surgery
• Suffer from active temporomandibular joint disorder (TMD), jaw clicking, or chronic jaw pain
• Have extensive tooth loss, loose teeth, or gum disease that compromises appliance retention
• Experience heavy bruxism, which can not only damage the device but also stress the TMJ
• Have a compromised bite or are undergoing orthodontic treatment

The biggest red flag? TMJ dysfunction. Mandibular advancement devices work by holding the jaw in a forward position throughout the night. While this opens the airway, it also places constant strain on the temporomandibular joints. For a healthy TMJ, this is usually tolerable. But for someone with a history of jaw issues — clicking, popping, locking, or pain — this can lead to worsening symptoms, including inflammation, headaches, and difficulty chewing.

Another concern is dental stability. If your teeth are shifting, loose, or missing, the MAD may not sit correctly. This can lead to bite changes, uneven forces on the jaw, and in some cases, damage to the remaining teeth.

That’s why a full dental exam and sleep study are required before starting MAD therapy. At KYT Dental Services, we use 3D scans, airway evaluations, and collaboration with local sleep physicians to ensure that every patient is properly screened. If you’re not a good candidate, we’ll help you explore other options — whether it’s CPAP, nasal therapy, weight management, or surgical alternatives.

In short, mandibular advancement devices work best for the right patient — one with mild to moderate OSA, healthy TMJs, and a strong dental foundation. If that’s you, the device could dramatically improve your nights. If not, pushing forward could do more harm than good.

While a mandibular advancement device (MAD) can be a game-changer for patients with snoring or sleep apnea, it’s important to understand the possible downsides. Like any dental or medical intervention, this treatment comes with its own set of risks — especially when used long-term or without proper oversight.

The most common side effects reported by patients include:

1. Jaw Discomfort or Muscle Soreness

Since the MAD holds the lower jaw in a forward position throughout the night, it places tension on the muscles and joints surrounding the jaw. Patients often report soreness in the morning, especially during the first few weeks of use. This is usually temporary and can be resolved through gradual adjustments or stretching exercises, but in some cases, the discomfort persists.

2. TMJ Issues

This is perhaps the most serious concern. For patients with pre-existing TMJ problems — such as clicking, popping, or jaw locking — the forward pull of a MAD can worsen symptoms. Even for those without a known history of TMJ dysfunction, chronic use may eventually lead to inflammation in the joint, causing pain, reduced range of motion, or changes in bite alignment. It’s crucial that your dentist performs a TMJ screening before fitting the device.

3. Changes in Bite or Tooth Position

One of the lesser-known but more permanent side effects of long-term MAD use is bite shifting. The constant forward pressure can cause teeth to move, especially the front teeth. Over time, patients may develop an “open bite,” where the upper and lower teeth no longer meet properly. This can affect chewing, speech, and even facial appearance if not monitored and addressed early.

4. Dental and Gum Irritation

Poorly fitted MADs, or devices worn without regular adjustment, can cause localized irritation to the gums or inner cheeks. Some patients also report pressure points on specific teeth, which can lead to soreness or even minor tooth mobility if not corrected.

5. Dry Mouth or Excessive Salivation

Depending on the design of the device and the patient’s natural mouth-breathing tendencies, some people experience dry mouth, while others develop excessive salivation. Both can disrupt sleep and increase the risk of cavities or gum problems if left unmanaged.

Despite these risks, many patients tolerate MADs well — especially when the device is custom-made, professionally monitored, and regularly adjusted. Problems usually arise when patients use over-the-counter versions or skip follow-up appointments.

That’s why patient education and close supervision are non-negotiable. At KYT Dental Services, we provide thorough instructions on how to wear, clean, and monitor your device. We also schedule routine check-ins to assess jaw health, tooth movement, and sleep quality.

In summary, the risks of a MAD are real but manageable. The key is recognizing whether your anatomy and habits are compatible with the device — and committing to ongoing care. Used properly, a MAD can dramatically improve sleep. Used blindly, it can create a whole new set of problems.