Mandibular Advancement Devices (MAD)

The lung specialist recommended me as first line of treatment CPAP but also mentioned Mandibular Advancement Devices (MAD) as option. I only know that I would have to get them from a dentist specialized in sleep apnea according his information.

Simply searching on Google Mandibular Advancement Devices (MAD) doesn't give me helpful information besides several ads and some medical journals regarding the effect of them. Are there certain brands to look for or to avoid? Do MADs need continuous follow-ups or could I get them done abroad (i.e. Mexico)? The reason why I am asking; one of the sleep clinics told me that many extended health benefit insurances in Canada only pay either a CPAP or MAD.

There are a couple of sleep dentists that check in here and I'm sure will have some good information for you. But if it were me, I would not even think for one second about getting one from Mexico. There are boil and bite options from the pharmacy stores that I would be tempted to try before I would risk anything from Mexico. One issue to consider with these devices is that unless you get a sleep study done with them in place you don't really know if they are working or not. A CPAP gives you daily feedback on how well they are working for you. The $900 cost of an Auto CPAP is also much less than the typical $2000+ for a dentist fitted device. But if the insurance company is paying then perhaps that is not a factor.

I am a dentist working in dental sleep medicine. CPAP machines are classified as durable medical equipment. Oral sleep apnea appliances are also classified as durable medical equipment. I have observed on this forum that patients are extremely careful to research their PAP machines for safety, effectiveness, features, durability, and cost. The same level of care and seriousness should be applied in the search for oral sleep apnea appliances. In my opinion, the availability of anti-snore(NOT RATED TO TREAT OSA) appliances readily on line does send out the wrong message to the public and tends to trivialize the whole mode of treatment. Unfortunately, poorly fitted and poorly made oral appliances can do serious damage to your teeth, oral tissues, bone structure, throw off your bite, and ruin your jaw joints. My advice to the public is-- don't use them. The ones at the drug stores are for snoring only, again, not legal to treat obstructive sleep apnea. There are over one hundred oral sleep apnea appliances on the market, some good, some bad, and some fair. No one is good, or even usable for all patients. It takes a highly sophisticated and experienced sleep dentist to select just the right appliance for you and to fit it just right in your mouth. So your one job is to find a top-notch sleep dentist. If you do, hopefully, good things will follow. Arthur B. Luisi, Jr., D.M.D., The Naples Center for Dental Sleep Medicine.

I have a "ResMed Narval CC" that I got this year. I use it with my AirCurve 10 vAuto. The dental appliance helps a bit to move my jaw forward, but doesn't help every night. I still get obstructions, and I have my jaw pushed as far forward as I can tolerate. I'm seeking other options now, like tongue-base reduction surgery.

The Narval also only locks onto my upper teeth. Doesn't seem to lock on my lower teeth. My dentist said that was normal but I think he is trying to cover up a mistake.