Here is an article that seems to be fairly current (2017) that compares the two approaches to normalizing apnea.
An update on mandibular advancement devices
It may be a much deeper dive than you want to take. What I gathered from it is that neither CPAP or MAD are a silver bullet to solve apnea. In basic obstructive apnea especially in the moderate range that you are in (AHI 19) a very high reduction of AHI is almost certainly to be achieved by CPAP, BUT, and it is a big BUT, that is only if you use the CPAP. The MAD on the other hand is likely to have a higher compliance rate, but less likely to normalize AHI fully (<5).
So on one hand you have a very good solution (CPAP) but say for example only a 50% chance of sticking with it. On the other hand you have a solution that may only achieve a 50% reduction, but you are likely to use it. Kind of hard to compare on an apples to apples basis, but this article attempts to do it, and out of it rationalize that MAD is just as good as CPAP on a statistical basis. That to me is a little misleading. At the end of the day you are going to use a CPAP or not use a CPAP. So it is really an all or nothing solution. The MAD is a near certain partial solution, unless you have a personal issue that makes it not suitable as your ENT has suggested. You kind of have to pick your poison. My thoughts are that the reasonable approach is to try the CPAP first. If it works and you like it, then you have the best solution. If the CPAP does not work, or you just can't tolerate it, then the MAD is certainly worth trying. A partial solution is better than no solution. In short I think it is a sequential decision not a one or the other decision.
That all said, I know I didn't answer your direct question. However, there are a couple of dentists that specialize in sleep appliances that check in here and can give you a much better answer to your real question which was on how you can determine you are suitable for a MAD.
Thanks so much for the replies. I had a second opinion from a top sleep specialist and he agreed there was no need for the MAD given my jaw structure. This is quite odd to me given that research shows it to be very successful for a broad range of patients. He said that since I mouth breathe the focus should be on opening up the nasal airway.
Mouth breathing has its own set of issues, and is not ideal with or without a CPAP. If you do go down the CPAP route, I would suggest trying a nasal pillow mask first, despite the fact you may be steered away from it due to mouth breathing. If necessary you can mouth tape to stop the mouth breathing. It is not nearly as bad as it first sounds, and in my opinion a better solution than using using a full face mask. For sure a full face mask prevents air loss out of your mouth, but it does not stop mouth breathing. A video to watch if you are interested.
I am a dentist working in dental sleep medicine. Actually, your statement that your lower jaw is too far forward doesn't make a whole lot of sense. I think what you are trying to say is the following: M.A.D. appliances work by moving your lower jaw forward. This forward movement does several good things, but the net effect is that the airway space in the back of the throat is opened up. The average person can protrude his lower jaw forward somewhere between about nine to twelve millimeters. However, some people can only move their lower jaws forward considerably less than that. If your protrusion potential is less than five millimeters, it probably would not be enough to open up your airway. I suspect that this was your problem. Arthur B. Luisi, Jr.,D.M.D., The Naples Center For Dental Sleep Medicine
Hi Dr. Luisi, basically my dentist told me that because my current bite is normal, that is the lower jaw is not pushed backward, no severe overbite, that pushing it forward during sleep would result in my not being able to bite correctly. Is this the case? I got the sense this dentist didn't have a lot of experience.
Well, what you are repeating back to me is kind of unclear, but I guess that you have to consider the source. Everybody's lower jaw gets pushed forward during the night with an M.A.D., but, generally, the bite returns to normal the next morning. There are little morning devices called A.M. aligners that help the process. However, bite change is a valid side effect of M.A.D.s and treating dentists and the patients need to be vigilant for any developing problems. Actually, M.A.D.s could possibly used with retruded lower jaws and classically normal lower jaws, and even with protruded lower jaws IF the lower jaw can be sufficiently protruded from the original position as per my post directly above. I can't tell if you aren't processing the information that the dentist is giving you correctly or if he is unclear in his own mind. It might be a good idea to get a second opinion from another dentist experienced in dental sleep medicine if such is available in your area. Arthur B. Luisi, Jr., D.M.D.
