Oral Appliance Therapy for Snoring: How Mandibular Advancement Works and If It’s Right for You

Snoring isn’t just annoying-it’s a sign your airway is collapsing while you sleep. If you’ve tried pillows, nasal strips, or sleeping on your side and still wake up to the same loud noise, you’re not alone. About 34.5 million American adults snore regularly, and many are looking for something better than a CPAP machine. That’s where oral appliance therapy comes in.

What Is Mandibular Advancement for Snoring?

Oral appliance therapy uses a custom-fitted device worn at night to gently move your lower jaw forward. This simple shift opens up the space behind your tongue and soft palate, keeping your airway open so you can breathe without snoring. It’s called a Mandibular Advancement Device, or MAD. Think of it like a mouthguard that doesn’t just protect your teeth-it keeps your breathing smooth.

This isn’t new. Dentists have been using these devices since the 1990s. A landmark 1999 study showed that moving the jaw just 2 to 6 millimeters forward reduced breathing pauses during sleep. Today, the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine both recommend MADs as a first-line treatment for people with primary snoring or mild-to-moderate sleep apnea-especially if CPAP feels too bulky or uncomfortable.

How Do These Devices Actually Work?

The science is straightforward: when your jaw moves forward, it pulls the tongue and soft tissues away from the back of your throat. That’s where most snoring happens. Without that blockage, air flows freely, and the vibration that causes snoring stops.

Custom MADs are made from semi-rigid acrylic with titanium connectors. They’re designed to allow 3 to 12 millimeters of forward movement, depending on your anatomy. Most devices have a titration mechanism-you can adjust the jaw position in small 0.5 to 1.0 mm steps. This lets your dentist fine-tune the fit over time.

Over-the-counter versions, like Zyppah or Good Morning Snore Solution, are cheaper (around $99) and made from thermoplastic that you mold in hot water. But they’re not as effective. A 2015 meta-analysis found custom devices reduced snoring by 72.3% on average, while OTC models only hit 48.6%. The difference? Custom devices are precisely fitted and adjustable. OTC ones are one-size-fits-none.

Who Is a Good Candidate?

Not everyone can use a MAD. You need:

• At least 6 to 8 natural teeth in each arch to hold the device
• Healthy gums and no advanced periodontal disease
• A jaw that can move forward without pain or joint issues

People with severe obstructive sleep apnea (AHI over 30) or those with Mallampati class IV airways (very limited throat visibility) often don’t benefit. One 2021 study found failure rates hit 38.6% in these cases.

Also, if your snoring is caused by nasal congestion or obesity alone, a MAD won’t fix it. It only helps when the problem is tongue or soft tissue collapse.

How Effective Is It?

The numbers speak for themselves. In compliant users, MADs reduce snoring intensity by 50% to 75%. That’s not perfect, but it’s life-changing for partners. One Reddit user reported his wife’s snoring dropped from 65 decibels to 38 dB-like going from a vacuum cleaner to a whisper.

Compared to other non-invasive options:

• Nasal dilators: 20-30% reduction
• Positional therapy (sleeping on your side): 35-45% reduction
• CPAP: 85-95% reduction

CPAP is still the gold standard for stopping snoring completely. But here’s the catch: only about 45% of people stick with CPAP after a year. With MADs, adherence jumps to 76.4%. Why? Because you can take it on a trip, it’s quiet, and you don’t feel trapped under a mask.

What Are the Side Effects?

No treatment is without trade-offs. About 25% of long-term users develop changes in their bite. Teeth may shift. The jaw joint can get sore. Some people report:

• Morning jaw pain (68.3% in early use)
• Excessive saliva (42.7%)
• Tooth discomfort (28.9%)

Most of this fades after 2 to 4 weeks. But for 14.7% of users who’ve worn MADs for over five years, dental correction became necessary. That’s why regular check-ups with your dentist every six months are non-negotiable.

Cost and Insurance: What You’ll Pay

Custom MADs cost between $1,800 and $2,500. That includes the dentist visit, impressions, device fabrication, and follow-ups. Some insurance plans cover part of it-but only 38% of U.S. commercial plans do, according to 2023 data.

If you’re paying out of pocket, it’s expensive. But consider this: a CPAP machine costs $500-$1,000 upfront, plus $200-$400 a year for replacement masks and filters. And if you stop using it? You’re back to square one. With a MAD, you pay once and use it for years.

Over-the-counter devices are cheaper, but they rarely deliver lasting results. You’re paying for hope, not science.

How to Get Started

You can’t just buy one online and expect results. Here’s the right way:

1. Get a sleep study. Rule out severe sleep apnea with a home test or lab study.
2. See a dentist trained in dental sleep medicine. They’ll check your teeth, jaw, and airway.
3. Get custom impressions. In-office digital scans are 23% more accurate than at-home kits.
4. Start with a 4- to 6-week titration period. Adjust the device by 1mm every 3-5 days until snoring stops or you hit max comfort.
5. Use it every night. Snoring returns within 48 hours if you skip.

Most people adapt within 10 to 14 days. To ease the transition, wear the device for an hour during the day while watching TV. Warm water soaks can help soften the material if adjustments feel stiff.

What’s New in 2025?

The field is evolving fast. In 2023, the FDA cleared the SomnoDent EVO 3-a device with built-in sensors that track your snoring and send data to your phone. Next year, Sleep Solutions Inc. is launching a MAD with AI that auto-adjusts your jaw position based on your breathing patterns.

Researchers are even exploring genetic markers to predict who’ll respond best to MADs. Within five years, your device might be designed around your DNA, not just your jaw shape.

Is It Worth It?

If you snore, your partner is losing sleep, and CPAP feels impossible, then yes-it’s worth trying. MADs aren’t magic, but they’re the only non-surgical, non-invasive treatment with strong clinical backing for primary snoring.

The key is choosing the right device and the right dentist. Don’t go for the cheapest option. Don’t skip the sleep study. And don’t expect instant results. Give it 4 to 6 weeks. Track your progress. Talk to your dentist.

For many, it’s the first time in years they’ve slept through the night-and so has their partner.

What If It Doesn’t Work?

If you’ve followed the protocol and still snore, it’s time to reevaluate. Maybe your anatomy doesn’t respond to jaw advancement. Maybe you have a nasal issue. Or maybe your device isn’t fitted right.

Talk to your sleep specialist. They might suggest:

• A different MAD design
• Combining it with nasal therapy
• Considering surgery like UPPP (if you’re a candidate)

Don’t give up. Snoring is treatable. You just need the right tool for your body.