How mandibular advancement works
The lower jaw is the mandible, and advancement means bringing it forward. Two trays fit over your upper and lower teeth and connect so that the lower one sits ahead of where it would otherwise rest. The tongue is anchored to the mandible, so moving the jaw takes the tongue with it and opens space behind it.
The trays are made from impressions of your own teeth, so they seat precisely and stay in place. How far forward the jaw sits is adjustable, and that's what we refine over the first few weeks. Too little advancement has no effect, and advancing too far tends to make the jaw ache without improving the result. An appliance also needs something to hold on to, so enough sound teeth, healthy gums and a joint that tolerates the position all matter, which is why the first visit is an examination.
What the process involves
From the first appointment to a confirmed result usually takes a few months, and most of that time is spent adjusting the appliance between short visits.
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Examination and records
We check the teeth, gums, joint and how far you can open, then take impressions of both arches. Crowns, bridges and loose teeth all matter here.
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Fitting the appliance
The laboratory returns a device made to fit your teeth. We check that it seats without rocking, doesn't press on gum tissue, and lets you open and close comfortably.
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Titration over several weeks
You advance the jaw a fraction of a millimeter at a time, with days between changes so the muscles can adapt. Moving too quickly tends to cause soreness, so we keep the pace deliberate. The aim is the smallest advancement that works.
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A follow-up sleep test
Your physician arranges a repeat study with the appliance in place. That study is what confirms the appliance is working and that the breathing events have decreased.
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Ongoing checks
We see you periodically to inspect the appliance, confirm the fit and keep an eye on your bite.
Side effects
People usually adapt within a few weeks. Several of these are common early on and settle down. One of them matters for as long as you wear the appliance.
- Morning jaw soreness. Common in the first weeks and after each advancement, and it usually eases within an hour of removing the appliance.
- Tooth tenderness. Individual teeth can feel bruised early on. Tell us which teeth are affected, because that can mean the fit needs adjusting.
- Extra saliva, or a dry mouth. Both happen, sometimes to the same person on different nights, and both usually fade.
- Clicking or tightness in the joint. Let us know if that happens. If it continues, see TMJ and jaw pain.
- Bite changes over time. Holding the jaw forward for hours every night, year after year, can gradually change how your teeth meet: front teeth touching less, back teeth touching more, and none of it noticeable while it happens. Regular checks catch it early, which is why we review your bite at follow-up visits.
Cleaning, care and lifespan
- Every morning
- Brush it with a soft brush and cool water. Skip the toothpaste, which is abrasive enough to scratch the surface. Let it dry, then keep it in its vented case, away from heat and out of reach of pets.
- Weekly
- Soak it in a cleaner made for dental appliances. No hot water, no dishwasher, no boiling and no bleach, all of which can warp the material.
- How long it lasts
- Several years of normal use is typical, and heavy grinders wear through them faster. If you notice cracks or the fit has loosened, bring it in and we'll take a look.
- When your teeth change
- A new crown, an extraction or a filling that alters the shape of a tooth can stop an appliance seating. Let whoever does that work know that you wear one.
Common questions about oral appliances
Will it stop my snoring?
It reduces or stops snoring for many people. Snoring is the audible part, and the breathing events underneath are what the treatment is aimed at, so the follow-up sleep study is what shows how the apnea itself has responded.
Can I wear one if I have crowns, bridges or missing teeth?
That depends on what remains for the appliance to hold on to. Several missing teeth or extensive bridgework may mean other work comes first, and a full upper denture usually rules it out. Teeth loosened by untreated gum disease are treated first.
Does it hurt to sleep with?
It feels bulky for a week or two, and people generally stop noticing it after that. Morning ache is common early on and after each adjustment. Pain that doesn't settle is something we'd like to see you about.
Do I have to wear it every night?
Yes. The airway collapses again on the nights it isn't worn, and consistent wear also keeps the bite settled. It packs into a small case, which makes it convenient for travel.