Most people know sleep apnea through the CPAP machine. Fewer realize that a custom mouthpiece made by a dentist is also a recognized treatment option for some patients. This guide explains how oral appliances for obstructive sleep apnea work, who they may suit, how the fitting process goes, and why a dentist should be working alongside a physician rather than on their own.
A quick primer on obstructive sleep apnea
In obstructive sleep apnea, the upper airway repeatedly narrows or becomes blocked during sleep, interrupting breathing. Common signs include loud snoring, pauses in breathing noticed by a bed partner, gasping during the night, and daytime sleepiness. Snoring alone does not mean you have sleep apnea, and sleep apnea can occur without loud snoring, which is why diagnosis matters.
Diagnosis comes first
According to the National Heart, Lung, and Blood Institute (NHLBI), treatment decisions follow a sleep study. That is a medical diagnosis, made by a physician, often a sleep medicine specialist. A dentist can screen for warning signs and refer you, but a mouthpiece should not be a substitute for an evaluation. Over-the-counter “anti-snoring” devices are not the same as an appliance prescribed for diagnosed sleep apnea.
Where oral appliances fit among treatments
NHLBI lists several approaches:
- Lifestyle changes, such as physical activity, healthy sleep habits, maintaining a healthy weight, limiting alcohol and caffeine, quitting smoking and sleeping on your side.
- Positive airway pressure (PAP), which NHLBI calls the most common treatment, including CPAP, bilevel and auto-adjusting machines.
- Medicines in certain situations.
- Oral devices.
- Mouth and facial muscle therapy (orofacial therapy).
- Surgical procedures, including hypoglossal nerve stimulation and jaw advancement surgery.
NHLBI explains that a provider may prescribe an oral device if you do not want to use, or cannot tolerate, a CPAP machine, and that you may be referred to a dentist or orthodontist to have it custom fitted.
Types of oral appliances
Mandibular repositioning devices
NHLBI describes these as mouthpieces that cover the upper and lower teeth and hold the lower jaw in place, preventing it from sliding back and blocking the upper airway. These are the type most dentists provide. Many are adjustable, so the jaw position can be moved forward gradually.
Tongue-retaining devices
These hold the tongue forward so it does not fall back and block the airway, according to NHLBI. They may be considered for people who cannot use a jaw-positioning device, for example because of too few teeth to anchor one.
Daytime tongue muscle stimulators
NHLBI also describes a removable device worn while awake, typically once a day, that stimulates and tones the tongue to help keep it from falling back during sleep.
The dentist’s role
When a physician prescribes an oral appliance, the dentist typically:
- Examines your teeth, gums and jaw joints to make sure they can support a device. Untreated decay, gum disease or loose teeth may need attention first. See our guide to gum disease signs.
- Takes impressions or a digital scan so a lab can make a custom device.
- Fits and adjusts the appliance, showing you how to put it in, take it out and clean it.
- Adjusts it over follow-up visits until it is comfortable and positioned as prescribed.
- Coordinates with your physician, who may order a follow-up sleep test to confirm the device is working.
NHLBI notes the dentist will custom fit the device so it is comfortable and teach you how to use it for best results.
Possible side effects
Because a mandibular device holds the jaw forward overnight, some people notice jaw soreness, tooth discomfort, extra saliva or dry mouth, especially at first. Over time, some people experience changes in how their teeth meet. Report persistent jaw pain or bite changes to your dentist. If you already have jaw joint problems, mention them; our guide to TMJ and TMD explains those conditions, and NIDCR’s TMD page notes that changes in how teeth fit together can also be a symptom worth discussing.
Living with an oral appliance
- Clean it each morning as instructed and store it in its case.
- Bring it to dental checkups so it can be inspected for wear.
- Do not adjust it beyond what your dentist instructs.
- Keep follow-up appointments with both your dentist and your physician.
- Tell your physician if symptoms such as daytime sleepiness or snoring come back.
Cost and coverage
We do not publish prices because we have not found a reliable national figure to cite. Costs depend on the device design, lab fees, the number of follow-up adjustments, and whether a follow-up sleep test is needed. Because sleep apnea is a medical condition, custom oral appliances are often billed to medical insurance rather than dental insurance, typically requiring a physician’s diagnosis and prescription. Ask both the dental office and your medical insurer before treatment. Our guide to dental insurance explains common billing terms.
Finding a provider
Ask your sleep physician for a referral, or ask dentists whether they provide oral appliance therapy and how they coordinate with physicians. You can search for dentists near you in our directory and use our checklist on how to choose a dentist.
Frequently asked questions
Can a dentist diagnose sleep apnea?
A dentist can spot warning signs and refer you, but diagnosis is made by a physician, typically after a sleep study, as NHLBI describes.
Are oral appliances as good as CPAP?
NHLBI describes PAP as the most common treatment and says oral devices may be prescribed if you do not want to use or cannot tolerate CPAP. Your physician can explain which is right for you.
What types of oral appliances are there?
NHLBI describes mandibular repositioning mouthpieces, tongue-retaining devices and daytime tongue muscle stimulators.
Is a store-bought snoring mouthguard the same thing?
No. Appliances for diagnosed sleep apnea are custom fitted and adjusted by a dentist under a physician’s prescription.
Does insurance cover sleep apnea oral appliances?
They are often billed to medical insurance with a physician’s diagnosis. Check with your insurer and the dental office.
Photo: Eren Li / Pexels
Sources
By the Dentist Review Editorial Team.
This is general information, not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.
