Dental sleep medicine · Snoring
Snoring disrupts sleep, yours and your partner's, and is sometimes a sign of sleep apnea. A mandibular advancement device (MAD) gently holds the lower jaw forward during sleep, opening the airway and reducing snoring. The appliance is custom-made for your teeth and jaw, adjusted gradually, and followed up by Dr. Andra Rettman, a specialist in Oral Medicine.
During sleep the muscles of the throat and tongue relax and the airway narrows. Air passing through a narrow passage makes the tissues vibrate, that is snoring. Further narrowing can cause repeated pauses in breathing, obstructive sleep apnea (OSA).
When to get checked: if your partner notices breathing pauses, or you have daytime sleepiness, morning headaches, high blood pressure or wake up choking. In these cases a sleep study is recommended before fitting an appliance, because snoring can mask sleep apnea that needs a different treatment.
The appliance has two parts, for the upper and lower teeth, connected by a mechanism that holds the lower jaw slightly forward. This small movement also brings the tongue and soft tissues forward, widening the airway and reducing vibration.
According to the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine (AASM/AADSM, 2015), oral appliances are recommended for primary snoring in adults, and for obstructive sleep apnea in patients who cannot tolerate CPAP or prefer an alternative. The guideline recommends a custom, titratable appliance provided by a qualified dentist.
| Over-the-counter ("boil and bite") | Custom appliance | |
|---|---|---|
| Fit | Generic, tends to move | Precise to your teeth and jaw |
| Jaw advancement adjustment | Limited or none | Gradual and controlled |
| Long-term comfort | Usually low | Higher, thin and tailored |
| Durability | Months | Years, with check-ups |
| Clinical follow-up | None | Periodic checks of teeth, bite and effectiveness |
A snoring appliance is not part of the basic Israeli health basket. Some supplementary and private insurance plans participate, mainly when sleep apnea has been diagnosed in a sleep study, check with your insurer. We can provide a medical letter and receipt for submission.
Fitting a snoring appliance is a medical treatment: it affects the teeth, the jaw joints and breathing during sleep. Dr. Andra Rettman is a specialist in Oral Medicine and a senior physician in the Oral Medicine Department at Hadassah Ein Kerem. She fits the appliance with your teeth and joints in mind, coordinating with your sleep study and sleep physician when needed. Treatment is available in English and Hebrew.
For most patients with primary snoring, the appliance significantly reduces snoring loudness and frequency. Effectiveness depends on proper fit and adjustment, which is why a custom appliance and follow-up matter.
It is recommended, especially with breathing pauses, daytime sleepiness or high blood pressure. A sleep study rules out sleep apnea needing other treatment and allows the appliance's effect to be measured.
A grinding night guard protects the teeth and does not move the jaw. A snoring appliance advances the lower jaw to open the airway. They are entirely different devices.
Usually a few days to a few weeks. Adjustment is gradual to allow comfortable adaptation.
For mild to moderate sleep apnea, often yes, including for patients who cannot tolerate CPAP. For severe sleep apnea CPAP is usually first-line, and the decision is made with a sleep physician.
It is not in the basic basket. Some supplementary and private plans participate, mainly with a sleep apnea diagnosis. We provide a medical letter and receipt for submission.
A custom appliance usually lasts several years, depending on use and care. Its condition and fit are checked at periodic visits.
At first there may be jaw and tooth tenderness and extra saliva, which usually pass. Long-term use may cause minor bite changes, so regular check-ups are important.
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