Mandibular Advancement Device


A mandibular advancement device (MAD) is a solution for snoring and sleep apnea. It is also sometimes called a mandibular repositioning device (MRD).

What is Obstructive Sleep Apnea?

Sleep apnea is a common sleep disorder in which an individual’s breathing repeatedly stops and starts during sleep. Symptoms include daytime sleepiness, loud snoring, and restless sleep.

The involuntary pause in breathing can result either from a blocked airway or a signaling problem in the brain. Most people with the condition have the first kind, obstructive sleep apnea (OSA). Sleep apnea due to a signaling problem is known as central sleep apnea (CSA).

The person will unknowingly stop breathing repeatedly throughout sleep. Once the airway is opened or the breathing signal is received, the person may snort, take a deep breath, or awaken completely with a sensation of gasping, smothering, or choking.

Untreated sleep apnea can lead to potentially serious health complications, such as heart disease and depression. It can also leave a person feeling drowsy, increasing the risk of accidents while driving or working.

Mandibular Advancement Device (MAD): This is a custom-made oral appliance suitable for individuals with mild or moderate OSA. This mouthpiece holds the jaw in a forward position during sleep to expand the space behind the tongue. This helps keep the upper airway open, preventing apneas, and snoring.

Side effects of an MAD may include jaw or tooth pain, and potential aggravation of temporomandibular joint disease.

Untreated sleep apnea and its effects can have severe consequences. Any individual with excessive daytime sleepiness or other symptoms of sleep apnea should ask a doctor about their symptoms.

How does a MAD work?

A MAD is an alternative treatment method that people can try. It works by temporarily moving the jaw and tongue forward, which reduces throat constriction and prevents sleep apnea and snoring. Moving the tongue forward increases airway space.

Some MADs are custom or semi-custom and fit a specific person’s mouth. Others, also known as boil-and-bite MADs, are available over the counter (OTC). They feature soft materials that become more pliable under exposure to hot water. Biting down on the flexible mold helps fit the device.

It is important to note that MADs are not suitable for people who wear dentures or have severe dental issues.


The main benefit of an MAD is that it helps reduce snoring and sleep apnea.

  • those with mild-to-moderate sleep apnea
  • young people
  • people with sleep apnea that improves when sleeping on their side
  • females
  • those with a receding jaw structure (also known as a retrognathic mandible)

The following people are less likely to see symptom improvement with MADs:

  • older adults
  • individuals with obesity and those with excess fat tissue around the neck
  • those with a stiff jaw, which makes advancement difficult
  • people with dental conditions, such as gum disease
  • people with central sleep apnea, which is a neurological condition rather than a mechanical one

Risks and side effects

Although a MAD can help limit sleep apnea symptoms and snoring, there are some side effects. These can include:

  • discomfort around the jaw and mouth area
  • toothache
  • excess drooling
  • dry mouth
  • gum irritation

Our Dental Specialist for Mandibular Advancement Device

Dr. Nattakarn Hosiriluck (Ph.D.)

Dental Occlusion, Temporomandibular disorders


  • 2019: Ph.D. (Dental Science: Oral Biology), Health Science University of Hokkaido, Japan
  • 2014: Higher Grad. Dip. (Masticatory Science), Faculty of Dentistry, Mahidol University
  • 2013: Doctor of Dental Surgery, Faculty of Dentistry, Srinakharinwirot University

Academic and professional background

  • 2014-present: Full time faculty, Faculty of Dentistry, Mahidol University (Department of Masticatory Science)


  • Thai Dental Council
  • Thai Association for the study of pain