Mandibular advancement device in Cologne – treatment for snoring and sleep apnea
Loud snoring or pauses in breathing at night? A custom-fitted mandibular advancement device keeps the airway open during sleep – gentle, quiet and with no mask at all.
Snoring occurs when the soft tissue in the throat relaxes during sleep and the flow of air narrows the airway. In mild to moderate obstructive sleep apnea, an individually measured mandibular advancement device gently holds the lower jaw forward – so the airway stays open.
Sleep apnea is a condition in which breathing repeatedly stops for a short moment during sleep. The consequences for those affected are wide-ranging, and restful sleep is barely possible. This can lead to many health problems.
Fortunately, there are solutions: with a mandibular advancement device, sleep apnea can be treated effectively.
Fewer breathing pauses in sleep apnea thanks to an oral appliance
The pauses in breathing that are typical of sleep apnea syndrome are a real burden for those affected. Snoring is characteristic of sleep apnea. This is why oral appliances are used to provide relief.
An oral appliance tailored to your individual needs keeps the upper airway clear, so that regular, shallow breathing is possible during sleep – without pauses in breathing, so that you can truly recover at night.
Sleep with pauses in breathing – sleep apnea
With this sleep disorder, breathing stops for longer than 10 seconds at a time. The result is an insufficient supply of oxygen throughout the bloodstream – including the brain.
This repeatedly triggers arousals that go unnoticed. Restful deep sleep is no longer possible – daytime performance is considerably reduced.
Sleep apnea can have serious effects:
• High blood pressure, cardiac arrhythmia, increased risk of heart attack
• Increased risk of stroke
• Microsleep while driving and at work
• Depression and listlessness
• Impaired sexuality
In short: quality of life is reduced and life expectancy is lowered.
Do you sleep well, or are you still snoring?
Snoring occurs when muscles and soft tissue flutter in the narrowed throat. During sleep the muscles relax, the lower jaw and the tongue fall back and narrow the airway. Low tissue tension and excess weight increase this, which is why snoring becomes more common with age. Sleep apnea is not always behind it. In a consultation, we will show you the treatment options.
How common snoring is
60% of all men and 40% of all women over the age of 60 snore. Among 30-year-olds, it is only 10% of men and 5% of women.
People who snore often do not notice it themselves – but they do suffer from the consequences, such as a dry mouth, hoarseness and a sore throat. Usually, however, it is partners who are more disturbed by the snoring sounds. That is why a solution has to be found together. Dentists can help you!
Treating snoring and sleep apnea with oral appliances as a solution
Disruptive snoring and mild to moderate sleep apnea can be treated with oral appliances, also called mandibular advancement devices. To fit the appliance individually to your needs, a digital impression of your teeth can be taken. It forms the basis for a mandibular advancement device intended to treat your sleep apnea.
- They are fabricated on the basis of your digital dental impressions.
- During sleep, the appliances hold the lower jaw, the tongue and the soft palate forward. This keeps the throat wide open, stabilizes the slack throat muscles and supplies the lungs with enough air again to saturate the blood with sufficient oxygen.
- In our in-house master dental laboratory, we produce your mandibular advancement devices with a precise fit using a 3D printing process for you.
The consultation and the fitting of the mandibular advancement device are carried out by us as specialized orthodontists, so that you and your partner can sleep more quietly and more restfully at night.
Frequently asked questions / FAQ about the mandibular advancement device
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Where can I get a mandibular advancement device in Cologne?
You can get a custom-made mandibular advancement device (an appliance that holds the lower jaw forward) at JUST KFO – Dr. Steinmaier & Kollegen in Köln (Hauptstraße 50). The appliance is custom-made in our in-house master dental laboratory after a digital 3D scan and is used in coordination with sleep physicians and ENT doctors – effective against snoring and mild to moderate obstructive sleep apnea. Unlike standard appliances from the drugstore, the custom-made device fits precisely and is fine-tuned to your individual degree of advancement. You can book a consultation appointment online.
How much does a mandibular advancement device cost?
The cost depends on the type, the material and the manufacturer. In Germany, a mandibular advancement device custom-fitted by an orthodontist usually costs between 1.000 and 2.200 €.
How well do mandibular advancement devices work?
Mandibular advancement devices are an established option for snoring and for mild to moderate obstructive sleep apnea. A custom-fitted device moves the lower jaw slightly forward and thereby helps keep the airway open – the soft palate and tongue are less likely to fall back. This reduces snoring and pauses in breathing. Compared with CPAP therapy or surgery, it is less invasive and easier to use. When it fits well, it can noticeably improve sleep quality. In a randomized study using custom-made devices, 84 percent of bed partners reported quieter snoring and 76 percent reported snoring on fewer nights per week.
Who prescribes a mandibular advancement device?
A mandibular advancement device can be prescribed by a dentist, an orthodontist or a sleep physician. Orthodontists have particular experience in making and fitting these devices, since snoring is often related to jaw or tooth misalignment. Before a device is fitted, the underlying causes should be carefully investigated. Since 2021 the following applies in Germany: if a physician has diagnosed obstructive sleep apnea, statutory health insurance may cover a mandibular advancement device under certain conditions.
What helps against snoring right away?
A few measures can reduce snoring quickly:
- Sleeping position: sleeping on your side or with your head slightly raised improves airflow.
- Relaxing the jaw muscles: targeted exercises can help.
- Nasal strips or nasal dilators: these improve breathing through the nose.
- Avoiding alcohol and sedatives: they relax the muscles of the throat and make snoring worse.
- Mandibular advancement device: a custom-fitted device often reduces snoring considerably.
Which option suits you best is something we clarify after a diagnosis. Avoid alcohol in the evening – in an analysis of 13 sleep laboratory studies, there were on average around four more pauses in breathing per hour with alcohol than without.
Can a dentist help with snoring?
Yes – a dentist can improve your oral health and fit a mandibular advancement device. An orthodontist additionally brings experience with jaw misalignment and airway problems, which are often behind snoring. The orthodontist investigates the cause and offers a suitable therapy – for example a mandibular advancement device, jaw correction or exercises for the jaw muscles. Around 95 percent of people with obstructive sleep apnea snore – which is why, before any device is fitted, we work together with a physician qualified in sleep medicine to find out what lies behind your snoring.
Can an ENT doctor help with snoring?
Yes – an ENT doctor examines the airways and may recommend, for example, nasal surgery or CPAP therapy. If the snoring is related to the jaw or the teeth, the orthodontist adds a mandibular advancement device or jaw correction. The two often work together in order to cover both cause and treatment comprehensively. In a randomized study, the number of nighttime breathing pauses after palate-and-throat surgery fell below 20 per hour in 59 percent of those who had the operation, compared with 6 percent in the untreated control group – whether such a procedure is an option is decided by the ENT doctor.
How effective are mandibular advancement devices?
For snoring and mild to moderate sleep apnea, they are effective.1 The device moves the lower jaw slightly forward and keeps the airway open, so that snoring and breathing pauses are reduced. In most patients, snoring can be successfully reduced or eliminated in this way. It is less invasive than CPAP or surgery; what matters is precise, individual fitting and the correct fit.
For mild to moderate obstructive sleep apnea, mandibular advancement devices are a guideline-supported alternative to CPAP therapy.1
Which mandibular advancement device is best?
The best device depends on your needs – in most cases, a device custom-made by the orthodontist is the right choice. It should sit comfortably, not disturb your sleep, and be made of high-quality, hygienic material. Because it is matched to your anatomy, it offers the best comfort and the best effect. In a randomized comparison study, a device individually made in the laboratory was successful in 60 percent of participants, while a prefabricated device softened in a water bath was successful in only 31 percent.
Where can I get a mandibular advancement device?
Mandibular advancement devices are available from online retailers, in pharmacies, or from a dentist. For fitting and care, an orthodontist is the best point of contact: they clarify the underlying cause and make sure the device fits properly and is the right treatment option for you. Since February 2021, the mandibular advancement device (a splint that holds the lower jaw forward) has been a covered benefit of the statutory health insurance system in Germany; since January 1, 2022, it has been billed as a dental service. It is made in a dental practice, but only at the request of a physician with a qualification in sleep medicine.
How long does a mandibular advancement device last?
How long a device lasts depends on the material, how it is used and how it is cared for. A high-quality, custom-fitted device normally lasts a long time. Over time, however, it can wear down – have it checked regularly and readjusted if needed so that it remains effective. We will also give you tips on caring for it. In one observational study, the average time a device was worn before being replaced was just under three years; independently of this, the condition of the device should be checked every six to twelve months, depending on your individual risk profile.
How do you stop someone from snoring?
Snoring is best stopped by addressing its cause. To do this, the orthodontist determines what lies behind it – for example a narrowed airway or a jaw or tooth misalignment – and recommends a suitable treatment: a mandibular advancement device (it moves the lower jaw forward and helps keep the airway open), a jaw correction, or specific exercises for the jaw muscles. In most people, snoring can be reduced or eliminated this way. In around 62 percent of those affected, the nighttime pauses in breathing occur mainly when lying on the back, and aids that prevent sleeping on the back reduced their number in studies by an average of about 43 percent.
Can you train yourself out of snoring?
Partly – certain exercises can strengthen or relax the jaw and throat muscles and reduce snoring; however, they have to be done in a targeted way and regularly. Often a treatment tailored to the cause is more effective: after a diagnosis, options include a mandibular advancement device, a jaw correction or additional exercises. This combination usually gives more lasting results. In a review of nine studies, targeted exercises for the tongue, palate and throat reduced the proportion of sleep time spent snoring from around 14 to about 4 percent on average – but only with regular practice over several months.
Degrees of obstructive sleep apnea
Obstructive sleep apnea occurs in various degrees of severity and is measured using the apnea-hypopnea index (AHI), which indicates the number of pauses in breathing per hour. An AHI of up to five is considered harmless. Higher values are categorized as mild (AHI 5 to 15), moderate (AHI 15 to 30) and severe (AHI over 30) cases, depending on how often breathing stops. The more pronounced the disorder, the higher the risk of possible secondary conditions such as strokes and heart attacks.
Treating snoring and sleep apnea: how a mandibular advancement device and a CPAP mask can help
Snoring affects many people and can become a burden not only for the person who snores but also for their partner. There are, however, effective treatment options for reducing snoring or even eliminating it altogether. In this article you will learn more about the treatment of snoring and of what is known as sleep apnea syndrome, in particular about the use of an anti-snoring appliance and of the CPAP mask.
Loud snoring and sleep apnea syndrome
Loud snoring occurs when the upper airways become narrowed or partly blocked during sleep. In some cases, snoring can point to a more serious condition known as sleep apnea syndrome. Here, breathing pauses occur during sleep, which can lead to a lack of oxygen and an increased cardiovascular risk. Treating snoring and sleep apnea is therefore important not only for quality of life, but also for health.
The role of the upper and lower jaw in treating snoring
The position of the upper and lower jaw can have a considerable influence on snoring. Moving the lower jaw forward can open the upper airways and reduce or prevent snoring. This is where so-called mandibular advancement devices (snoring appliances) come in: they are individually fitted and hold the lower jaw in a slightly forward position during sleep.
Different snoring appliances and how they are used
There are various snoring appliances on the market, and they differ in shape and material. It is important that the appliance is individually fitted, so that it is as comfortable as possible to wear and moves the lower jaw forward effectively. Patients should therefore seek advice, for example from a specialist such as an orthodontist in Cologne, in order to find the right anti-snoring appliance.
The CPAP mask for sleep apnea
In severe cases of sleep apnea, an anti-snoring appliance alone may not be sufficient. In such cases, a CPAP mask (Continuous Positive Airway Pressure) may be used. This mask is worn over the nose and/or mouth and keeps the upper airways open by means of a continuous flow of air. This prevents snoring and reduces the breathing pauses that occur with sleep apnea. A CPAP mask should, however, only be used under medical guidance and supervision.
Working together with medical experts
To find the best possible treatment for sleep apnea or for snoring, those affected should work closely with medical specialists and sleep laboratories. These experts can help to arrive at the right diagnosis and to select the most suitable treatment method, whether that is a snoring appliance, a CPAP mask or another form of therapy.
If jaw pain, a clicking in the joint or nighttime teeth grinding are also present, we look at TMD treatment in Cologne – temporomandibular disorder, often called TMJ – at the same time, because both conditions are connected through the position of the lower jaw.
Further measures for improving sleep
In addition to the measures for improving sleep described above and the use of aids such as mandibular advancement devices or CPAP masks, other individually fitted solutions can be considered. One such custom-made aid is an individual mandibular advancement device, also known as a protrusion splint for the lower jaw. This type of appliance is made to fit the individual patient’s teeth and helps keep the airway open during sleep.
The individual mandibular advancement device works by moving the lower jaw slightly forward. This is referred to as protrusion and helps to widen the space in the throat. It keeps the tongue and the soft palate from falling backward during sleep and blocking the airway. In this way the airflow remains unobstructed, which can lead to more restful sleep and a reduction in snoring. For the best effect, the individual mandibular advancement device should be held in position for at least ten seconds.
To ensure that this device is effective, close cooperation with medical professionals such as ear, nose and throat physicians and specialists in orthodontics is essential. They can carry out a thorough examination, determine the exact cause of the snoring and, based on this information, suggest the most suitable treatment. This may be the individual mandibular advancement device, but also other methods such as the CPAP mask.
The choice of treatment method should, however, always take the individual circumstances and needs of the patient into account. Individual advice and care are therefore essential for the success of the therapy. Such a tailored approach can considerably improve the quality of life and the health of those affected.
Sources & studies on snoring & sleep apnea
Sources:
Ramar, K., Dort, L.C., Katz, S.G. et al., 2015. Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy. Journal of Clinical Sleep Medicine, 11(7), S.773–827. https://doi.org/10.5664/jcsm.4858
- Kalra, A., Harrington, C., Minhas, G., Papageorgiou, S.N. und Cobourne, M.T., 2022. Wearability and preference of mouthguard during sport in patients undergoing orthodontic treatment with fixed appliances: a randomized clinical trial. Eur J Orthod, 44(1), S.101-109. https://doi.org/10.1093/ejo/cjab062
- Marklund, M., Persson, M. und Franklin, K.A., 1998. Treatment success with a mandibular advancement device is related to supine-dependent sleep apnea. Chest, 114(6), S.1630-5. https://doi.org/10.1378/chest.114.6.1630
- Vanderveken, O.M., Devolder, A., Marklund, M., Boudewyns, A.N., Braem, M.J., Okkerse, W., Verbraecken, J.A., Franklin, K.A., De Backer, W.A. und Van de Heyning, P.H., 2008. Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea. Am J Respir Crit Care Med, 178(2), S.197-202. https://doi.org/10.1164/rccm.200701-114OC
- Sutherland, K., Vanderveken, O.M., Tsuda, H., Marklund, M., Gagnadoux, F., Kushida, C.A. und Cistulli, P.A., 2014. Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med, 10(2), S.215-27. https://doi.org/10.5664/jcsm.3460
- Lettieri, C.J., Paolino, N., Eliasson, A.H., Shah, A.A. und Holley, A.B., 2011. Comparison of adjustable and fixed oral appliances for the treatment of obstructive sleep apnea. J Clin Sleep Med, 7(5), S.439-445. https://doi.org/10.5664/JCSM.1300
- Okuno, K., Sato, K., Arisaka, T., Hosohama, K., Gotoh, M., Taga, H., Sasao, Y., & Hamada, S. (2014). The effect of oral appliances that advanced the mandible forward and limited mouth opening in patients with obstructive sleep apnea: a systematic review and meta-analysis of randomised controlled trials. Journal of oral rehabilitation, 41(7), 542–554. https://doi.org/10.1111/joor.12162
- Petit, F.X., Pépin, J.L., Bettega, G., Sadek, H., Raphaël, B. und Lévy, P., 2002. Mandibular advancement devices: rate of contraindications in 100 consecutive obstructive sleep apnea patients. Am J Respir Crit Care Med, 166(3), S.274-278. https://doi.org/10.1164/rccm.2008167
- Gagnadoux, F., Fleury, B., Vielle, B., Pételle, B., Meslier, N., N’Guyen, X.L., Trzepizur, W. und Racineux, J.L., 2009. Titrated mandibular advancement versus positive airway pressure for sleep apnoea. Eur Respir J, 34(4), S.914-920. https://doi.org/10.1183/09031936.00148208
- Zhu, Y., Long, H., Jian, F., Lin, J., Zhu, J., Gao, M., & Lai, W. (2015). The effectiveness of oral appliances for obstructive sleep apnea syndrome: A meta-analysis. Journal of dentistry, 43(12), 1394–1402. https://doi.org/10.1016/j.jdent.2015.10.008
- Chan, A.S.L., Lee, R.W.W., & Cistulli, P.A.C., 2007. Dental appliance treatment for obstructive sleep apnea. Chest, 132(2), S.693-699. https://doi.org/10.1378/chest.06-2038
- Bartolucci, M. L., Bortolotti, F., Corazza, G., Incerti Parenti, S., Paganelli, C., & Alessandri Bonetti, G. (2021). Effectiveness of different mandibular advancement device designs in obstructive sleep apnoea therapy: A systematic review of randomised controlled trials with meta-analysis. Journal of oral rehabilitation, 48(4), 469–486. https://doi.org/10.1111/joor.13077
- Okuno, K., Sasao, Y., Nohara, K., Sakai, T., Pliska, B.T., Lowe, A.A., Ryan, C.F., & Almeida, F.R., 2016. Endoscopy evaluation to predict oral appliance outcomes in obstructive sleep apnoea. Eur Respir J, 47(5), S.1410-1419. https://doi.org/10.1183/13993003.01088-2015
- Randerath, W.J., Heise, M., Hinz, R., & Ruehle, K.H., 2002. An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome. Chest, 122(2), S.569-575. https://doi.org/10.1378/chest.122.2.569
- Lam, B., Sam, K., Mok, W.Y.W., Cheung, M.T., Fong, D.Y.T., Lam, J.C.M., Lam, D.C.L., Yam, L.Y.C., & Ip, M.S.M., 2007. Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea. Thorax, 62(4), S.354-359. https://doi.org/10.1136/thx.2006.063644
- Takaesu, Y., Tsuiki, S., Kobayashi, M., Komada, Y., Nakayama, H., & Inoue, Y. (2016). Mandibular Advancement Device as a Comparable Treatment to Nasal Continuous Positive Airway Pressure for Positional Obstructive Sleep Apnea. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 12(8), 1113–1119. https://doi.org/10.5664/jcsm.6048
Does health insurance cover a mandibular advancement device?
Since February 2021, the mandibular advancement device has been a benefit of statutory health insurance – but only under clearly defined conditions.
When statutory health insurance covers the cost
The Federal Joint Committee (Gemeinsamer Bundesausschuss), which decides what statutory health insurance pays for, added the device to the catalog of benefits on November 20, 2020; the decision has been in effect since February 2021. Three conditions must be met together:
- There is a medically confirmed obstructive sleep apnea in an adult person.
- The positive airway pressure therapy with a breathing mask (CPAP) cannot be used successfully.
- The prescription comes from a physician in private practice.
If the conditions are not met
For snoring without sleep apnea, the device is a private-pay service. In Germany, a custom-made mandibular advancement device usually costs between 1.000 and 2.200 Euro. We clarify which applies in your case before treatment begins – you receive the costs in writing in advance, not only with the invoice.
Diagnosis comes before the device
Whether sleep apnea is behind the snoring cannot be determined in the treatment chair. This requires a sleep medicine evaluation – through your family doctor, an ENT practice or a sleep laboratory. If you already have a diagnostic report, please bring it to your first appointment; then we can plan right away. Without a report, we will tell you which path is the shortest.
Mandibular Advancement Device in Cologne – Directions
You're interested in Mandibular Advancement Device in Cologne? Our orthodontic practice is located in southern Cologne – easily accessible from all parts of the city, with our own in-house master dental laboratory.
Sleeping quietly again?
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