Sleep Apnea Β· Oral Appliance Therapy
A custom device fitted to your mouth β not a one-size-fits-all solution
For patients with confirmed mild-to-moderate obstructive sleep apnea, a custom oral appliance is a clinically validated first-line treatment. We design and fit your device, calibrate it precisely over follow-up visits, and work alongside your sleep physician to confirm it's working.
Step 1: Talk to your physician β they confirm diagnosis and prescribe OAT
Already diagnosed? Schedule a consult βMedical disclaimer
Oral appliance therapy for OSA requires a physician prescription based on a validated sleep study. We do not diagnose sleep apnea. We provide appliances in coordination with your prescribing physician β not as a replacement for medical evaluation or treatment.
How oral appliance therapy works
A mandibular advancement device (MAD) is a custom-fitted oral appliance worn during sleep. It holds the lower jaw (mandible) in a slightly forward position relative to the upper jaw, which tightens the soft tissues of the upper airway and reduces the tendency for the throat to collapse during sleep.
By maintaining airway patency, the appliance reduces or eliminates the breathing interruptions β apneas and hypopneas β that define obstructive sleep apnea. It does not treat central sleep apnea (CSA), which originates in the brain rather than the airway. Your sleep physician's diagnosis will clarify which type you have.
The American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM) recognize custom oral appliances as a first-line treatment for mild-to-moderate OSA and as an acceptable alternative for severe OSA in patients who cannot tolerate CPAP. The key word is βcustomβ β over-the-counter boil-and-bite devices are not the same and are not what we provide.
Is oral appliance therapy right for you?
Oral appliance therapy is most appropriate when all three of these apply:
- βYou have a confirmed OSA diagnosis from a licensed sleep physician (AHI β₯ 5 with symptoms, or AHI β₯ 15 regardless of symptoms)
- βYour physician has prescribed OAT β either as a first-line option for mild-to-moderate OSA, or because CPAP has not been tolerated
- βYou have sufficient teeth and adequate jaw range-of-motion for an appliance to fit (we screen for this at consultation)
OAT is generally not indicated for central sleep apnea (CSA), complex sleep apnea, or as a first-line option for severe OSA unless CPAP has been tried and failed. Your sleep physician makes that determination β not us.
What insurance covers
OAT for diagnosed OSA is a medical procedure, not a dental one. It is billed to your medical insurance using HCPCS code E0486 (oral interface for use with sleep therapy device, custom fabricated). Most major carriers β including Medicare β cover it with appropriate documentation.
Medicare covers oral appliances for OSA under the DME (Durable Medical Equipment) benefit, Part B. Requirements include: a face-to-face physician evaluation, a physician-ordered sleep study with AHI β₯ 5, a prescription for OAT, and a letter of medical necessity. Prior authorization is required for Medicare.
Nationally, out-of-pocket cost for a custom oral appliance ranges from approximately $1,500 to $3,500 when insurance does not cover it, according to AADSM published data. Your cost after insurance depends on your deductible, copay, and plan maximum.
- βBilled to medical insurance β not dental β using HCPCS E0486
- βMedicare Part B DME benefit covers OAT with qualifying documentation
- βPrior authorization typically required β we handle this on your behalf
- βWe verify benefits before fabrication; you will know your cost before we begin
- βWe will not charge without first checking your coverage and informing you
Source: AADSM Treatment Protocol (2013, updated 2024); CMS Medicare Benefit Policy Manual, Chapter 15 β Covered Medical and Other Health Services; HCPCS E0486 coverage criteria.
What to expect at every visit
- 1
Initial consultation (30β45 min)
We review your sleep study report, physician prescription, and medical history. We screen for adequate jaw range-of-motion, TMJ health, and dental condition. We explain the process, answer your questions, and verify insurance benefits. No obligation at this stage.
- 2
Impressions and bite registration (30β45 min)
We take digital or physical impressions of your upper and lower teeth and record your bite relationship. These go to a specialized dental laboratory. Most appliances are ready in 2β3 weeks. We select the appliance design appropriate for your anatomy and grinding pattern.
- 3
Delivery and first fitting (30β45 min)
We seat the appliance, confirm it fits correctly on both arches, and instruct you on insertion, removal, and nightly cleaning. The jaw position at delivery is intentionally conservative β we advance incrementally in subsequent visits.
- 4
Titration visits β weeks 2 through 8 (15β20 min each)
We advance the jaw position by 0.25β0.5 mm at each visit, guided by your comfort and symptom response. Most patients reach their therapeutic position within 4β8 weeks. We monitor bite changes and jaw joint comfort at every titration.
- 5
1-month follow-up (30 min)
Full review of comfort, compliance, and any side effects. We report to your sleep physician and β if titration is complete β support the request for a follow-up sleep study to confirm AHI reduction.
- 6
3-month follow-up (20β30 min)
We confirm follow-up sleep study results (if completed), assess appliance condition, and fine-tune if needed. If AHI is still elevated, we discuss further adjustment or referral back to your sleep physician.
- 7
6-month and annual follow-ups (20β30 min)
Annual dental sleep follow-up is standard of care per AADSM guidelines. We assess appliance wear, bite changes, TMJ health, and coordinate with your medical team. Most insurers require documented annual follow-up to cover a replacement appliance.
Have your prescription ready?
Bring your sleep study report and physician prescription. We'll verify insurance benefits and walk you through the full process at no charge.
Care and maintenance
A well-maintained appliance lasts three to five years. These habits protect your investment:
- β
Daily brushing
After removing in the morning, rinse the appliance under cool water and brush with a soft-bristle toothbrush and mild liquid soap. Never use regular toothpaste β it is abrasive and will scratch the acrylic.
- β
Weekly enzyme-tablet soak
Soak in a non-abrasive retainer cleaner or dental appliance enzyme tablet (e.g., Retainer Brite) for 15β20 minutes once a week. This reduces biofilm and prevents staining.
- β
Storage
Store in the vented case provided. Do not leave in direct sunlight or in a hot car β heat warps acrylic. Keep away from pets.
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No hot water
Never rinse or soak in hot water. Heat distorts the appliance and will ruin the fit.
- β
Check for wear
Inspect monthly for cracks, sharp edges, or loose components. If anything feels different β unexpected tightness, new soreness, a different bite feel β contact us before your next scheduled visit.
Common Questions
Oral appliance therapy FAQ
Detailed answers to what patients ask most before and during treatment.
Related topics
Ready for a custom fit?
Request a free consultation. Bring your sleep study report and physician prescription β we'll verify insurance benefits before your first visit.