# Obstructive Sleep Apnea: The Expanding Role of Dental Sleep Medicine—A Systematic Review of Mandibular Advancement Devices, Treatment Efficacy, and Occlusal Complications

## TL;DR

This review explores how dental treatments like mandibular advancement devices help manage sleep apnea, showing effectiveness but also potential dental side effects.

## Contribution

The paper highlights the expanding role of dental sleep medicine and introduces novel techniques like Er:YAG laser therapy for mild OSA.

## Key findings

- MADs reduce AHI, improve oxygen saturation, and alleviate snoring and fatigue.
- Long-term MAD use may lead to occlusal or dental changes.
- Tooth loss is linked to increased OSA risk, especially in men over 65.

## Abstract

Background: Obstructive sleep apnea is characterized by recurrent upper airway obstruction during sleep, leading to intermittent hypoxemia, sleep fragmentation, and excessive daytime sleepiness. Affecting up to 11% of the adult Polish population and more commonly diagnosed in men, OSA poses a major public health concern due to its association with cardiovascular, metabolic, and neurocognitive complications. This review summarizes the current evidence on diagnostic methods, risk factors, and therapeutic approaches, with particular emphasis on oral appliance therapy using mandibular advancement devices (MADs). Methods: A systematic literature review was conducted using the PubMed and Scopus databases, covering publications from 2020 to 2025, including clinical trials, meta-analyses, and systematic reviews evaluating the efficacy and safety of MAD therapy. Results: Findings demonstrate that MAD effectively reduces apnea–hypopnea index (AHI) values, improves oxygen saturation, and alleviates snoring and daytime fatigue, offering a patient-tolerable alternative for those intolerant to continuous positive airway pressure (CPAP). However, long-term use may cause occlusal or dental changes. Novel techniques, such as Er:YAG laser therapy, show potential in treating mild OSA. Moreover, epidemiological data suggest a correlation between tooth loss and an increased risk of OSA, particularly among men over 65. Conclusions: Dentists play a pivotal role in early detection, screening, and interdisciplinary management of OSA, underscoring the importance of collaboration between dental professionals and sleep medicine specialists for comprehensive care.