Oral Appliance Therapy for Obstructive Sleep Apnea: From Treatment Alternative to First-Line Care

Obstructive sleep apnea (OSA) is a highly prevalent yet substantially underdiagnosed condition with serious cardiovascular, cognitive, and occupational consequences. Over the past decade, oral appliance therapy (OAT)-particularly the use of mandibular advancement devices-has evolved from a secondary alternative to continuous positive airway pressure (CPAP) into a recognized primary treatment for patients who are intolerant of, or noncompliant with, CPAP or prefer an alternative therapy. Advances in digital fabrication, intraoral scanning, home sleep apnea testing, and embedded device technology have significantly improved appliance fit, titration precision, and treatment monitoring. Meanwhile, the shifting treatment landscape-including the rise of over-the-counter sleep devices, hypoglossal nerve stimulation surgery, and GLP-1-driven weight loss therapies-underscores OAT's unique role as a safe, noninvasive, reversible, and combinable treatment modality. Looking ahead, artificial intelligence, expanded screening protocols, and stronger physician-dentist collaboration promise to extend effective care to millions of OSA patients who remain undiagnosed and untreated.