Mandibular Advancement Devices Are Superior to Nasal Strips for Snoring
For patients with snoring, mandibular advancement devices (MADs) are significantly more effective than nasal strips and should be the preferred treatment option. MADs provide objective reduction in snoring events and improve quality of life, while nasal strips show minimal to no benefit in controlled studies.
Evidence-Based Treatment Hierarchy
Mandibular Advancement Devices (First-Line for Snoring)
MADs are recommended with the highest level of evidence (Grade A) for snoring treatment, particularly when associated with mild to moderate obstructive sleep apnea 1. The European Respiratory Society guidelines explicitly recommend MADs for this indication 2.
- MADs reduce snoring more effectively than placebo in randomized controlled trials 1
- Custom-made, titratable devices are essential for optimal outcomes—prefabricated devices are significantly less effective 1
- The device must advance the mandible at least 50% of maximum protrusion with proper titration, as non-advanced devices are ineffective and may worsen symptoms 1
- Long-term adherence is superior: 76% of patients continue treatment after 1 year and 65% after 4 years 1
- Patients prefer MADs over CPAP with better compliance rates 1
Nasal Strips (Minimal to No Benefit)
Nasal strips show no significant objective benefit for snoring in controlled trials. A prospective randomized blinded trial found no significant improvement in palatal snoring, snoring loudness, or respiratory disturbance index when comparing nasal strips to no treatment 3.
- No objective acoustic improvement in snoring parameters was demonstrated 3
- No subjective benefit reported by patients or bed partners in controlled studies 3
- While one uncontrolled study suggested modest benefit 4, and internal nasal dilators may perform slightly better than external strips 5, these findings are not supported by rigorous controlled trials
- The German Society of Otorhinolaryngology guidelines do not recommend nasal strips as standard treatment for snoring 6
Clinical Implementation Algorithm
Step 1: Initial Assessment
- Evaluate for obstructive sleep apnea through sleep history and consider polysomnography if symptoms suggest sleep-disordered breathing 6
- Assess anatomic factors: nasal patency, oropharyngeal structures, tongue size, and facial skeletal morphology 6
- Screen for contraindications to MADs: severe periodontal disease, severe temporomandibular disorders, inadequate dentition, or severe gag reflex 1
Step 2: First-Line Interventions
- Weight reduction if overweight—this should be the initial approach for all overweight snorers 2, 6
- Positional therapy if snoring occurs only in supine position 6
Step 3: Definitive Treatment
- Refer to qualified dentist for custom-made, titratable MAD 1
- Ensure proper titration procedure to achieve at least 50% mandibular advancement 1
- Re-evaluate with objective sleep study after MAD fitting, as symptom improvement alone is an imprecise indicator of success 1
Step 4: Alternative Options (If MAD Contraindicated or Refused)
- Oropharyngeal exercises may provide modest benefit with significant reduction in objective snoring measures 7
- Minimally invasive palatal surgery in anatomically suitable cases 6
Important Caveats
Common pitfall: Assuming nasal obstruction is the primary cause of snoring and treating with nasal strips alone. While nasal patency is important, the primary mechanism of snoring involves pharyngeal soft tissue vibration that MADs address mechanically 1.
Side effects of MADs occur in over 50% of patients initially (jaw discomfort, tooth tenderness, excessive salivation, temporary occlusal changes) but are generally transient 1.
Persistent snoring during MAD treatment may indicate inadequate apnea control and warrants re-evaluation 1.
Interdisciplinary collaboration is essential: physicians should refer to qualified dentists for MAD fitting, and dentists should refer back to physicians for sleep study confirmation 1.