TRDs are one-size-fits-most, which can be challenging for patients with smaller oral cavities. If the bulb feels too bulky, a custom-milled MAD is usually a more comfortable alternative because the device is fit to your specific bite.
A tongue-retaining device (TRD) is a silicone bulb that uses negative suction to hold the tongue forward, while a mandibular advancement device (MAD) is a custom-fit tray that physically shifts the lower jaw. Clinical literature supports that TRDs work by maintaining the tongue in a protruded position with the suction force generated from a plastic bulb held between the lips and teeth (Chen et al., 2025). Both oral appliances prevent airway collapse during sleep, but they differ significantly in how they anchor within the mouth. Enamel Dentistry Lantana discusses the science behind TRD and MAD.
To understand which device is right for you, the physics of the airway need to be observed. A Mandibular Advancement Device (MAD) works through skeletal repositioning. This uses a precision hinge to hold the lower jaw forward, which creates structural space in the oropharynx. This is ideal for patients whose airway collapse is caused by a receding jawline. In contrast, a Tongue Retaining Device (TRD) utilizes negative suction. The silicone bulb creates a vacuum seal that pulls the tongue forward and away from the back of the throat. Protocol suggests that holding the tongue in a resting position will improve abnormal breathing events [1] (Fukuda et al., 2023). While the MAD moves the jaw, the TRD moves the tongue. For our Lantana patients who find that their tongue is the primary cause of their snoring, the suction-based approach of a TRD offers a targeted solution without the need for jaw-shifting hardware.
One of the most common questions we hear at Enamel Dentistry Lantana is whether sleep apnea can be treated if you are missing teeth. Most Mandibular Advancement Devices require at least 8 to 10 healthy natural teeth in each arch to act as anchors. If you wear full dentures or have significant edentulous areas, a MAD has nothing to attach to. This is where the Tongue Retaining Device becomes a life-changer. Clinical research indicates that with a mandibular repositioning device and tongue retaining device, a 60% protrusion decreases apnea signs and symptoms [2] (Pimentel et al., 2014). Because the TRD anchors against your lips and uses suction on the tongue, no teeth are required to function. Medical literature supports that tongue retaining devices may be proposed as an alternative to continuous positive airway pressure (CPAP), taking nasal obstruction into consideration as a contraindication [3] (Lazard et al., 2009). This is the primary non-CPAP alternative for patients with:
Feature | MAD | TRD |
Mechanism | Jaw advancement | Negative suction bulb |
Anchor point | Teeth and gums | None |
Candidacy | Strong teeth | Denture wearers |
Adjustability | High | Low |
Durability | 3-5 years | 1-2 years |
Maintenance | Cleaning pods | Daily soap and water |
Every oral appliance triggers a foreign body response, and the TRD is no exception. When you first begin using a tongue bulb, your brain may mistake the device for food, leading to temporary hypersalivation. This is a normal neurological reflex that typically resolves within the first two weeks as your salivary glands acclimate. During this 14-day window, you may also feel slight tenderness at the tip of your tongue or a stretching sensation in the frenum. At our office near Southwest Parkway, we recommend a low and slow approach: wear the device for 15 minutes during the day while watching Netflix to train your tongue to relax into the suction. By day 15, most patients find they can sleep through the night without noticing the device is even there.
At Enamel Dentistry, we use a protocol to determine your candidacy for sleep devices. As mentioned in our periodontal guidelines, a Mandibular Advancement Device applies constant pressure to your teeth. If you have periodontal pockets deeper than 4mm, this pressure can act like accidental braces, causing your teeth to shift or even loosen within the bone. If our AI-assisted screening shows that your gum health is compromised, we may recommend a Tongue Retaining Device as the safer alternative. Because the TRD does not put pressure on the dental roots or the alveolar bone, this allows you to treat your sleep apnea while we simultaneously work on stabilizing your gum disease. This ensures that solving your sleep issues does not come at the cost of losing your natural teeth.
The materials used in these devices require different levels of care to remain sanitary. MADs are typically milled from high-grade medical acrylic or 3D-printed polymers. They are highly durable, often lasting 3 to 5 years, but their hinges can collect tartar from your saliva. We recommend using a 42,000 Hz ultrasonic cleaning pod to keep the hardware moving smoothly. TRDs are made of soft, medical-grade silicone. While they are more flexible, silicone is naturally more porous than acrylic. This means a TRD may need to be replaced every 12 to 24 months as the material begins to soften or retain odors. To maximize the lifespan of your TRD in the Austin heat, always store the device in a ventilated case in a climate-controlled room. Never leave it in a hot car after a trip to Lantana Place, as heat can cause the silicone to warp and lose its suction capabilities.
TRDs are one-size-fits-most, which can be challenging for patients with smaller oral cavities. If the bulb feels too bulky, a custom-milled MAD is usually a more comfortable alternative because the device is fit to your specific bite.
Some tongue tip sensitivity may be experienced during the first 14 days of use.
For most patients, a custom MAD is more effective for heavy snoring because it can be titrated incrementally to find the exact position that stops the vibration of soft tissue in the throat.
Dr. Devish Patel, DDS, provides comprehensive general and cosmetic dentistry at Enamel Dentistry in Austin, TX. With a focus on modern clinical care, he specializes in aesthetic treatments, alongside preventative and restorative maintenance. Dr. Patel is committed to delivering safe, evidence-based solutions that keep patients comfortable and informed at every step.
[1] Chen Y, Alhozgi AI, Almeida FR. Dentoskeletal changes of long-term oral appliance treatment in patients with obstructive sleep apnea: A systematic review and meta-analysis. J Prosthodont. 2025 Apr;34(S1):62-79. doi: 10.1111/jopr.13946. Epub 2024 Sep 26. PMID: 39327689; PMCID: PMC12000640.
[2] Fukuda T, Kohzuka Y, Almeida FR, Iijima T, Masuda R, Tsuiki S. Control of Tongue Position in Patients with Obstructive Sleep Apnea: Concept and Protocol for a Randomized Controlled Crossover Trial. Int J Environ Res Public Health. 2023;20(11):6026. Published 2023 Jun 1. doi:10.3390/ijerph20116026
[3] Pimentel MJ, Bacchi A, de Castro GC, Rizzatti-Barbosa CM. Oral Appliance for the Treatment of Severe Obstructive Sleep Apnea in Edentulous Patients. J Indian Prosthodont Soc. 2014;14(Suppl 1):255-259. doi:10.1007/s13191-013-0312-4
[4] Lazard DS, Blumen M, Lévy P, et al. The tongue-retaining device: efficacy and side effects in obstructive sleep apnea syndrome. J Clin Sleep Med. 2009;5(5):431-438.
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