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Oral appliances (OAs) may be an effective alternative to continuous positive airway pressure or pharyngeal and jaw surgeries for obstructive sleep apnea (OSA) treatment. Mandibular repositioning devices are the most commonly used design for OAs, and they function by engaging the dental arches to pull the mandible forward. Efficacy rates for reduction of nocturnal respiratory events vary widely (26%-69%) for individual OAs evaluated in recent studies. Predicting treatment efficacy for individual OAs based on anatomic measurements is problematic. It is advisable that posttreatment nocturnal polysomnography be obtained to ascertain OA treatment response. Side effects with OAs are usually infrequent but include insomnia, temporomandibular joint dysfunction, and dental malocclusion. Long-term (>3 years) studies demonstrate self-reported compliance rates ranging from 50% to 90%. A recent survey of dentists determined that the average OA cost was $933 to manufacture and to fit.Specific OAs are useful as a first-line therapy for patients with other than severe OSA. Severe OSA patients are less likely to be adequately treated with OAs; hence, continuous positive airway pressure remains the first-line therapy in these patients. The use of OAs as an adjunct to pharyngeal surgeries for the treatment of OSA is still to be determined. The cost and side-effect profile may favor OA treatment compared with pharyngeal and jaw surgeries.