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Oral appliances are an alternative to continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA). Although CPAP is a highly efficacious treatment, there is a need for other treatment options because the clinical effectiveness of CPAP is often limited by poor patient acceptance and tolerance, and suboptimal compliance.There has been an expansion of the research evidence to support the use of oral appliances in clinical practice. Recent work has focused on the following clinically relevant areas: the effect of device design on efficacy and patient compliance, the role of different modalities for assessing the upper airway in the prediction of treatment outcome, the assessment of the impact of treatment on a range of health outcomes and the evaluation of long-term adverse effects.There is robust evidence of the efficacy of oral appliances for improving polysomnographic indices and modifying the health risk associated with OSA. The current evidence suggests a similar impact on health outcomes as CPAP. However, further research is required to address a number of unresolved issues, including the influence of device design, titration procedures, prediction of treatment outcome and the clinical effectiveness of oral appliances for modifying the adverse health consequences of OSA.