How often do mads need adjustment?

During the titration phase, the prescribing dentist advances the lower jaw incrementally, typically 0.25-1.0 mm per adjustment, until the patient reports symptom relief without significant morning jaw soreness. That window is narrow. Moving too fast causes TMJ irritation; moving too slow extends the compliance curve and frustrates patients who are already skeptical about appliance therapy. A well-fabricated device with a precise calibration mechanism makes that titration window predictable rather than a guessing game.

After the initial titration period closes, most patients stabilize and only need the annual recall. The exceptions are patients who gain or lose more than 10-15 lbs, patients whose OSA was confirmed by home sleep test rather than full polysomnography (where the baseline AHI measurement carries more variability), and patients who report morning soreness returning after months of comfort. Each of those scenarios signals that the therapeutic position has drifted and recalibration is warranted before the annual window.

For general dentists building an appliance program, the adjustment schedule is also a clinical touchpoint that reinforces the patient relationship and creates a billable recall structure. Devices that are difficult to adjust in-office, or that ship without clear titration documentation, add friction to every appointment. Dani Dental ships every MAD with a technician-authored titration card that states the starting position, the maximum advancement range, and the incremental step size for that specific patient's device.