Letter 2, Issue 13.2

Mechanoreceptor Stimulation for the Treatment of OSA

http://dx.doi.org/10.15331/jdsm.7446
 
G. Dave Singh, DMD, PhD, DDSc1
 
1CEO and Founder, REMA Sleep, Inc.
 
Dear Dr. Masse,

I found the recent article by Yousefian et al.1 intriguing and would like to add a few comments as follows:

The authors claim that their hybrid mandibular advancement device (HMAD) has six clinical applications; however, they provided no evidence for bruxism management, therapeutic outcome of intracapsular conditions/retrodiscitis, snoring amelioration, or orthodontic improvement of malocclusion in the Results section.  It would be prudent if they could back up their claims with data to support these claims in the current study. 

The Methods section states that in the overnight polysomnography study, the attending sleep technologist titrated the device.  It could be acknowledged that this technique is inferior to a protocol that deploys in-home monitoring2. Furthermore, for adjustments, the technologist used a key to turn the screws to gradually advance the device.  At least one of the authors in the current study (CC) is presumably aware of the invention of this technique, because CC was hired by Singh for FDA 510k clearance3 of a similar device (the mRNA appliance) in 2014.  It would be professional to cite that work if their current approach is reliant on it.

For its corrective mechanism, the study suggests that the HMAD device “incorporates a mechanosensory activator for mechanoreceptor stimulation, propelling the lower jaw forward”.  On closer inspection, a specific ‘mechanosensory activator’ could not be identified unless the authors are referring to the lingual flange, which is commonplace in most oral appliances, ranging from lower dentures, orthodontic appliances, orthotics, mandibular advancement devices, etc.  In addition, a component for “mechanoreceptor stimulation” could not be identified.  Singh4 was the first to patent a three-dimensional axial spring used in the DNA appliance for mechanoreceptor stimulation.  It would be wise to cite that work if their current approach is reliant on it.  Nevertheless, the authors claim that the component is active in “propelling the lower jaw forward”.  If so, why don’t other oral appliances with a lingual flange “propel the lower jaw forward”? 

Despite the aforementioned query, the authors contend that the lingual contact arm of the HMAD is similar to a bit in a horse's mouth, which is problematic.  First, reference 25 quoted in their article is not a peer reviewed paper.  Second, a bit in a horse's mouth does not activate periodontal receptors; it acts as a bite plane that increases the vertical dimension of the occlusion.  So-called ‘horse whisperers’ use a different principle to file down racehorse molars so that the mandible glides forward during duress.  These are two disparate mechanisms.  However, occlusal equilibration is no longer practiced by many dentists because it can precipitate (serious) adverse effects5.  

However, the HMAD has features that raise the tongue.  This concept is not new and can be attributed to other/different mandibular advancement devices6. It would be more professional to disclose previous work if the authors’ approach is reliant on it.  But the explanation of the putative corrective mechanism provided by the article appears to be unfounded.  It claims that the HMAD causes hyoid bone elevation, stretching of the oropharynx, widening of the oropharyngeal airway, increasing the rigidity of the airway, etc., without providing any data, references, or citations.  Therefore, because the article did not assess risks, benefits, and alternatives, it ostensibly represents bias in reporting, and it would be helpful for readers of the Journal of Dental Sleep Medicine to have some responses to these questions from the authors of this article.

CITATION

Singh, GD. Mechanoreceptor Stimulation for the Treatment of OSA. J Dent Sleep Med. 2026;13(2).

REFERENCES

  1. Yousefian J, Aggarwal S, Cozean C, Levy J. ApnoDent®: A new hybrid mandibular advancement device for the treatment of temporomandibular joint and sleep-related breathing disorders. J Dent Sleep Med. 2025;12(4).
  2. Espinosa MA, Ponce P, Molina A, Borja V, Torres MG, Rojas M. Advancements in home-based devices for detecting obstructive sleep apnea: A comprehensive study. Sensors (Basel). 2023;23(23):9512. 
  3. Singh GD (2014). https://www.accessdata.fda.gov/cdrh_docs/pdf13/K130067.pdf Accessed 03/11/2026. 
  4. Singh GD. (2009). https://patents.google.com/patent/USD600350S1  Accessed 03/11/2026. 
  5. Kent A. Catastrophic occlusion. Br Dent J 2006;201(7):419. 
  6. https://oasyssleep.com/. Accessed 03/11/2026.

SUBMISSION AND CORRESPONDENCE INFORMATION

Submitted for publication October 29, 2025
Submitted in final revised form February 23, 2026
Accepted for publication March 3, 2026

Address correspondence to: G. Dave Singh, DMD, PhD, DDSc; Email: drsingh@drdavesingh.com

DISCLOSURE STATEMENT

Professor G. Dave Singh, DMD, PhD, DDSc is the inventor of the DNA appliance, the mRNA appliance, and similar devices.

This study did not receive any intramural or extramural financial support.

No conflict of interest, off-label, or investigational use of any product or service is discussed in this article.


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