What’s the difference between oral appliances? Are some better than others?

In many cases of snoring or sleep apnea, oral appliances can be used as effective treatments, particularly when sleep apnea is not severe. Oral appliances are custom fitted devices that fit on the top and bottom jaw and are worn during sleep to hold the lower jaw forward, which holds the tongue away from the back of the airway. There are a range of appliances available. Everything from do-it-yourself appliances from around $70 to dentist-fitted customised, adjustable appliances for around $1,800. What’s the difference between these appliances?

Do-it-yourself appliances

These devices range from very simple boil-and-bite devices such as the Ripsnore ($69 for 2) or SleepPro ($65), that tend to be bulky and hard to adjust, to custom made appliances that are adjustable such as the SleepPro Custom ($199). Although the ApneaRX ($349, pictured) isn’t custom made, it has an adjustable mechanism allowing repeated fine adjustments. Although the advantage of these appliances is that they are significantly cheaper than dentist-fitted appliances, you are on your own, with no-one to help troubleshoot if you run in to problems or cause damage to your teeth. They are also bulkier, less comfortable and less effective than dentist fitted adjustable appliances that allow very fine adjustment of the degree of mandibular advancement which helps to prevent pain and helps achieve optimal results.


Dentist fitted appliances (customised & adjustable)

silensorAppliances fitted by dentists are custom-made and adjustable. This means that they are more comfortable and more effective than do-it-yourself appliances. As they are fitted by a dentist, you will also have the support of the fitting dentist to troubleshoot any difficulties you may have and helping you adjust the appliance so you get the most out of it. These appliances and the professional advice and assistance come at a price. Dentist fitted appliances cost between $1500-$2000.

Examples of dentist fitted appliances are the Dorsal, Silensor, EMA and Orthoapnea. For more details on these individual appliances see this post from the team at SleepWise clinic.

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Dr. David Cunnington: Amongst dental appliances Harry, there are some that are adjustable and some that aren’t adjustable and some fitted by dentists and not fitted by dentists. So what’s the difference between them?

Dr. Harry Ball: There’s a really big market for the what we call “boil and bite”. So it’s a one-size-fits-all type device which you can buy on the internet or in various stores. The way they work – I will show you one of them. So this is one from a large retailer. I won’t mention their name but they sell white goods and furniture but they’ve now gotten into the sleep apnea area.

So the Australian Sleep Association are quite concerned about a retailer treating sleep apnea and the main problem is that they’re selling a boil-and-bite, one-size-fits-all appliance like this and …

Dr. David Cunnington: What do you mean by boil and bite?

Dr. Harry Ball: Boil and bite, yes. So what it means is that because it’s – because you only get one go to get it right and everyone’s jaw is different, they’ve got to make it pretty big to fit around everyone’s jaw.

So it comes in a template like this or a framework like that and you put it in boiling water to soften it and then you fashion it over your teeth and you’ve got to work out the right forward position of the jaw as well. So that’s how these work.

This is one of the more sophisticated ones in that you can bring your jaw forward here but a lot of the ones that we find our patients come in with have bought them on the internet and you can’t adjust them at all. So they’re only $30, $40 or so. They get a money-back guarantee. Often they claim that there are clinical trials and that kind of thing. But really almost invariably people cannot use them, because the main problem with this type of appliance is that they don’t fit well. So you’ve got poor retention. So it’s really important that these appliances stay firmly on the teeth, so they kind of drop down.

But the mouth is a sensitive place and they tend to be quite bulky as well and they put more pressure on teeth. So they’re some of the problems.

Dr. David Cunnington: That’s what I find and often the same person who has got trouble with snoring and sleep apnea, they often got it because the interior dimensions of the jaw are relatively small. If your treatment is actually a big, bulky treatment, it takes up a lot of space in the mouth. It can make things worse, if not better.

Dr. Harry Ball: Exactly. We get asked quite often, “Can’t we just do one so people can see what it’s like to use a device?” and we don’t like to do that because for a lot of people, it can actually help with the snoring. So we have people come in and they say, “I can see that it can work in principle, that my snoring is reduced and I’m feeling better. However it’s just too painful to use and it’s too bulky.” So it’s just a world of difference when you custom make it like an appliance that we’re looking at here, which is just a millimeter or two thick all the way around and importantly, you can bring the jaw forward by putting the key in there and putting the key in and bringing the jaw forward is one of the most important aspects of making sure this appliance works really effectively in getting rid of snoring and sleep apnea.

Dr. David Cunnington: One of the things for me as a sleep physician is absolutely the appliances are different. So it’s adjustable. It’s much more slim and fits more in the mouth but it’s also having a dentist troubleshoot. That’s one of the keys for me. If someone goes to a retailer and buys a device and they get temporomandibular pain or they hurt their teeth, I can’t deal with that and that’s a really common thing with some of those boil-and-bite devices. So for me a lot of the value in having someone come to your dentist like yourself is not just a better appliance. It is actually that troubleshooting, the care, the after care, and I think actually that’s where a lot of the value is, getting it working for people.

Dr. Harry Ball: I think that’s a great point because if you look at both treatments for sleep apnea, snoring, CPAP machine, dental device, there’s something you’ve got to kind of adapt to and get used to and comfort is just number one. If something is comfortable and it’s working, people are going to use it in the longer term and you’re quite right. With the non-custom-made boil-and-bite devices, you have a lot more side effects and people will just give up on them basically. That’s why in our clinic, we do a trial of a custom-made oral appliance rather than use one of the boil-and-bite devices because we’re just much more likely to get good results with it.

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