January 28, 2020 • 5 min read

The Choice Is Easy: Custom vs. Over-the-Counter Oral Appliances

Online night guards and snore appliances are popular, but dentistry is not one of them. Custom oral appliances are better than boil and bite for several reasons.



Crystal May

Director of Medical Billing Education for Devdent

Custom vs. Over-the-Counter Oral Appliances

Everyone is learning about the importance of sleep and is tired, pun intended, of dealing with the symptoms. At the same time, there is an ever-growing offering of over-the-counter or online night guards and snore appliances. While online healthcare certainly has a place, dentistry is not one of them. Patients need to know the risks and side effects that can occur when they take treatment into their own hands. When it comes to boil and bite vs. custom oral appliances, there are several reasons why custom is the better option.

The boil and bite technique leads to a poor fit with potential pain and long-term damage.

Over-the-counter (OTC) snore guards are made from a standard template and most use a boil and bite technique. This means that a flat piece of plastic is added to boiling water to become pliable. While still warm, the patient bites into it causing it to shape to their teeth. It may seem like it fits because it has captured a copy of the teeth. But, the more important part of a well-fitted appliance is what position the jaw is held in.

Boil and bite appliance do not allow for the jaw position to be selected in the fitting process. This leaves the jaw susceptible to the wrong position. If this happens, it can cause serious and sometimes irreversible damage to the temporomandibular joint (TMJ).

Common symptoms of an ill-fitting oral appliance include:

  • Jaw pain

  • Jaw popping and clicking

  • Headaches

  • Sores in the mouth

  • Falling out throughout the night
Over-the-counter appliances are not adjustable in any way.

Most OTC appliances are not adjustable, so if you have the wrong position, there is no room for improvement. This often leads to poor results and wasted money. Additionally, when it comes to sleep appliances, many people do better with an adjustment period. It can be uncomfortable if the jaw is moved too far initially, so a dentist-supervised adjustment period alleviates that. Custom appliances are more comfortable, better fitting, and grows with your patient to slowly adjust the jaw to the optimal position.

Getting a professional diagnosis can be life-changing and life-saving.

What really leads to patient confusion is that treating the snoring doesn’t necessarily mean they have treated the root cause. Snoring may seem like the problem to fix, however, it is actually a symptom of sleep apnea, which is a very serious medical condition. The use of an over-the-counter snore guard may just be silencing the body’s natural alarm system to let you know there is a problem.

Without proper testing, there is no way to know if the snoring is a symptom. Furthermore, you won’t know how severe the sleep apnea might be or what other conditions exist. Sleep apnea is not something to take lightly and, certainly, shouldn’t be treated without medical diagnosis and trained specialist oversight.

The protocol for dental practices to provide a sleep appliance is very meticulous:

  1. The dentist completes a thorough medical history review and exams to identify if a patient is at risk.

  2. A home sleep test is ordered, (available in most states) which is then reviewed and diagnosed by a board-certified sleep specialist. This test reveals if the patient has sleep apnea, how severe the condition is, and many other relevant factors.

  3. Next, x-rays are often taken to evaluate the health of the mouth and teeth. This is taken into account and great consideration is given in the selection of the oral appliance that will create the best results for the patient.

  4. Impressions of the teeth are taken and sent to be manufactured by a skilled lab specializing in custom oral appliances.

  5. During delivery, the dentist applies their training to determine the best position to open the airway. This is important because an open airway allows for unobstructed breath, which reduces snoring in a safe, effective way.

  6. Once satisfied with the custom appliance, the patient is later retested to ensure the effectiveness after putting it into use.
Custom appliances are proven to be more effective.

Both the American Academy of Dental Sleep Medicine (AADSM) and the American Academy of Sleep Medicine (AASM) specifically recommend custom appliances that are provided, monitored, and evaluated only by trained dentists. Custom oral appliances have been studied and tested for their comfort, fit, and effectiveness in the treatment of sleep apnea and snoring, while over-the-counter appliances are unproven and can lead to dangerous side effects.

Based on the science and the recommendations of the AADSM and AASM, I am not alone in thinking that many of the at-home or OTC services should be provided only by trained dentists. All patients suffering from signs and symptoms of sleep disorders should be screened and treated by a dentist trained in dental sleep medicine. Sleep apnea is a serious disease worthy of the knowledge and consideration that goes into diagnosing, choosing, and fitting a custom sleep appliance. The choice is easy when comparing boil and bite vs. custom oral appliances, it is simply putting your health at risk to forgo a professional diagnosis and use an over-the-counter oral appliance instead.

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