Ineffective versus effective oral appliances for snoring and sleep apnoea

[Dr David Cunnington]: So, 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 dentist, so what's the difference between them?

[Dr Harry Ball]: Yes, so there's a really big market for the what we call boil-and-bite, so it's a one-size-fit-all-type device which you can buy on the internet or in various stores. And the way they work, and I'll show you one of them. So, this is one from a large retailer. I won't mention their name, but they sell whitegoods and furniture, but they've now gone into the sleep apnoea area. To the Australian Sleep Association are quite concerned about a retailer treating sleep apnoea and the main problem is that they're selling a boil-and-bite one-size-fit-all appliance like this.

[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 you only get one go to get it right and everyone's jaw's different, they've got to make it pretty big to fit round 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, then you fashion it over your teeth, and you've got to work out the right forward position of the jaw as well and this is 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. And so they're only thirty/forty dollars or so. They get a moneyback guarantee. Often, they claim that there's clinical trials and that kind of thing. But really, almost invariably people can't use them, because the main problem with this type of appliance is that they don't fit well so you've got poorer tension. It's really important that these appliances stay firmly on the teeth, so they kind of drop down. But the mouth's 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's got trouble with snoring and sleep apnoea, they've often got it because the interior dimensions of the jaw are relatively small.

[Dr Harry Ball]: Yes.

[Dr David Cunnington]: And so if your treatment's actually a big, bulky treatment that takes up a lot of space in the mouth, it can make things worse if not better.

[Dr Harry Ball]: Yes, exactly. And we get asked quite often can't we just do one so people can see what's it 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. We have people come in, 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'. And 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 millimetre or two thick all the way round. And importantly, you can bring the jaw forward by putting the key in there and putting the key in then 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 apnoea.

[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. 

[Dr Harry Ball]: Yes.

[Dr David Cunnington]: If someone goes to a retailer and buys a device and they get temporomandibular joint 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. 

[Dr Harry Ball]: Yes.

[Dr David Cunnington]: So, for me, a lot of the value in having someone come and see a 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 apnoea snoring - CPAP machine, dental device - they're something you've got to adapt to and get used to and comfort is just number one. If something's 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 just give up on them, basically. That's why in our clinic we do a trial of a custom-made state-of-the-art device rather than use one of the boil and bite-type devices, because we're just more likely to get good results with it.

Oral appliance selection:

https://www.sleepwise.com.au/appliance-selection-snoring-sleep-apnoea/

Oral appliance reviews:

https://www.sleepwise.com.au/review-of-oral-appliances/