Custom Fitted Oral Appliances versus Over the Counter Non Custom Appliances for Snoring and Sleep Apnea

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Many of our patients frequently ask if an over the counter device will work the same as the custom fitted appliances we make. There are quite a few similarities between the two, but they also differ in several ways. This article will summarize some of the key differences between a Custom Oral Appliance and an Over the Counter Non Custom Oral Appliance.



Many over the counter appliances use boil and bite technology. These are typically “DIY” appliances where you boil the appliances and mold the material over your teeth to create some type of retention. After a few seconds, the appliance is taken out and placed in a bowl of cold water to help the material “set up”. In comparison, custom oral appliances are professionally fit by a qualified dentist. In Texas, a dentist has to take special courses and training each year to be able to make custom oral appliances for managing snoring or obstructive sleep apnea. A trained dentist takes impressions of your teeth and then sends the impressions off to a lab to create a custom oral appliance that closely fits your teeth and gums.

Once the appliance returns from the lab, your dentist ensures a proper fit and makes necessary adjustments. An improperly fit appliance can cause undesirable side effects such as pain or discomfort, or persistent snoring due to the appliance falling out at night – this happens quite often with a non-custom appliance. Over the counter non custom appliances typically are a “one size fits all” and as a result, tend to be much bulkier. If snoring and sleep apnea is due to a “crowded airway”, imagine using a bulky appliance!



Sleep apnea and snoring is an anatomical problem that likely will persist or possibly worsen throughout lifetime. A custom oral appliance has the ability to be adjusted in incremental levels to “advance the jaw.” Most over the counter appliances do not have this ability.  Having the adjustability features of a custom oral appliance also allows slow incremental advancements when you are initially trying to get used to the appliance. Advancing the jaw too quickly can sometimes produce pain – we typically see this often in a non-custom appliance.



Generally speaking, a custom oral appliance tends to have a longer lifespan. On average these appliances can last anywhere from two to five years before requiring replacement. This estimate greatly varies depending on whether or not you grind your teeth at night.
On average, over the counter non custom appliances typically last only about a year.


What Does Research Show?

Numerous studies have revealed that custom-fabricated oral appliances showed greater efficacy and patient acceptance than non-custom (pre-fabricated) oral appliances.1,2,3 Pre-fabricated oral appliances tend to be bulky and ill-fitting, resulting in difficulties retaining the device on the oral structures.4 This diminishes the ability of the appliance to maintain a stable mandibular protrusive position during sleep and may increase patient discomfort.

Obstructive Sleep Apnea is a life threatening disease. In my opinion, an over the counter non custom appliance may not control the disease effectively. It is important to have a qualified dentist watching you for potential side effects. Custom oral appliances are less likely to produce harmful side effects to the teeth and gums, and also manage obstructive sleep apnea much more effectively. At Texas Sleep Solutions, our doctors are trained in managing obstructive sleep apnea with custom oral appliances. We are also trained in managing TMJ disorders that occur very frequently in patients suffering from obstructive sleep apnea. At Texas Sleep and TMJ Solutions, we fabricate custom oral appliances for the management of obstructive sleep apnea. Call us at 469-712-6865 for a consultation!


1. Marklund M, Verbraecken J, Randerath W. Non-CPAP therapies in
obstructive sleep apnoea: mandibular advancement device therapy. Eur
Respir J 2012;39:1241-7.
2. Ahrens A, McGrath C, Hagg U. Subjective efficacy of oral appliance design
features in the management of obstructive sleep apnea: a systematic
review. Am J Orthod Dentofacial Orthop 2010;138:559-76.
Journal of Dental Sleep Medicine 50 Vol. 1, No. 1, 2014

3. Vanderveken OM, Devolder A, Marklund M, et al. Comparison of a
custom-made and a thermoplastic oral appliance for the treatment of
mild sleep apnea. Am J Respir Critical Care Med 2008;178:197-202.

4. Cooke ME, Battagel JM. A thermoplastic mandibular advancement device
for the management of non-apnoeic snoring: a randomized controlled
trial. Eur J Orthod 2006;28:327-38.