Which Oral Appliance Is Right for You? Four Designs, Explained

If you've been told an oral appliance could help your snoring or sleep apnea, you might picture one generic mouthpiece and worry it won't suit your teeth, your bite or the way you sleep. In fact, custom sleep appliances come in several designs, and the right one depends on things like missing teeth, grinding and claustrophobia. At A-Z Sleep & Airway Center in Glen Allen, Dr. Ashlee Goodman-Tabari chooses the design around you.

What every sleep appliance has in common

A custom sleep appliance, sometimes called a mandibular advancement device, gently holds your lower jaw forward while you sleep. That keeps your tongue and the soft tissue at the back of your throat from falling back and crowding your airway, so air can move more freely. MedlinePlus describes these dental devices as something "you wear in your mouth while you sleep to keep your jaw forward and the airway open." ( MedlinePlus)

The American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine recommend oral appliances for adults with primary snoring and for adults with obstructive sleep apnea who can't tolerate CPAP or prefer another treatment. They suggest a custom, adjustable appliance made by a qualified dentist over a non-custom device, along with follow-up sleep testing to confirm it's working. ( AASM)

"Every appliance is selected based on your needs," Dr. Goodman-Tabari says. Here are the designs she reaches for most.

Four designs, and who each one suits

Missing teeth or dentures: a dorsal-style design

If you're missing back teeth, you may assume an oral appliance isn't possible. A dorsal-style design still gives your jaw stability and holds it forward when teeth are missing, and it can even work with dentures. "We can even make an appliance for people with no teeth," Dr. Goodman-Tabari says.

Grinding or clenching: a Herbst-style design

If you grind or clench at night, a rigid appliance can feel like something to fight against. A Herbst-style design lets your jaw move, open and close freely while it keeps your lower jaw forward. That freedom makes it a good match for grinders, who may still grind while their treatment is being fine-tuned.

Claustrophobia or veneers: a thinner milled design

For people who feel claustrophobic with anything bulky in their mouth, or who have veneers and don't want a rigid device pressing on cosmetic work, there's a thinner, lighter version of the same design milled from one solid piece. It feels less noticeable and is very durable.

Snoring without breathing pauses: a simpler snoring appliance

If your sleep study shows that you snore but don't stop breathing, you may not need a more complex design. A simpler, more flexible snoring appliance is often comfortable and effective for quieting snoring on its own.

How we choose the right design for you

The choice starts with your sleep study. A sleep physician we work with reads your results and gives you a diagnosis, so we know whether we're treating snoring, sleep apnea or upper airway resistance syndrome. Then Dr. Goodman-Tabari looks at how many teeth you have, whether you grind, whether you breathe through your mouth and how you feel about having something in your mouth at night.

From there, we take a 3D scan of your mouth and find a comfortable forward position for your jaw. The appliance is made by a dental lab and is usually ready in about three weeks. We show you a model first, so you can see how light it is before you commit.

We make sure it's working

An appliance isn't finished the day you get it. We adjust it until it feels comfortable and then arrange a follow-up sleep study to confirm your breathing and oxygen have improved. "We don't just give them the device and say here you go," Dr. Goodman-Tabari says. "No, we actually make sure it's working."

For a side-by-side look at custom appliances and store-bought mouthpieces, see our custom vs. over-the-counter page.

Common questions about choosing an oral appliance

What are the different types of sleep apnea mouthpieces?

Custom sleep appliances share one job, holding your lower jaw forward, but they differ in how they're built. Common designs include dorsal-style appliances for missing teeth, Herbst-style appliances that allow jaw movement for grinders, thinner milled versions for comfort, and simpler appliances for snoring alone. Dr. Goodman-Tabari chooses the design in Glen Allen.

Can I get an oral appliance if I'm missing teeth?

Often, yes. A dorsal-style design can hold your jaw forward even when back teeth are missing, and appliances can be made for people who wear dentures. We'll look at your teeth and bite at your consultation in Glen Allen and tell you what's possible for you.

Which oral appliance is best if I grind my teeth?

A design that lets your jaw move freely, such as a Herbst-style appliance, is usually the most comfortable choice for people who grind. It keeps your jaw forward without locking it in place. Grinding can also be a clue to an airway problem, so we'll talk about a sleep study too.

How long does it take to get a custom sleep appliance?

After your diagnosis and a 3D scan of your mouth, the appliance is made by a dental lab and is typically ready in about three weeks. We then fit and adjust it with you and confirm with a follow-up sleep study that it's working.

Find the appliance that fits you

Missing teeth, grinding or feeling claustrophobic doesn't rule you out. Call us at (804) 767-2507 or request a consultation at our Glen Allen office. If you haven't had a sleep study yet, start with our home sleep test.