But the challenge as a snorer is:
How to choose an MAD that actually works?
Snoring Aids and Cures are becoming increasingly popular as we realise the impact poor sleep has upon performance.
Indeed, a Daily Mail article “Ten Snoring Cures” reviewed 10 Over-the-Counter (OTC) snoring ‘cures’ widely available on the UK market. Using partner reporting as his standard for comparison, the journalist tried to stop his own snoring, with chin straps, pillows, sprays and ‘gumshields’ aka anti-snoring devices.
He had little success.
The journalist concluded his review by quoting a snoring expert: Consultant Respiratory Physician, Dr Tom McKay, from Edinburgh Royal Infirmary Sleep Centre, UK, as saying:
‘Sprays don’t have any great effect although nasal steroids have a small role if you’ve got nasal congestion. It can help to lose weight or avoid alcohol last thing at night or to sleep lying on your side. Various forms of gumshield are reasonably successful – maybe 50 or 60 per cent.’
Which Anti-Snoring Devices (‘Gumshields’ for snoring) Actually Work?
To answer that, I’ve updated (2018) this independent review (unlike some, I don’t sell them or have affiliate links).
By evaluating the costs involved, whether they work for the long-term, the top-selling features & benefits, and the side-effects of the expert cited ‘Gumshields‘ for snoring, I aim to help you make more informed choices.
‘Gumshields for snoring’ could more accurately be described as mandibular advancement devices (MADs). They are also known as mandibular repositioning devices (MRD) or even sometimes mandibular advancement splints (MAS).
But there are essentially just two categories:
- Over-the-Counter (OTC) ‘gumshields’
- Prescription, Custom-Made Dental Appliances
How to Choose the Best Anti-Snoring Device?
If you’re wondering ‘How to Choose?’ the best anti-snoring device, one that actually works, and is safe & effective. Then read this updated (2018) Expert Review of Mandibular Advancement Devices (MADs).
I review how the best Over-the-Counter (OTC) anti-snoring devices and prescription, custom-made appliances, (available through a sleep-trained dentist) measure up against my Top 13 Criteria for choice (see call out box) to determine whether they work, and if they’re safe and effective.
I have included references and a glossary at the end, and I would welcome your comments/review.
And the best bit?
Each section ends with my verdict and there’s a free bonus at the end!
- Clinical Evidence that it works
- Comfort and bulk
- Impact on your teeth
- Are your jaw joints at risk?
- Retention (how well it stays in place)
- Ability to adjust protrusion
- Lifespan & cost-per-wear
- Control of mouth opening
- Lateral movement
- Tongue space invasion
- Easy to keep clean
The Top 13 Criteria
CAUTION: Snoring may be a symptom of Obstructive Sleep Apnoea / Apnea (OSA)
Snoring may be Sleep Apnoea / Apnea (OSA)
Snoring is a major symptom of sleep apnoea/apnea.
Without a home sleep test (which your GP can arrange for you) and a professional medical assessment, your purchase of an OTC anti-snoring device, could harm you and if you snore because you have undiagnosed Obstructive Sleep Apnoea (OSA) the OTC gadget delays effective (and free on the NHS!) treatment that will prolong your healthy life.
Consult your GP if you snore. Especially if you snore and are drowsy during your normal awake time.
Grab our GP Guidelines and take them with you.
In the UK, you can also find sleep-trained dentists who can screen you and recognise Obstructive Sleep Apnoea/Apnea (OSA) symptoms2, make custom anti-snoring devices for snorers, without a prior medical diagnosis, or if they suspect OSA refer you on for further investigation.
Learn more about OSA in our award-winning, information guide: Overview of Snoring and Obstructive Sleep Apnoea (OSA)
№ 1. Clinical evidence (proof) that the Mandibular Advancement Device (MAD) works
What does 'Clinical evidence' actually mean?
Judging MAD Research Quality
When selecting an MAD, it’s important to look for this clinical evidence. To judge the quality of an MAD’s clinical research evidence you need to look past the headlines stating “Clinical research– tick”.
Typical patient-centred measures of outcome
Measurement of what patients perceive as important effects from wearing an MAD typically include:
- Partner reported snoring (a no-brainer!)
- Daytime sleepiness
- Quality of life
- Adherence (long-term use)
- Device preference
Gumshields for snoring
Our results suggest that the thermoplastic device cannot be recommended as a therapeutic option nor can it be used as a screening tool to find good candidates for mandibular advancement therapy.3
…patients overwhelmingly found the ready-made MRD difficult to tolerate…4
…96% of patients reported minor adverse events, which related predominantly to discomfort.4 [referring to a study by Dr. Tim Quinnell 5
Prescription, custom-made MADs
MAD research now focuses on:
Predictors of satisfactory outcome before purchase (who will benefit and why) and which type of custom MAD is most effective for a given genotype (which MAD is best for YOU as opposed to a vanilla approach).
Expert’s Verdict on Clinical Evidence for MADs
A positive outcome from clinical research can be thought of as a ‘guarantee’ of sorts.
My advice is to do your homework (grab the Bonus Mouthpiece Guide at the end) and be guided by a sleep-trained dentist. You can find one on via our Links page.
Typical Mandibular Advancement Device (MAD) research quality metrics include:
- Total sample size (the ‘N’ or number of patients who used the device)
- Could they tolerate it in their mouth (known as tolerance)
- How many hours they used it for each night (known as compliance)
- How many nights they used it for per week (part of the compliance metric)
- Partner reporting of cessation of snoring
- Perceived sleepiness before and after use
- Before and during use blood oxygenation level
- Before and during use AHI (apnoea hypopnea index – an index used to indicate the severity of sleep apnea. The number of apnea and hypopnea events per hour of sleep)
- Whether a placebo was used with a control group
- Whether patients crossed over to a different therapy / device
- Whether the researchers and/or patients were ‘blind’ (who was aware which device was a placebo or an actual MAD?)
- Has the research been published in a high profile and peer-reviewed journal? (This means other experts in the field judge it for quality)
№ 2. Anti-Snoring Device Costs
Why use a Dentist to get an Anti-Snoring Device (MAD)?
Financially, its tempting to cut out the dentist.
After all, a large part of the cost to you when purchasing a mandibular advancement device, is their clinical time.
The device fees vary, but what are you paying for?
Dentists know about teeth, gums and jaw-joints
Some dentists are specially trained in snoring and sleep apnoea / apnea, known as sleep-related breathing disorders (SRBD) and work closely with medics. Dentists with a special interest in sleep, can help you find the correct balance of benefits versus side-effects.
If you have certain medical conditions, or grind your teeth, you might break an OTC ‘gumshield’ whilst you’re asleep. When you are asleep you cannot spit out pieces of a broken gadget. You could INHALE or SWALLOW pieces.
You can find sleep-trained dentists on our Links page. In the UK, look for the British Society of Dental Sleep Medicine.
Expert's Verdict on whether to Cut Out the dentist
The terrifying thought of bits of gadget breaking off and being inhaled while you sleep, should surely make you realise you need to see a sleep-trained dentist and use a prescribed custom-made, adjustable anti-snoring appliance, made to quality standards. In case you’re wondering, I’m not a dentist.
№ 3. Comfort and Bulk of Mandibular Advancement Devices
If you had a car that was so small you couldn’t get in it – you might as well not have that car. A gadget that is so uncomfortable to wear, soon ends up being thrown across the bedroom or just left in the bathroom at bedtime.
The design and clinical expertise in how an anti-snoring device is supplied, also directly impacts your likelihood of successfully wearing it (and therefore whether it stops your snoring) – particularly during the first two weeks of use.
This is when most people who aren’t going to get on with them, quit. It might seem obvious:
but if you don’t wear it – it doesn’t work.
OTC Gumshields for snoring
Custom made MADs
Expert's Verdict on Comfort and Bulk
№ 4. Will an Anti-Snoring Device (MAD) Damage My Teeth?
You wear these things in your mouth. What impact will it have?
Gumshields for snoring
Over time your teeth will move.
This load on your teeth will hurt. And you will either stop wearing the mandibular advancement device and accept the financial loss (good luck trying to get a refund on a used product), or under duress from your partner and family, continue wearing it and risk losing the tooth or an expensive crown/cap/bridge.
An expert sleep-trained dentist can help identify (and save that tooth) if it could not withstand the lateral loading required.
A dental technician would ‘block out’ the identified tooth and not include it in the device.
Expert's Verdict on Risk to your Teeth
Boil-and-Bite devices will flex when worn and over time, this will procline (tilt forwards) your lower incisors and retrocline (tilt backwards) your upper incisor.
Certain custom-made anti-snoring devices are designed to avoid this tooth tilting movement. Consult your sleep-trained dentist.
№ 5. Are your Jaw-Joints at risk?
Jaw pain is truly horrible and once you have a jaw pain problem it persists.
All types of mandibular advancement device (MAD) work by moving your lower jaw forwards, and the amount it does this to be effective, and not hurt too much, is specific to you.
Gumshields for snoring
While of course it won’t initially prevent snoring in this position, the dentist will gradually advance your jaw until you stop snoring over a matter of weeks or perhaps even longer (this is known as titration). This gives you, your device (and your jaw joint) time to get accustomed.
Which means you STOP SNORING! And don’t permanently harm yourself. Yay!
Expert's Verdict on Jaw-Joint Risk
- you DON’T have one,
- explain why,
- and direct you to appropriate help.
If everything is OK, they’ll monitor the effect the MAD is having upon your teeth, gums, jaw joint and snoring. If your jaw joint isn’t healthy before you start using an anti-snoring device then it may cause irreversible harm. (The exception is when a specialist sleep and jaw joint pain [Temporo-Mandibular Joint Dysfunction or TMD] dentist prescribes a device for BOTH issues.)
A sleep-trained dentist would know what to avoid and ensure you did not experience premature posterior contact that would damage your jaw-joint.
This gets a bit technical.
A common problem particular to OTC ‘gumshields’ occurs when the device is adjusted forwards known as ‘protrusion’ (you might do this to try and increase the effect – and stop the snoring noise). The upper and lower parts of the device may then come into contact on just your back teeth.
This acts like a ‘bit’ for a horse – it gives you something to chew on. It ‘gags’ open the bite (keeps your jaws more open than they should be) and this places enormous load on your jaw joints.
It would be even worse for your jaw joint, if this was on one side only, and as you close your mouth, your jaw has to ‘rotate’ around this ‘premature contact’. What the above means, is that your jaw has to move in unnatural ways.
This hurts. And if you use the device in this position (because you’re trying to appease your partner) you will irreversibly damage your jaw joint.
№ 6. Retention / Fit of your Mandibular Advancement Device (MAD)
Retention has two meanings in dental sleep medicine (DSM is the term for dental devices used to help with sleep-related breathing disorders, including snoring and OSA).
How well your anti-snoring device fits, is known in dental terminology as ‘retention’.
Which means how well it keeps hold of your teeth, or to put it another way, how well it ‘clips on’ or stays in place. Most MAD designs rely upon its ability to ‘clip’ into place to then be able to hold your jaw forwards – and stop you snoring.
The second DSM interpretation of the word ‘Retention‘ relates to the MAD’s ability to hold open your airway, retain it in a forward position, and prevent snoring.
So, the right amount of retention (or fit) is essential for it to work.
Gumshields and retention
Due to the necessary choice of thermo-plastic (it softens and becomes adaptable to you, when heated in boiling water) material used in ‘boil and bite’ devices, getting and keeping the right degree of retention, for the long-term is nigh on impossible.
The material ‘wants’ to go back to its original shape as it cools down, which is technically due to both the elastic memory and elastic recovery of the material. There’s more about the material used in the Lifespan or ‘Cost per wear’ section below.
On the other hand, ‘Customized fit‘ devices are the ‘Boil-and-Bite’ OTC type of gadget (and I know you know that water boils at 100 deg. C!).
Expert's Verdict on Retention of Anti-Snoring Devices
№ 7. Ability to Adjust the Protrusion of your MAD
The ability to adjust the forward position of your jaw (adjust the protrusion to prevent snoring) impacts upon both comfort and how well it works. The optimum position is unique to you. It has to be just far enough forward to prevent you from snoring, yet not so far forward it hurts your jaw joints.
Fixed devices (sometimes called ‘monobloc’ devices) take an arbitrary approach to the forward position of your lower jaw. This primitive design (exhibited by both OTC and some old technology custom-made ones) is likely to be less than ideal for comfort and effect.
Gumshields for snoring
You need a different device.
If you’re trying to ensure you breathe through your nose and stop your mouth falling open, then read Chinstraps for snoring? Safe, Effective or Dangerous? [new window]. In my chin strap review, I examine if they have a role for snoring and obstructive sleep apnea (OSA).
If you can only breathe through your mouth and/or sometimes struggle to breathe through your nose, then consult your GP and seek an ENT assessment.
Custom adjustable MADs
- Whether this is sufficient
- Whether it dictates a hard to tolerate initial protrusion
The most modern custom adjustable MADs have between 8-10mm range of movement. If more is needed – you will most likely need a remake.
Expert's Verdict on Ability to Adjust the Protrusion
№ 8. LifeSpan or ‘Cost-per-Wear’
To ensure your purchase of an anti-snoring device (MAD) is not a waste of money or a false-economy, you have to consider:
- Its outright price (including clinical fees) and VAT (if its for snoring)
- Its length of useful life
Amongst other things…
OTC Gumshields for snoring
- This material absorbs saliva from your mouth (and also any cleaning chemicals that may then leak back out into your mouth overnight).
- They are damaged if you grind your teeth because the material is quite soft and elastic.
- Typical lifespan is 6 months to 1.5 years before the EVA made device becomes too smelly and unpleasant to use.
- They also distort and place high lateral loads on your front teeth making them very sore in the morning.
Custom-Made Anti-Snoring Devices
However, most are typically made from a type of denture acrylic (polymethylmethacrylate) or ‘PMMA’, and as such are much stronger and less likely to absorb saliva than EVA materials. Some new variants are made from at type of ‘Nylon’ (polyamide) and are very strong in thin section (see Bulk above). This means they will last longer and therefore the ‘cost per wear’ may be reduced.
In the UK, it is also possible to obtain a custom-made anti-snoring device manufactured entirely from metal (known as ‘Chrome’ = Cobalt Chrome wiki link: http://en.wikipedia.org/wiki/Cobalt-chrome ) While this type of manufacture may cost more (they are more time consuming to make) the material cross-section is extremely thin (fractions of a millimetre are possible) making the bulk in the mouth minimal (see Comfort and bulk above). The metal device does not absorb saliva or cleaning agents either.
However, the downside is that adjustment of the ‘fit’ of metal devices may be problematic.
Expert's Verdict on LifeSpan
The high-end devices using nylon or chrome are thinner and less bulky but are also difficult (if not impossible) to adjust. This does not mean to say that’s a problem, it just has to be perfectly made.
So, if its not – then it needs to be remade. Do not accept a poor fitting custom-made anti-snoring device.
№ 9. Control of Mouth Opening
When using a mandibular advancement device (MAD) it is essential to prevent your mouth from falling open for effective snoring relief and to avoid making your airway narrower than it would be without a mandibular advancement device.
It should not be necessary to resort to a chin strap to control this.
Why does vertical opening matter?
The lower jaw rotates backwards as it opens which narrows your airway and makes snoring worse (or if you have sleep apnoea / apnea may increase the severity and duration of apneaic episodes).
If your jaw is protruded with a mandibular advancement device (MAD) and your jaw falls open your airway may be narrower than without using an MAD.
See the three X-ray diagrams below to understand why vertical opening with an MAD should be avoided. The red dots highlight how the airway increases / decreases with protrusion and vertical opening.
Images courtesy of Dr Ulrich Huebers DDS.
Gumshields and custom MADs
- Jaw advancement must increase as the mouth opens (protrusion must increase proportionally [to maintain the same effect] if vertical opening occurs).
- Less protrusion correlates with:
- Less side-effects (including less risk of tooth movement and jaw pain)
- Increased tolerance and improved long-term compliance.
An interincisal opening (the distance measured between the upper and lower front teeth) of more than 5 mm has been associated with lower patient adherence (long-term use), perhaps as a result of discomfort.6
Expert's verdict on mouth opening
- the tongue is large
- the jaw is small
However, opening beyond 5mm (measured between the incisors) is uncomfortable, inhibits lip closure and detrimentally impacts long-term use. A design principle for MADs is control of vertical opening (note my previous comment about not needing a chin strap).
№ 10. Ability to Move Side-to-Side (lateral movement)
It might seem obvious, but unless the MAD is worn, it cannot stop snoring.
As such, it must be comfortable to use. Part of this comfort equation is the MAD not creating a ‘trapped’ sensation.
This may occur when the lower jaw is unable to move from side-to-side.
Gumshields and custom MADs
Experts verdict on lateral movement
Finally, while it is perhaps a contentious area, if you routinely ‘brux’, then an anti-snoring device that does not permit side-to-side (lateral) movement may actually disrupt your sleep. One theory suggests that this is because your attempts to move are hindered. The opposing theory suggests you will no longer brux when your apnea is resolved.
№ 11. Does not invade your tongue space
If you’ve had a filling or a crown, then you may recall how you found yourself very conscious of it. You probably explored it with your tongue and it felt alien. Every anti-snoring device will feel huge in your mouth when you start to use it.
Consequently, less is more! Less physical presence in your mouth, squashing your tongue, enhances your ability to initially accept it and keep using it.
The concept behind an MAD is to advance the jaw, and in turn, move the tongue forwards and away from the back of your throat. This increases the airway dimensions and improves tissue tone, which stops you snoring.
So, when an MAD is too bulky, it squashes your tongue. Which is self-defeating.
Gumshields and tongue space
Technically, this may occur with ‘gumshields’ at the junction between two materials, typically with devices that have a hard-outer shell and a softer thermoplastic liner, or when they are crudely ‘adjusted’ with home equipment i.e. scissors!
Prescription, custom-made MADs
Some primitive custom MADs are bulky and invade tongue space. Materials technology is continually improving, and thinner cross-section devices are now appearing on the market using laser sintered polyamide (a type of nylon).
While traditionally manufactured metal (known as ‘chrome’) devices are available. These may be expensive to make (as they are labour intensive) and may necessitate plastic and metal combined devices, which builds in failure points (because dissimilar materials exhibit different mechanical properties).
Placement of the adjustment mechanism
The placement of adjustment mechanisms in the tongue space is uncomfortable and counter-productive (see concept note above). Some early custom MADs used orthodontic screw mechanisms in the palate or inside the lower jaw.
A sleep-trained dentist will guide you when you choose and to get informed for that conversation download our free, evidence-based How to Choose a Mouthpiece Guide.
Expert’s verdict on tongue space invasion
Anything placed where your tongue can contact it, is a negative. Remember less is more, when it comes to MAD design.
№ 12. Easy to Keep Clean (Extend useful life, hygiene)
Consult your dentist and the MAD manufacturer’s instructions on how to clean your MAD. I would suggest that broadly speaking you should (every time you remove it in the morning) use a toothbrush and toothpaste on the device before/after cleaning your teeth. Floss too if you have the enthusiasm and discipline!
Having worked in this industry for longer than I care to remember, I know that MADs must be:
- Easy to keep clean
- Not absorb cleaning fluid or saliva
- Ideally not have intricate mechanisms to retain food and bacteria
- Be entirely made of one material
Bacterial biofilm (a slimy film of infectious microbes) will form on the device. It’s important to pay extra attention to your oral hygiene (and keep the MAD clean with a toothbrush immediately you remove it in the morning).
Gumshields for snoring
Prescription, Custom MADs
If you are lucky enough to have a marble bathroom, make sure that the MAD cleaning fluid does NOT splash out (they are commonly a type of acid that permanently damages marble). Ideally, clean your MAD elsewhere! (Voice of experience! Customer reported the above to me when I ran Zacher Sleep Appliances).
№ 13. Side-Effects of Anti-Snoring Devices (Mandibular Advancement Devices)
There’s always a down-side!
Or in ‘English’:
“You don’t get nowt for nowt”
The Most Common Side-Effect from Anti-Snoring Devices (MADs)
The Next Most Common Side-Effect is Jaw Ache
Longer term, Changes in the Position of your Teeth may occur
This is why even the most wonderful anti-snoring devices are NOT suitable for children – because they would act like an orthodontic device and move their teeth in uncontrolled ways (exceptionally an orthodontist may prescribe an anti-snoring device for certain children with particular needs).
Expert's Verdict on Side-Effects
A sleep-trained dentist would screen you for sleep apnoea, help you stop snoring and minimise (and if necessary correct) any side-effects. They also carry professional indemnity insurance and use prescription anti-snoring devices made to quality standards by registered dental technicians.
Download our free, NHS England’s Information Standard accredited, evidence-based, expert-written and jargon-decoded Guide
(that’s a mouthful!):
You’ll learn about your options and be able to make more informed choices.
No registration is required.
They’re also available on:
If you’re worried about snoring and/or experience excessive daytime sleepiness consult your Doctor or a sleep trained Dentist.
Finally, if contacting your Doctor about sleepiness is not an option for you consider the ASAP Anonymous Sleep Apnoea Process™.
Note: The best anti-snoring device for YOU, is one that:
- Is only prescribed after you’ve been screened for Obstructive Sleep Apnoea/Apnea (OSA)
- Stops your snoring
- Costs you the least money because it isn’t a false economy
- Creates the least side-effects while it helps you breathe and sleep at the same time
My final verdict is that while a ‘boil-and-bite’ gumshield may prevent snoring for a short while (if you fit the gadget) they are ultimately a false economy and won’t work for long (if at all).
Longer-term, if you were to persevere with a ‘gumshield’ for snoring, it would:
- Create unpleasant and sometimes permanent, unmanaged dental side-effects
- Potentially irreversibly damage your jaw-joints
- And it delays potential OSA diagnosis and effective treatment
In conclusion, clinical research 3 has established that ‘boil-and-bite’ gumshields are not valid as either a trial or treatment device.
But this is not a definitive guide to OTC anti-snoring device manufacturers claims. This is.
What works to stop snoring?
My advice is to get screened for OSA first and then look for scientific studies and clinical data to prove the MAD really works. Consult a sleep-trained dentist.
Here’s the Next Step:
Now, I want to turn it over to you.
Have you or your other half tried a mouthpiece to prevent snoring?
Did it work?
Let me know by leaving a comment (or writing a review) below right now.
Related sleep apnoea dental device posts
Here are some more high quality posts reviewing snoring and sleep apnoea / apnea products, cures and aids:
I HATE instant snoring cures, because they do more harm than good. Learn why I get so agitated, why you should too, and how to ACTUALLY stop snoring.read more
Over-the-Counter (OTC) anti-snoring devices are widely available. But are they any good?read more
Using video, X-ray images & diagrams, I provide an expert technical review of chin straps and their underlying concept. I explain why (with 1 exception) most chin straps are dangerous, because they may collapse your airway. I explain the options to stop snoring, treat obstructive sleep apnoea/apnea (OSA).read more
Anti-Snoring Device – generally considered a product worn in your mouth to stop you snoring.
Boil-and-Bite – a type of gumshield for snoring that may be adapted to you by softening the material in boiling water.
Custom-made – a bespoke device made exclusively for you by a registered dental technician, working to prescription, using CE marked materials. In Europe working to the Medical Devices Directive administered in the UK by the Medicines and Healthcare Products Regulatory Authority (MHRA).
DSM Dental Sleep Medicine – the management of sleep related breathing disorders using dental devices.
Gumshield for snoring – see ‘Boil-and-Bite’ above.
Information Standard – NHS England’s Information Standard. Organisations that join The Information Standard are showing their commitment to producing good quality health and care information.
MAD Mandibular Advancement Device – Jaw advancing device, worn at night while asleep to hold forward the lower jaw to stop snoring and prevent obstructive sleep apnoea / apnea.
MAS Mandibular Advancement Splint – See ‘MAD’.
MRD Mandibular Repositioning Device – See ‘MAD’.
OSA Obstructive Sleep Apnoea – When an individual is unable to sleep and breathe at the same time. Visually, a repetitive pattern of breathing interruptions (apnoeas) occurring while the individual sleeps, due to a physical obstruction in the airway.
OTC – Over-the-Counter product sold over the pharmacy counter without prescription, medical assessment or review of medical history.
Sleep-trained Dentist – A dentist that has undergone special interest training in sleep. As such they are able to obtain professional indemnity insurance.
TMD – Temporo-Mandibular Joint Dysfunction. Jaw-ache or pain, due to abnormal or impaired movement.
- Snoring cures success ‘exaggerated’ http://news.bbc.co.uk/2/hi/health/1701735.stm [accessed 16th Oct 2016]
- Stradling, J. and Dookun, R. 2009, Snoring and the role of the GDP: British Society of Dental Sleep Medicine (BSDSM) pre-treatment screening protocol, British Dental Journal, 206, 307 – 312. Available here: http://www.nature.com/bdj/journal/v206/n6/abs/sj.bdj.2009.214.html [accessed 12 April 2017]
- Vanderveken OM, Devolder A, Marklund M, et al, 2008. Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea. Am J Respir Crit Care Med; 178: 197–202. Available here: http://www.atsjournals.org/doi/abs/10.1164/rccm.200701-114OC#.V9ukcFT_rio [accessed 12 April 2017]
- Ready-Made Versus Custom-Made Mandibular Repositioning Devices in Sleep Apnea: A Randomized Clinical Trial, Johal A, Haria P, Manek S, Joury E, Riha R. Ready-Made Versus Custom-Made Mandibular Repositioning Devices in Sleep Apnea: A Randomized Clinical Trial. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine. 2017;13(2):175-182. doi:10.5664/jcsm.6440. Available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5263072/ [accessed 18th June 2018]
- A crossover randomised controlled trial of oral mandibular advancement devices for obstructive sleep apnoea-hypopnoea (TOMADO). Quinnell TG, Bennett M, Jordan J, Clutterbuck-James AL, Davies MG, Smith IE, Oscroft N, Pittman MA, Cameron M, Chadwick R, Morrell MJ, Glover MJ, Fox-Rushby JA, Sharples LD. Thorax. 2014 Oct; 69(10):938-45. Available here: http://thorax.bmj.com/content/68/Suppl_3/A4.1 [accessed 18th June 2018]
- Pitsis AJ, Darendeliler MA, Gotsopoulos H, et al: Effect of vertical dimension on efficacy of oral appliance therapy in obstructive sleep apnea. Am J Respir Crit Care Med 166:860, 2002. Available here: https://www.ncbi.nlm.nih.gov/pubmed/12231498 [accessed 18th June 2018]
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