What is the best tooth guard for reducing sore throat associated with snoring?

Mandibular Advancement Devices for Snoring-Related Sore Throat

For patients with snoring-related sore throat, a custom-made, titratable mandibular advancement device (MAD) fitted by a qualified dentist is the most effective oral appliance, as these devices reduce snoring intensity and frequency while maintaining proper airway patency. 1

Why Custom MADs Are Superior

Custom, titratable MADs are the most effective oral appliances for snoring treatment compared to over-the-counter options. 1 The thermoplastic material allows for proper fitting and adjustment, which is critical for both efficacy and minimizing side effects that could worsen throat symptoms. 1

• Custom devices reduce snoring episodes from approximately 40 episodes per hour to 20 episodes per hour after one month of use. 2
• The snoring index decreases significantly (p < 0.001) with properly fitted MADs. 3
• These devices work by advancing the mandible forward, which increases upper airway caliber and reduces soft tissue vibration that causes both snoring sounds and throat irritation. 1

Addressing the Sore Throat Component

The sore throat associated with snoring typically results from:

• Vibration trauma to pharyngeal tissues during snoring 1
• Mouth breathing and airway dryness during sleep
• Potential underlying obstructive sleep apnea (OSA) causing repeated airway collapse 1

Before treating with any oral appliance, patients must undergo sleep testing to rule out OSA, as 80% of OSA cases remain undiagnosed and simple snoring can mask more serious sleep-disordered breathing. 1 This is critical because untreated OSA carries significant cardiovascular mortality risk. 1

Proper Implementation Protocol

Initial Evaluation

• Referral to a sleep physician for diagnostic sleep study is mandatory before MAD fitting, even for presumed "simple snoring." 1
• ENT examination should be performed to identify anatomical contributors. 4
• Dental evaluation must confirm adequate dentition and absence of temporomandibular joint (TMJ) disorders. 1

Device Selection and Fitting

• Only custom, titratable MADs should be used - not over-the-counter "boil-and-bite" guards. 1
• The device must be fitted and adjusted by a qualified dentist trained in dental sleep medicine. 1
• Titration occurs through "trial and error" over several weeks to find the optimal mandibular advancement position. 1

Follow-Up Schedule

• Evaluation at 6 months for the first year, then annually thereafter. 1
• Follow-up sleep testing with the device in place should be performed after final adjustments to confirm therapeutic benefit. 1
• Annual reassessment by the sleep physician is required to monitor for OSA development or worsening. 1

Expected Side Effects and Management

Short-Term (First Few Weeks)

Common temporary side effects include: 1

• Hypersalivation or dry mouth
• Dental or gingival discomfort
• TMJ discomfort
• Myofascial pain

Mandibular exercises during the adaptation period improve discomfort and allow treatment continuity; physiotherapy consultation may help. 1

Long-Term Considerations

• Decreases in overbite/overjet may occur with prolonged use. 1
• Proclination of lower incisors and retroclination of upper incisors are possible. 1
• These dental changes are generally acceptable given the cardiovascular and quality-of-life benefits of treating sleep-disordered breathing. 1

Compliance and Efficacy Data

• Approximately 68% of patients achieve cure or substantial improvement in snoring symptoms. 4
• Long-term compliance shows only 50% of patients continue using the device after 3 years. 5
• Most discontinuation occurs due to TMJ issues or appliance intolerance, though these are usually transient. 1, 5
• High initial compliance (84% using device nightly) is typical when properly fitted. 2

Critical Pitfalls to Avoid

1. Never treat presumed "simple snoring" without objective sleep testing - this misses undiagnosed OSA in the majority of cases. 1

2. Do not use over-the-counter devices as definitive treatment - they lack the adjustability and customization needed for efficacy and safety. 1

3. Avoid treating patients with severe OSA with MADs alone - these patients require CPAP as first-line therapy. 1

4. Do not skip the multidisciplinary approach - coordination between sleep physician and qualified dentist is essential for diagnosis confirmation, treatment success monitoring, and complication management. 1

Alternative Considerations

Weight reduction should be pursued as first-line therapy when excess weight contributes to snoring. 6 The European Respiratory Society does not recommend injection snoreplasty due to insufficient evidence. 6 Nasal dilators (strips) should not be used, as they have a Grade D recommendation against their use for snoring reduction. 7