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Do dentists have the best treatment for snoring?

22 Aug 2016

With so many people searching for a remedy, and so many claiming to have the answer, people are often left frustrated and disappointed. I define “best treatment” as one that is scientifically proven to be effective, comfortable and cost effective.

I also want to be clear that I am talking about snoring alone and not sleep apnoea.

When looking at all the available treatments, and the scientific evidence, it has been obvious to me, for some time, that dentists have the best available treatment - custom made oral appliances. 

Yes, as a dentist I might be expected to make that claim. So for some time now I have asked sleep physicians their view on the best treatment for snoring, based on scientific evidence and their experience, and generally they agree. 

So I would like to back this up by looking at the effectiveness of the various methods and treatments for overcome snoring.

Weight loss


If a patient goes to their GP complaining about their snoring they are often told to lose some weight.  While weight loss can be important to reduce sleep apnoea it is mostly insufficient to overcome problematic snoring which is caused by an anatomical obstruction at the back of the throat. Yes it might reduce the volume of the snoring, however it often still remains a problem for those sleeping nearby.

Surgery


A number of years ago surgery was a common treatment with removal of the uvula at the back of the palate. Although different surgical techniques have evolved, and in selected patients the results can be good, overall the results have not been great with many people snoring again within 2 years.

It has been my experience that the majority of people do not want to go down the surgical route in the first instance. According to the SleepHealth Foundation, surgery for snoring and sleep apnoea in adults should only be a last resort… “As a rule, it is only worth it if you can’t wear CPAP or use an Oral Appliance”.

Another draw back of surgery is the potential for significant pain and side effects. We have many patients referred to us by ENT surgeons for treatment of their snoring with an oral appliance. These patients were initially referred to the ENT surgeon by their GP for a surgical solution to their snoring. The ENT will often advise against the surgery, for the reasons mentioned, and refer to a dentist for an oral appliance.

Sprays, Pillows, Nasal Plugs, Boil and Bite Dental Devices etc.


Available on the Internet, or in stores, these devices have been shown to be ineffective for the majority of people. Many of the patients who come to our clinic having tried these remedies, and while they are relatively inexpensive they have been disappointed with the results.

An article in Choice magazine covered an assessment of many of these devices by a group of sleep specialists. They were demonstrated to be ineffective and the conclusion was that if you were going to use one of these devices then “Good night and good luck”.

Provent


Recently introduced to the market, Provent are nasal adhesives that, through a valve like action, open the airway to reduce snoring.  Around 60% of people who try Provent find it effective, with snoring no longer a problem. Comfort can be an issue and they are single use only which can be expensive if used every night.

CPAP (Continuous Positive Airway Pressure machine)
CPAP is a very effective treatment for sleep apnoea and certainly it can overcome snoring, however, it can be obtrusive, difficult to travel with and expensive.  CPAP is regarded as “overkill” for treating snoring alone.

Body Position


For some people, sleeping on the side, or more upright, can reduce their snoring. A simple thing like placing a tennis ball in a pouch on the back of a shirt can help keep people off their back.  There are now more sophisticated electronic devices such as the Night Shift, that can keep people sleeping on their side, and while it may be important in reducing sleep apnoea, it’s often insufficient in overcoming problematic snoring.
 
Custom-Made Oral Appliances


Made by dentists on moulds of the patient’s teeth, adjustable oral appliances have been demonstrated in studies to be over 90% effective in overcoming snoring.
Apart from the potential for some minor initial discomfort most people are using an appliance comfortably a week or two after receiving it. While bite changes can occur over the longer term, these are not usually a problem and should be monitored by the dentist.
Oral appliances can be a cost effective treatment considering they have the potential to last for 6 or more years.

Other Remedies


There are many other “solutions” on the market, too many to mention, however if they are not discussed here then you can be pretty certain there is no evidence for them.

Conclusion


Snoring can be a significant problem and there is no need to put up with it. Be careful of not going down “dead end” pathways in looking for a solution. If you have at least some of your own teeth then you should consider visiting a dentist experienced in providing oral appliances.

If this is not an option then combining treatments might be helpful such as weight loss, and sleeping on your side and avoiding alcohol in the hours before sleep.

 

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