I followed instructions for fit by placing in boiling water for 20 seconds then biting down to size it. It should have came with a lanyard for convience and the inserts where you bite fall out creating a possible choking hazzard. I sometimes take out the inserts and my teeth fit into crevices and the device stays in place better. I have no bad side effects as some described tooth pain but I do not have that issue. I like using it and hope to see a difference in my jaw line and just overall muscle tone within a 30 day period I expect.