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A night guard, or occlusal splint, is a custom appliance worn over the upper teeth while you sleep, for people who grind or clench at night. It protects the teeth from wearing and cracking against each other, it is designed so that the jaw muscles cannot work as hard, which eases the strain on the muscles and joints, and in many patients it reduces the grinding itself. It does not cure grinding. At Vizcaya Dental Arts we make a Michigan-style splint from a digital scan, in two visits.
How we find out whether you grind
Nighttime grinding, or bruxism, shows up as:
- Jaw muscles that feel tight or tired in the morning
- Teeth that feel sore or sensitive on waking
- Headaches around the temples
- Most reliably, a partner who hears it
Many patients already know they grind. Others realize it when we ask.
We do not diagnose grinding from worn teeth alone. Other things wear or damage teeth too, acid reflux among them, and that needs its own attention, with your physician where appropriate. So the diagnosis rests mainly on what you tell us, together with the examination and the history. A history of not tolerating a previous guard is worth knowing too. Sometimes the guard was poorly made, and sometimes the patient did not need one.
The Michigan splint
Designs vary and every dentist has a favorite. Ours is the Michigan splint, a hard, flat upper guard with two properties. When you close, every tooth meets it evenly, so the bite is stable and no single tooth takes the load. When you grind sideways or forward, only the front teeth touch the guard and the back teeth separate. The jaw muscles cannot generate nearly as much force on the front teeth as on the back ones, so grinding on a Michigan splint is weaker grinding. Patients tolerate the design well.
How a night guard is made
- Step 1 of 4 Scans
Digital scans of both arches and a digital record of your bite. No impression material.
- Step 2 of 4 Design
The guard is designed on a computer to give even contacts when you close and front-tooth-only contact when you grind, then printed in a dental resin. Older guards were made of acrylic or vacuum-formed sheets; printing gives a more precise, consistent fit.
- Step 3 of 4 Fitting
At the second visit the guard is tried in, the bite is checked and adjusted so it is even, and the guard is polished. It should fit with a light snap and feel passive on the teeth, not tight.
- Step 4 of 4 Follow-up
Bring it to your cleaning visits. We check the fit, clean it in the ultrasonic bath and adjust or repolish it as needed.
Living with a night guard
- Wear it every night.
- In the morning, brush it with liquid hand soap and a toothbrush to remove plaque, rinse it, and let it dry during the day so it is ready for the next night.
- Expect it to last at least five years and often closer to ten, with the occasional adjustment. Wear on the guard is wear that would otherwise have been on your teeth.
- If you have dental work done later, the guard may need attention. Nearly all of ours fit the upper teeth, so work on the lower teeth rarely matters, while new crowns or fillings on the upper teeth may mean an adjustment or, with enough change, a new guard.
The first weeks
A new guard feels large for a few nights. You may produce more saliva and your speech may sound odd if you talk with it in; both pass within days as the mouth adapts, and most patients stop noticing the guard within a week or two. If a spot rubs, or the bite on the guard feels uneven, come in. A small adjustment fixes it, and a guard that is uncomfortable will not get worn. The muscle relief tends to arrive gradually. Morning tightness and tenderness usually ease over a few weeks of consistent wear, and a partner usually notices quieter nights sooner than that.
Daytime clenching
A night guard addresses what happens while you sleep. Many people also clench during the day, at a desk, in traffic, in the gym, usually without noticing. A guard does not help with that. Awareness does: check several times a day whether your teeth are touching. At rest they should be slightly apart, lips together, tongue relaxed.
Store-bought guards
Anything you put between your teeth will take some of the grinding. The trouble with store-bought guards is that they do not support the bite evenly, and we have seen patients whose teeth shifted significantly after wearing one for a long time. A boil-and-bite guard is acceptable for a few weeks while your custom guard is being made. It is not a long-term solution.
Guards and retainers
If you wear retainers after orthodontic treatment, a night guard needs some planning. An upper guard takes the place of an upper retainer and has to bite against your actual lower teeth, not a lower retainer. The usual answer is a thin fixed wire bonded behind the lower front teeth to keep them from shifting. The alternative, for light grinders only, is a pair of thicker retainer-style shells for both arches, made in a heavier material than a standard retainer; they are comfortable, but a heavy grinder cracks them. Dr. Hong and Dr. Kottar coordinate this between them.
When a night guard is not the answer
Sleep apnea. A night guard is not a treatment for sleep apnea, and it should not be made for someone whose breathing during sleep has not been assessed. If a physician has ruled out apnea, a guard is fine. If there is any suspicion of it, see a sleep physician first. Snoring without apnea is addressed with a different appliance, on our snoring appliances page.
Grinding through the guard. A few patients grind heavily on even a perfectly adjusted guard. For them, muscle-relaxing injections into the jaw muscles can be a useful addition alongside the guard. We discuss that option when it applies.
Joint problems. Some grinders also develop problems in the jaw joint itself. That needs a proper evaluation by a specialist in jaw joint disorders, usually with MRI imaging, at a university clinic or with an oral surgeon or facial pain specialist. A night guard is not a joint treatment, and we refer.
Frequently asked questions
Will a night guard stop me grinding?
It will not cure grinding, and nothing reliably does. What it does is take the damage out of it: the guard wears instead of your teeth, and the design reduces how hard the jaw muscles can work during the night, which most patients feel as less tightness in the morning.
Upper or lower?
Nearly all of ours fit the upper teeth. An upper guard means later dental work on the lower teeth rarely affects it, while changes to the upper teeth may need the guard adjusted or remade.
How long does a night guard last?
In our experience at least five years and often closer to ten, with occasional adjustment and polishing. Heavy grinders wear through sooner; that is the guard doing its job.
Can I wear it with my retainers?
An upper guard replaces an upper retainer, and it has to bite against your lower teeth, not a lower retainer. Many patients in that situation have a thin fixed wire bonded behind the lower front teeth to hold them. For light grinders, thicker retainer-style shells for both arches are another option; for heavy grinding they crack.
Is a store-bought guard good enough?
As a stopgap while a custom guard is being made, yes. For long-term use, no. They do not support the bite evenly, and we have seen teeth shift noticeably in patients who wore them for a long time.
What if I cannot tolerate a guard?
Tell us; it is worth asking why. Some patients who could not tolerate a previous guard turn out not to grind at all. Others need the fit adjusted, a different design, or, when grinding persists despite a well-fitted guard, an additional treatment such as muscle-relaxing injections alongside the guard.
Sources
Professional guidelines and peer-reviewed reviews this page draws on.
- Macedo CR, Silva AB, Machado MA, Saconato H, Prado GF. Occlusal splints for treating sleep bruxism (tooth grinding). Cochrane Database of Systematic Reviews. 2007;(4):CD005514. Cochrane
