Nighttime Grinding (Bruxism)

Why I No Longer Prescribe a Night Guard for Grinding

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If you grind your teeth, you likely have sleep apnea. Here's everything you need to know about what to expect from your dentist if you grind your teeth.

by Dr. Burhenne

Why I No Longer Prescribe a Night Guard for Grinding

If you grind your teeth and your dentist has given you a night guard for it, this article is for you.

The old fashioned method of treating bruxism is to cover the teeth with a night guard to protect them from the strong vertical forces caused by grinding, which causes teeth to crack, break, and, over decades, slowly wear the teeth away to stubs.

The problem with this thinking is that a night guard fails to treat the root cause of why we grind our teeth.

The newest research shows that the brain stimulates the grinding response every time you stop breathing at night. The grinding motion pushes the jaw forward, reopening your airway, allowing you to breathe again.

This evidence demonstrates that teeth grinding (bruxism) is a red flag for sleep apnea.

So while your night guard might protect your teeth at night, it’s at the very best a bandaid solution for the symptom of a deeply serious underlying condition.

A night guard will protect your teeth, but it isn’t going to protect your grinding muscles and jaw joint from damage. A night guard could also be interfering with a vital instinctual response that you use every night to prevent yourself from suffocating.

I no longer will make night guards for my patients because of this new paradigm. Typically, standard of care is treating the root cause of a condition, not just the symptoms.

Treating sleep disordered breathing (sleep apnea being on the far right of that spectrum) can protect your teeth by eliminating your need to grind, but more importantly, will allow your brain and body to properly repair themselves with uninterrupted sleep.

What You Should Know Before You Accept a Mouth Guard From Your Dentist

Teeth grinding (bruxism) is the instinctual response the body uses to reopen a collapsed airway by advancing the jaw forward.

So, if you’re grinding your teeth, you should be concerned with two things:

  1. Protecting your teeth from the strong vertical forces of grinding, which can cause them to break, crack, become sensitive, cause you pain, and prematurely yellow and cause your gums to recede.
  2. That you should be tested for sleep apnea, a potentially life-threatening condition.

Have you ever felt like your night guard just makes your grinding worse?

A night guard can making bruxism worse because it can prevent you from being able to push out your lower jaw, thereby preventing the airway from opening and making your sleep apnea even worse, effectively choking you and causing you to need to grind harder and more often.

Grinding as an Indicator for Sleep Apnea

One of my pet peeves is seeing dentists who treat the mouth and the teeth in isolation from the rest of the body.

So, what do teeth have to do with sleep apnea?

Every time you put something into the mouth before you go to sleep, you reposition how the jaw, tongue, and soft palette all interact at the back of the airway, determining the way you are able to breathe and sleep at night.

This means that your dentist is responsible for your airway and, thus, your sleep ability. You deserve and should expect a dentist who considers sleep apnea if you grind your teeth. A dentist who treat just your teeth in isolation from the rest of the body is doing you a great disservice and maybe even harming you.

You certainly can’t die from grinding your teeth, but you can die from the reason you grind your teeth: obstructive sleep apnea (OSA).

Treating Sleep Apnea to Treat Grinding

I can’t treat my patients’ grinding without treating the root cause of their grinding—and that’s treating their airway.

Prescribing a night guard to someone who is grinding their teeth at night is, at best, a bandaid solution and, at worst, could be making it even harder for you to breathe at night.

Not everyone in the dental and medical field is up to speed on this just yet, so be prepared to have to really advocate for yourself or find a dentist and doctor who is up to speed.

What You Should Expect From Your Dentist

So personally, as a practicing dentist and someone who treats bruxism, TMD, and sleep apnea and having read all the latest literature on this topic, I now have decided not to make night guards for my patients the way I used to — I now have to rule out a sleep disturbance first and proceed only after having an sleep specialist MD verify the status of a person’s sleep ability — that is, how well they are able to breathe at night after the muscles in their airway become paralyzed during deep sleep.

  • If your dentist isn’t screening you for sleep apnea, find one who can through the Academy of Dental Sleep Medicine database.
  • Work with your dentist to identify if you grind your teeth.
  • Get a referral from your primary care physician to see a sleep specialist, who can get you a prescription for a sleep study.
  • The sleep study will determine the level of sleep apnea that you have—mild, moderate, or severe. Sleeping with a CPAP machine at night will blow air down your throat so that you’re able to access deep sleep.
  • If you can’t stand the idea of sleeping with a CPAP, you may be a candidate for an oral appliance from your dentist. An oral appliance is like a retainer that you wear at night that keeps your jaw pushed forward, and thus, your airway open even as your muscles become paralyzed in deep sleep. If you have severe sleep apnea, oral appliance therapy is not recommended.
  • If your dentist has recommended a repositioner for you, get a second opinion. A repositioner does what it sounds like—it repositions your jaw. This could be playing with fire when it comes to whether you’re able to breathe at night.

Your dentist must treat the root cause of your grinding. The only way s/he can do that is by:

1. Suggesting that you get a sleep study.

2. Ruling out sleep apnea before making you a night guard

or

3. Properly addressing your sleep apnea with a CPAP and oral appliance therapy. Your teeth grinding will be cured if you treat your sleep apnea because you will have taken away your body’s impulse to grind in the first place.

If you’re grinding your teeth and not happy with your sleep quality, check out my #1 bestselling book The 8-Hour Sleep Paradox, which is all about how to achieve your best night of sleep to become your brightest, healthiest, most capable self.

Mark Burhenne DDS

Sources

Sleep bruxism etiology: the evolution of a changing paradigm

Bruxism & Obstructive Sleep Apnea

read next: The Complete Guide to At-Home Sleep Tests, Plus My Favorite Way to Track Sleep

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