Do you need a night guard for grinding?

Teeth grinding (bruxism) is a serious condition that affects 8-16% of adults and 14-20% of children.

If you grind your teeth during sleep, your dentist may prescribe a night guard to protect you from jaw pain, broken teeth, tooth sensitivity, and frequent tooth decay.

A dental night guard for sleep is not the same thing as a mouthguard for protecting your teeth during sports. These specialty oral appliances for sleep, grinding, and clenching are custom fitted to protect your teeth from damage if you grind during sleep.

But a night guard for grinding is often not the final solution to address the symptoms of grinding. 

Emerging science actually tells us that grinding teeth isn’t just a stress-related issue (though it can be). There are many other risk factors and potential causes of teeth grinding, including sleep apnea.

Let’s discuss all you need to know about night guards — from why they are prescribed to how to choose one — as well as how to get to the root cause of your teeth grinding.

What is a night guard?

A night guard, also called an occlusal guard, is a custom-fitted mouth guard for grinding teeth that you wear during sleep. Sometimes, these mouth guards are prescribed for TMJ (which can be exacerbated by teeth clenching).

You can get a custom night guard through your dentist or purchase an over-the-counter brand at any drugstore or on Amazon. Buyer beware: Not all night guards are created equally.

These dental devices are thinner and less intrusive than other sleep apnea dental devices, like a mandibular advancement device.

The best custom night guard is one with a custom fit manufactured with your dentist. Whether you buy one at your dentist’s office or at Target, make sure it’s designed so that all teeth are in contact with the guard.

Get Dr. B’s Dental Health Tips

Free weekly dental health advice in your inbox, plus 10 Insider Secrets to Dental Care as a free download when you sign up

Yes, I want this support

Teeth Grinding (Bruxism): Causes & Dangers

Bruxism, or teeth grinding/clenching, is a sleep-related movement disorder in which your upper and lower jaw clench together.

Often, grinders clench their teeth without being aware of their actions, particularly at night. 

Teeth aren’t built to withstand the constant force and abrasion of bruxing (grinding). In most cases, grinding teeth exerts 250 pounds of force per square inch of tooth surface.

What causes teeth grinding?

Usually, bruxism is a “multifactorial” condition, meaning it can be caused by a combination of many different factors. Common causes of teeth grinding/bruxism include:

• Disordered sleep breathing (sleep apnea)
• ADHD in children and teens
• Depression and/or anxiety
• High levels of stress/poor stress response
• Poor occlusion/bite (when your upper and lower teeth don’t meet the way they should)
• Chronic or acute trauma to the mouth and/or jaw
• Genetic predisposition
• Neurotransmitter disruptions
• Neurodegenerative disorders like Huntington’s or Parkinson’s diseases
• Use of antidepressants, amphetamines, anti-anxiety drugs, or antipsychotics
• Nicotine use
• Frequent alcohol use
• Excessive coffee intake

Dangers of Teeth Grinding

Some of the well-known dangers of teeth grinding over time include:

• Tooth pain
• Cavities/tooth decay
• Facial pain
• Fractured teeth
• Teeth yellowing
• Gum recession
• Temporomandibular joint disorder (TMD)
• Migraine headaches 

Because grinding ages your teeth prematurely, it will greatly disrupt your oral health if left untreated.

Many conditions and other symptoms are closely associated with teeth grinding. It’s not clear whether these are risk factors for or complications of grinding. 

You are at a higher risk for the following if you grind your teeth:

• Restless leg syndrome 
• Depression
• Sleep-disordered breathing
• Behavioral problems in children (like ADHD)
• Gastroesophageal reflux disease (GERD) 
• Obstructive sleep apnea

Why a Night Guard is Prescribed for Teeth Grinding (Bruxism)

Night guards are prescribed for teeth grinding because your teeth would otherwise wear down and age prematurely. Guards offer protection for your tooth enamel.

This is most important for your back teeth (molars) because they’re most susceptible to wearing (attrition).

If you have TMJ from bruxism, a night guard may help to relieve soreness in your jaw muscles.

Types of Night Guards

There are 5 types of night guards to choose from. 

Dentists recommend using an over-the-counter night guard for 2 weeks, not long-term.

Night guard types include:

• Stock mouth guard (over-the-counter)
• Boil-and-bite night guard (over-the-counter)
• Soft night guard (professional fit)
• Dual laminate night guard (professional fit)
• Hard acrylic night guard (professional fit)

1. Stock Mouth Guards (Over-the-Counter)

Stock mouth protectors are the only kind of night guard with no custom fit option. 

Pros:

• Inexpensive

Cons:

• One-size-fits-all
• Bulky
• Ineffective (not recommended by dentists)
• Likely contains BPA
• Not durable
• Short-term use only
• No warranty

2. Boil-and-Bite Night Guards (Over-the-Counter)

Over-the-counter night guards may come with an impression kit that allows you to boil the mouth guard and mold it to your bite. 

These moldable dental guards are made with a flexible thermoplastic material.

Pros:

• Custom fit
• Inexpensive
• Can trim excess material

Cons: 

• Not as perfect a fit as a professionally manufactured guard
• Likely contains BPA
• Not durable
• Short-term use only
• No warranty

3. Soft Night Guard (Professional Fit)

Soft night guards are the most common night guard prescribed by dentists for mild bruxism. They are typically flexible and thin.

Your dentist will take physical or digital impressions of your teeth and send them to a lab, where your night guard can be manufactured.

Pros:

• Most comfortable fit of all night guards
• BPA-free
• Easiest to adapt to and sleep with
• Lower cost than other professional guards
• More durable than over-the-counter options

Cons:

• Least durable of all professional night guards
• Not adjustable after initial impressions
• More expensive than over-the-counter guards
• Usually lasts only 6 months maximum (not long-term)
• Warranties offered for 6 months or less

4. Dual Laminate Night Guard (Professional Fit)

Also called a bilaminar night guard, dual laminate night guards are used for severe bruxism. Some literature considers these “splints” rather than true night guards. 

They are made from ethylene-vinyl acetate and polycarbonate with a soft inside and hard outer layer.

Pros:

• Most effective for severe teeth grinding
• BPA-free
• Very durable
• Comfortable fit
• Acrylic can be added to make fit adjustments
• Last 9 months to 5 years, depending on the severity of grinding
• Longer-term warranties than a soft night guard

Cons:

• One of the most expensive night guard types
• May break down quickly in severe bruxism

5. Hard Acrylic Night Guard

Made from cured acrylic in variety of colors, hard night guards are used for extremely severe cases of bruxism. They may be better for TMJ than other options.

Hard acrylic night guards are used to realign the jaw.

Pros:

• Most durable night guard
• Prevents shifting of teeth
• Longest warranty of all professional guards
• Can be adjusted to make fit adjustments

Cons:

• Very expensive
• Thicker than other options
• Most complaints about fit and comfort
• Can cause damage to soft tissues in the mouth if improperly fit

How to Fit Your Night Guard

If you buy a boil-and-bite night guard, you’ll use an impression kit to create a good custom fit.

To fit your boil-and-bite night guard:

1. Fill a pan with 3-4 inches of water. 
2. Heat to a rolling boil.
3. Remove the water from heat.
4. After 30 seconds, place the night guard in the hot water for 1 minute (no longer).
5. Gently take the night guard out of the water.
6. Lick your lips.
7. Using a mirror, bring the night guard to your upper teeth and line up the front center with your front teeth.
8. Gently mold the guard around your upper teeth using your fingers and tongue.
9. Line up the bottom of your night guard with your bottom teeth and mold it around your lower teeth arch.
10. Bite down hard and suck in for 20-30 seconds.
11. Use your fingers to push all edges in and create a comfortable fit around each tooth.
12. Place the mouthguard in cool water for 30-60 seconds.
13. Put the guard back in your mouth and make sure the fit is good. You can re-boil it if necessary.

Stock mouth guards/night guards cannot be custom fit.

For all professional fit night guards, your dentist will create an impression and order your guard to be manufactured according to those specifications.

Best Night Guards for Grinding 

The best night guard for grinding is a dual laminate night guard custom fitted by your dentist. If your grinding is mild, a soft night guard may be a less expensive option to try.

These high-quality boil-and-bites are the best night guards for grinding in the short-term:

• Oral-B® Nighttime Dental Guard
• Dental Duty Professional Dental Guards 

For maximum benefit, make sure you only use a night guard that touches all tooth surfaces (not partial arches). Partial coverage night guards may ruin your teeth by causing problems with your bite.

How to Adjust to Sleeping with a Night Guard

It can be difficult to get used to sleeping with a night guard. Often, the bulk of a new dental device or an awkward fit are to blame.

To adjust to sleeping with a night guard:

1. For the first few days, try wearing your night guard during the day to get used to the feel.
2. Talk to your dentist about a thinner material, if possible.
3. If your night guard makes you sore or feels sharp, discuss a fit adjustment with your dentist.
4. Try wearing only the upper or lower portion of the night guard at first.
5. Don’t give up for 30 days.

If you’re still having trouble after a month, you may need to pursue other alternatives to a night guard.

Unfortunately, a poorly fitted night guard can make sleep worse by being too thick. A thick night guard can open up the vertical dimension of your mouth and close your airway

Individuals with sleep apnea may struggle more than average to sleep with a night guard because their airway is already obstructed. In these cases, the night guard is only a Band-Aid for the primary problem, which must be corrected for optimal sleep.

If you have sleep apnea and just started using a night guard, try mouth taping. This can help reduce mouth breathing and the consequences of a dry mouth.

How to Take Care of Your Night Guard

Similar to most dental devices, the best way to take care of your night guard is to keep it moist when not in use and prevent the buildup of bacteria.

To take care of your night guard:

1. Each morning, rinse your night guard with warm water (no soap) for 20 seconds.
2. Soak the night guard in ¾ cups of water and 1 teaspoon of baking soda while not in use. (For best results, use a stainless steel container.)
3. Once a week, combine water, baking soda, and white vinegar and soak your night guard for 15-20 minutes to eliminate excess bacteria. 
4. Do not brush your night guard. A toothbrush can create micro-abrasions that can house bacteria.
5. Use an ultrasonic cleaner to further protect your night guard from damage and bacteria.
6. Thoroughly wash the case with dish soap or in the dishwasher at least once a week.

Avoid effervescent cleaners like Polident or Efferdent. These ADA-approved cleansers may cause allergic reactions in some people.

Sleep Apnea and Bruxism

Obstructive sleep apnea (OSA) is the most commonly identified cause of bruxism. This severe form of sleep-disordered breathing may be responsible for up to a third of all teeth grinding.

When your breathing stops due to sleep apnea, your brain may wake you up by clenching your teeth together so you start breathing again. 

Grinding may also be a result of the poor sleep of people with OSA.

If sleep apnea is to blame for your teeth grinding, a night guard may not be the right treatment.

At worst, a night guard could interrupt the necessary response of grinding. Grinding is what your brain uses to open the airway during an apnea, and a night guard can interfere with that.

Additionally, while a night guard will protect your teeth from grinding, it can’t protect your grinding muscles from overuse and harm. 

If you have sleep apnea or another form of sleep-disordered breathing, it’s important to work with your healthcare team to address that as the root cause of your issues. 

Snoring is a telltale sign of sleep apnea or a similar condition. It may be more common in women than previously thought, so don’t assume if you’re female, young, or fit, that you’re immune.

You may want to try a sleep app for an overall look at your sleep quality. If you score very low on a consistent basis, it’s important to talk to your doctor immediately and potentially request an in-office or home sleep study.

Treating sleep-disordered breathing can protect your teeth by eliminating your need to grind. In addition, it will improve your overall oral health.

It will allow your brain and body to properly repair themselves with uninterrupted sleep. 

Alternative Treatments for Teeth Clenching/Grinding

Depending on the cause of your teeth grinding and when it happens (during sleep or while awake), there are several alternative treatments to address it.

Treatments for bruxism include:

• Oral appliance therapy: Using other dental devices like an oral splint, mandibular advancement device (MAD), or tongue retention device (TRD), you may be able to reposition the jaw and reduce grinding. Good Morning Snore is a high-quality TRD available without a prescription. Oral appliances may or may not be used in conjunction with sleep apnea treatments.
• Sleep apnea treatment: One out of three (or more) cases of teeth grinding is caused by sleep apnea. To address sleep apnea, your healthcare provider(s) may recommend treatments including:
  • A CPAP or APAP machine
  • Positional therapy
  • Lifestyle changes, such as weight loss, quitting smoking, cutting alcohol intake, or giving up coffee
  • Mouth taping
  • Myofunctional therapy
  • Surgery (in severe cases), including removal of tonsils/adenoids, correction of a deviated septum, or UPPP surgery
• Fix your bite: You can improve your bite by replacing damaged teeth with implants or getting Invisalign or braces to correct misaligned teeth. This may minimize the damage of teeth grinding.
• Adjust medications: Many medications cause teeth grinding as a side effect. Talk to your doctor about how prescription medications you take may be adjusted to improve teeth grinding symptoms.
• Relaxation techniques: If you’re grinding your teeth during the day, stress could be a factor. Try stress relief by practicing yoga, mindfulness, breathwork, or prayer.
• Biofeedback or psychotherapy: These solutions aren’t likely to help with sleep bruxism. However, there is some (limited) evidence they may be effective for daytime grinding.
• BruxZir crowns or muscle relaxant drugs: Patients with Huntington’s and Parkinson’s disease are unable to control bruxing as their diseases progress. In these cases, muscle relaxant drugs like botox or more drastic measures such as using BruxZir crowns may be appropriate.

Key Takeaways: Night Guard for Grinding

Night guards used to be the first line of defense for treating teeth grinding or bruxism. However, they often fail to treat the underlying causes of teeth grinding.

Today, your dentist should rule out sleep apnea and other causes of grinding before prescribing a night guard. Ideally, you should use a night guard temporarily while fixing the actual cause of your bruxism.

By treating the root cause of your grinding, you’re accomplishing much more than the quick fix of protecting your teeth from wear and tear.

Bruxism is a complex disorder. If you have sleep apnea or if you grind your teeth for other reasons, give yourself time to get used to new treatments and give them a chance before giving up.