Do you need a night guard for grinding?

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Hi, I’m Dr. B, practicing functional dentist for 35 years. I graduated from the Dugoni School of Dentistry in San Francisco, CA in 1987 and am a member of the American Academy of Dental Sleep Medicine (AADSM), Academy of General Dentistry (Chicago, IL), American Academy for Oral Systemic Health (AAOSH), and Dental Board of California. I'm on a mission to empower people everywhere with the same evidence-based, easy-to-understand dental health advice that my patients get. Learn more about Dr. B

It’s frustrating to spend your nights gnashing your teeth together, only to awaken with a sore jaw, headache, and damaged teeth. It’s even more frustrating to be prescribed a night guard that addresses the symptoms of grinding—but may not provide a solution to stop the grinding for good.

While eight percent of the population reports grinding their teeth, I believe this number is underreported.

As a result, people are continuing to suffer from dental issues and skyrocketing bills.

If you’ve been prescribed a night dental guard in the past, or if you’ve been led to believe that your grinding and clenching were solely caused by stress, this article is for you.

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 for teeth grinding.

I’ll explain this more in the article, as well as why my first reaction to patients who grind their teeth isn’t just to prescribe a night guard. I now want to get to the bottom of the issue and find out exactly how to resolve it for good.

First, though, let’s take a closer look at why grinding is so harmful and what it actually takes to put a stop to it.

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What is teeth grinding and why is it so bad?

Essentially, teeth grinding is exactly what it sounds like: You either clench, gnash, or grind your teeth—often without being completely aware of your actions, particularly at night.

The medical term for teeth grinding is bruxism, and our teeth just aren’t built to withstand this constant force and abrasion.

Here are some of the well-known consequences of grinding your teeth over time:

There are also a number of conditions and other symptoms closely associated with teeth grinding. It’s not clear whether or not all of these conditions are caused by grinding, or the other way around. But it’s possible that you’re at a higher risk for these if you grind your teeth:

  • Restless leg syndrome (5)
  • Chronic kidney disease (6, 7)
  • Depression (8)
  • Sleep-disordered breathing (9)
  • Behavioral problems in children (10, 11, 12)
  • Gastroesophageal reflux disease (GERD) (13)
  • Obstructive sleep apnea (more on this below) (13)

Causes of Grinding

When you experience bruxism, there are usually multiple factors at play. It’s very rarely a condition experienced in a vacuum. In addition, the causes of awake bruxism and sleep bruxism are significantly different.

I get into the very complex causes of bruxism here, but below are the main reasons you may grind your teeth. Keep in mind, some of these (like poor occlusion and stress) are usually very minor causes of grinding and unlikely to be the only factor. (14, 15, 16, 17, 18, 19, 20, 21)

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

This last potential cause is one I want to emphasize.

Sleep Apnea and Grinding (When a Night Guard Isn’t the Solution)

In a massive study of over 13,000 subjects with self-reported bruxism, sleep apnea was the most commonly identified cause. (21) Sleep apnea might be the culprit in up to as many as a third of bruxism cases.

Unfortunately, if bruxing is caused by sleep apnea, a night guard isn’t necessarily the best solution. This is because it doesn’t deal with how your airway is being obstructed.

When someone is experiencing an apnea, during which the airway has relaxed to the point of obstruction during sleep, the response of thrusting the jaw and grinding is sometimes how the body reopens the airway.

For patients with undiagnosed sleep apnea, or patients who are not actively treating it, this may be quite literally a life-saving response.

Research isn’t clear on whether or not bruxing is always the body’s way of opening the airway during apnea, or if grinding is a result of the poor sleep of people with OSA. (22, 21)

The old-fashioned method of treating bruxism was to prescribe a night guard without seeking out why a patient was grinding in the first place. But there are problems with this method—namely that a night guard may fail to treat the root cause of why you grind your teeth.

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

Dentists with training in sleep medicine (especially those practicing functional dentistry) understand that grinding is a comorbidity of sleep apnea. This means that both conditions may occur together in many patients.

A night guard, at best, is a bandaid for grinding caused by sleep apnea that only protects the teeth and jaw joint.

At worst, a night guard could interrupt this necessary response of grinding. (23) Additionally, while a night guard will protect your teeth from grinding, it can’t protect your grinding muscles from overuse and harm.

Sleep apnea is on the far end of the sleep-disordered breathing spectrum, but even patients with milder forms of airway-obstructed sleep can have issues with grinding that are absolutely worth treating.

Treating sleep-disordered breathing can protect your teeth by eliminating your need to grind. And, more importantly, it will allow your brain and body to properly repair themselves with uninterrupted sleep.

I’ve experienced this firsthand. After my wife was diagnosed with obstructive sleep apnea several years ago, I also had a sleep study done. As it turned out, I was struggling with sleep-disordered breathing as well, so I was then treated for sleep apnea.

To my surprise, this treatment resolved my grinding and myofascial pain…after many other therapies had failed.

Today, I’m not shocked when this treatment offers patients a form of relief they thought impossible.

Treating Bruxism Without a Sleep Apnea Night Guard

As a dentist treating bruxism and TMD, and having read a great deal of literature on this topic, I no longer immediately prescribe night guards for my patients who grind their teeth.

By dealing with their sleep issues first, I have been able to solve the issue of grinding while also helping patients with TMD, as well as neck, upper back, and shoulder pain.

I now proceed with treatment only after verifying 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.

The first step in determining sleep ability (and discovering whether sleep apnea is an issue) is to talk to your dentist about your grinding and its potential causes.

If your dentist isn’t screening you for sleep apnea, find one who can through the Academy of Dental Sleep Medicine database.

From there, you can 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—whether it’s mild, moderate, or severe.

Sleep studies can be expensive and inconvenient, and at-home sleep tests are a good way to get an initial idea of your sleep ability. I recommend beginning with an app called SnoreLab.

Sleep Apnea Treatments

If your home sleep test detects snoring or poor sleep ability, you can then follow up with a doctor to discuss treatment or a more specific diagnosis.

With moderate-to-severe sleep apnea, your sleep doctor will probably prescribe more invasive therapies. You may also be a candidate for an oral appliance from your dentist.

I discuss detailed ways that sleep apnea can be treated here, but this list encompasses most sleep apnea treatments. They’re listed from the least to most invasive method of correcting sleep apnea.

Mouth Tape: Although I no longer need invasive sleep apnea treatments, I still tape my mouth shut every night. Mouth taping is both a great way to prevent nighttime mouth breathing, which can cause dry mouth and a host of dental issues, as well as a great diagnostic tool. I’ve seen some patients with mild sleep apnea reverse it just by using mouth tape.

Positional Therapy: For many people, the habit of sleeping on the back contributes to sleep apnea. By switching to side sleeping, you can cut down on your sleep interruptions significantly. (24)

Lifestyle Changes: If you frequently smoke, drink alcohol, or consume coffee, minimizing these habits may help to improve sleep apnea. Weight loss is another (minor) factor in reducing your symptoms but probably won’t make a significant difference without other treatment methods. (25)

Oral Appliance Therapy: Devices like the over-the-counter tongue retention device (TRD) or the custom-made mandibular advancement device (MAD) can improve tongue or jaw posture. In turn, they can minimize sleep apnea symptoms like jaw clenching. (26) These devices aren’t often indicated in severe sleep apnea, although they can be used in combination with other therapies.

Myofunctional Therapy: By retraining your facial and jaw muscles to sit in more optimal positions, you can improve sleep apnea. In fact, this therapy is effective in 50-62% of cases, depending on the age of the patient. (27)

CPAP or APAP Machine: Your doctor may recommend that you sleep with a CPAP or APAP machine at night, which will blow air down your throat so that your airway stays open. If you need a CPAP or APAP, this can do wonders for sleep apnea and the resultant grinding. (28)

Surgery: Certain surgeries may be fairly straightforward in correcting sleep apnea, like the removal tonsils/adenoids or correction of a deviated septum. (25) Others, like UPPP surgery, are very difficult and may do little to resolve symptoms. (29)

Treating Other Causes of Grinding

Following are tips on how to treat some other causes of grinding unrelated to sleep apnea:

Fix your bite: Replacing teeth with implants and getting Invisalign or braces to correct misaligned teeth are just two methods for improving your bite and minimizing the damage from grinding.

Talk to your medical doctor about your prescriptions: If a medication is making you grind your teeth, work with your doctor to try a different medication. S/he may also help you change the dosage until you find a solution that causes the grinding to subside.

Consider relaxation techniques: If you’re grinding your teeth during the day, stress could be a factor. Try stress relief by practicing things such as yoga, mindfulness, breath work, or prayer. (30)

Talk to a therapist about biofeedback or psychotherapy: Again, these solutions aren’t likely to help with sleep bruxism. However, there is some (limited) evidence they may be effective for daytime grinding.

If you have a neurological condition, think about more extreme measures: 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 bruxer crowns may be appropriate. (14)

What’s the best night guard for clenching teeth?

The best bruxism guard is actually not a night guard, but a different oral appliance: a tongue retention device.

A night guard will cover your teeth, but it won’t properly position your jaw/tongue. TRDs do separate your teeth and can be a good temporary, inexpensive measure that may actually help with sleep apnea, if that’s the cause of your grinding.

Good Morning Snore is a TRD available to consumers online that can help you find out if pulling the tongue opens your airway. If tongue posture is at play, which is likely, this device may remove your need to grind.

Plus, like a night guard, it also prevents the teeth from touching—so it will protect your teeth from damage at the same time by acting as a bite guard. It’s a much less expensive option and accomplishes the same night guard benefits, while also correcting tongue posture.

If you choose to go with a night guard instead, I would avoid services that allow you to take impressions at home. Always purchase a custom night guard with your dentist.

A night guard for grinding (sometimes called an occlusal guard or a mouth guard for sleep apnea) is a special kind of night guard and requires very precise experience to create well.

Key Takeaways: Night Guard for Grinding

Night guards used to be the first line of defense for treating teeth grinding or bruxism; however, they 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. 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.

Read Next: Sleep Apnea: The Real Reason You Grind Your Teeth?

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