Do you need a night guard for grinding?

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night guard

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?

30 References

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  27. Epstein, L. J., Kristo, D., Strollo, P. J., Friedman, N., Malhotra, A., Patil, S. P., … & Weinstein, M. D. (2009). Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of clinical sleep medicine, 5(03), 263-276. Full text:
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  30. Valiente López, M., Van Selms, M. K. A., Van Der Zaag, J., Hamburger, H. L., & Lobbezoo, F. (2015). Do sleep hygiene measures and progressive muscle relaxation influence sleep bruxism? Report of a randomised controlled trial. Journal of oral rehabilitation, 42(4), 259-265. Abstract:

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Leave a Comment

  1. Can i get exact solution for night grinding other than night guard? Do coronoplasty can be done if that habit is due to occlusal disturbances?

  2. teeth grinding (bruxism) is a red flag for sleep apnea.

    I cant find any relation or any paper or study to stand with this cause.

    Dr.Ahmad Shouhdy

      • Anna Brown says:

        Im not a medical professional or anything but I do feel this makes sense.
        I recently went to the dentist and he wanted to give me a night guard because he said I showed signs of developing cracks in my teeth and receding gums.
        I dont have the money for it right now and I wasnt convinced that it would help as I have trouble breathing.
        However I have trouble with my breathing when I sleep. When I was younger my nose was damaged and it did not heal properly which has left me with extremely bad sinuses which can leave me waking up gasping for air and a very dry throat. I am barely able to breathe through my nose which I now feel causes me to grind my teeth.

        I will mention this to my dentist and see what he says.
        Thanks for an interesting article!

      • Patricia Thornton says:

        Hello, I have become grinding my teeth for a long time. I am now 52 years old, I am 5’1 @ 103 lbs. I don8t snore at night and no sign of breathing issue.

    • chris kelly says:

      Dr Ahmed,
      You are correct.
      grinding is not in its self an indication of SDB or OSA.
      The only way to really treat bruxism is to correctly quantify the TYPE.
      Sleep Disordered Breathing can be the bedfellow of bruxism.
      Trying to treat one without an introduction to the other is like fighting Tyson one armed.
      Bruxoff diagnoses the bruxism
      …look up
      Any type three or four (or 1 or 2) level test will zero in on AHI for SDB.
      Weinmann Somnocheck micro cardio type four will do a health check.
      Look up Weinmann Somnocheck on you tube.
      I use these tools with a bunch of other tools to bring a new level of assessment to the issue.
      Lastly a splint issued without a correct investigation into sleep architecture is a grab for cash.
      Hands down truth.

      • Tillie Isler says:

        My mom doesn’t have sleep apnea she has dementia she’s in that stage of grinding her reeth

      • Jay Hobbs says:

        Chris, I am VERY intrigued by objective testing for bruxism. With a brief literature search, I am a bit dismayed. Perhaps you can help clarify the issue. Although the BruxOff EMG device recordings are well-correlated with polysomnogragh(PSG) recordings(, the BruxOff recordings indicating high jaw muscle activity do not correlate AT ALL with clinical diagnosis of burxism( transient jaw muscle pain in the morning, muscle fatigue at awakening,
        presence of tooth wear or shiny spots on restorations ):

        Based on that, I don’t see how to use this device in clinical practice for bruxism, but then maybe that wasn’t your point.

    • My husband did a lot of damage to his teeth over the years by grinding his jaw at night. When he was finally diagnosed with sleep apnea and started on cpap, he stopped grinding his teeth altogether. It was the same for me, as well. I know that’s anecdotal but it was a very pronounced and permanant change. The one problem I still have, though, is that my jaw still can’t relax at night. The air pressure of a cpap holds your airway open but it’s not something you can relax against. So my jaw is always very tired. If I relax it all the way, my airway closes.

  3. i don’t have sleep apnea via sleep study. I grind so much and have for many years that my 2 nd molars have 2+ mobility. I do snore. I am currently in a sleep appliance for snoring which has reduce some volume but am completely frustrated as I can’t grind freely. The fluid build up in the a.m. Can be painful too. I do believe the hard acrylic occlusal guards are best as the mandible is free to move around as needed.

    • can you explain that everytime a patient or an individual has bruxism,he will be having sleep apnea??
      Is always bruxism is related to sleep apnea??
      I have seen individuals who have bruxism but don’t have sleep apnea or related sleep issues..
      So how do you treat such patients with bruxism??
      Will always a individual with bruxism has to undergo screening for sleep apnea??

      • I am surprised that occlusion was not mentioned once in this article, which is how the teeth fit together. When the teeth fit together in perfect occlusion then wear on the teeth will be less likely to occur, and the jaw will then be very relaxed, resolving issues with the jaw or “TMJ.” The process to fix occlusion is called equilibration and very similar to when you bite on a bite ribbon after getting a filling placed to grind down any unnecessary bulk, equilibration takes off any areas that interfere with occlusion. At night when the bite guard is placed the teeth should still “fit” in perfect occlusion… To complete perfect equilibration a 3D model of the teeth should be poured from impressions and a dentist should determine when OUTside of your mouth what needs to be fixed INSIDE of the mouth to properly correct the occlusion. When perfect occlusion is achieved, and a perfect fitting bite guard is made, then the jaw is relaxed at night. There are no “hills” in the way that hit before other areas of the bite, so the jaw is not constantly trying to compensate…I am going to look more into the apnea topic, but I am a true believer of occlusion being a major problem of grinding…I believe if perfect occlusion is achieved, the jaw will be relaxed, therefore no grinding.

        • Haley, you’re absolutely right—proper occlusion is imperative—unfortunately, dentistry has not been able to define what proper occlusion is. I do occlusal equilibration in my practice and there is a place for it, but the point is this: you can have perfect occlusion and a perfectly made bite guard, but if your airway collapses at night, your body will automatically go into an instinctual state of grinding and clenching to help open the airway and save itself.

          • Thanks for replying!! I was excited to stumble along this new idea I had never heard of the correlation before. I am in the process of getting my teeth equilibrated, and if the grinding/clenching/tenseness at night does not resolve I will be looking into apnea..It was actually something my doctor brought up a while back being that I am very tired during the day. Maybe graduating hygiene school in May will resolve the tenseness!!

          • I’ve broken 3 teeth in my sleep. I now have a cpap which wakes me up about 8x a night. I’m unable to get a properly fitted mask. The straps cause pain but loosened they cause leak. A dentist gave me a mouth guard since I still snore and grind. At 1st I couldn’t shut my mouth with it but now I bite it so hard my face hurts all day. My entire bite shifted. My tmj is worse.

          • I have had an expert dentist for 50 years. My bit is perfect. But I ground my teeth, not from sleep apnea, but unconscious childhood trauma I was going over at night in night mares. I also have chronic rhinitis.

            After 8 years of psychotherapy with an experienced clinical psychologist, my nightmares were felt, integrated and stopped. I still have the rhinitis and a nasal steroid helps me sleep deeply. I sometimes still end up sleeping with my mouth open in hay fever season. Finding a healed clinical psychologist who integrated their own childhood trauma was the difficult part, I was lucky.

        • I just read these comments discussing occlusion. I have perfect occlusion and still suffer from moderate to severe bruxism and TMJ. Along with perfect occlusion I also have a small overbite, so when I wear my night guard every night it falsely and temporarily fixes the issue as it is not how my teeth/jaw naturally fit together, making TMJ still an issue for me nearly a year later. Do you have any advice about this on how to discuss this with my dentist? I’ve brought it up to her in the past before but she seemed dumbfounded that I could have natural perfect occlusion (never any braces/retainers) and still be having issues, sometimes even more so, with both bruxism and TMJ.

          • Occlusion is typically classified using “Angle’s classification of occlusion” and though you may have a “class I” “Normal” bite, there could still be other issues going on. I have class I occlusion too, but I grind/clench at night and after making 3d Models of my teeth with a dentist who specializes in equilibration I could see the numerous problems that truly exist. I was told that once we fix these areas that my joint will relax… But I have not completed treatment yet so I cannot properly say whether or not it truly worked for me. Evaluation, Diagnosis, And Treatment of Occlusal Problems by Dr. Peter Dawson is a book that my dentist bases his approach off of. I would find someone who specializes in occlusion and is familiar with Dr. Peter Dawson’s approach if it is a topic you are truly interested in finding more information about.

          • From what I’ve read, I think you’re saying that your bite in the morning is off a little bit after wearing your night guard, which is common in people that have a CR/CO discrepancy. I would ask your dentist if you have a CR/CO discrepancy. Let me know what happens.

        • Unfortunately I went through multiple teeth grindings to fix occlusion before I saw a sleep apnea dentist. At the time I was knocking my bottom front teeth out. I no longer am damaging my front teeth, but I now also have unnecessary wear on my teeth and they don’t fit as well as they used to.

          One of the things I learned post procedure is that the jaw fits and moves on many plains, not just one. It is extremely difficult to fix occlusion and not cause new ones. it’s important to balance the significant wear and tear having this procedure puts on the teeth with whether or not it will actually provide benefit.

          Personally, given my sleep apnea is fully treated and I’m still grinding (stress and habbit – do it daytime too), I’m trying to find a good option for bite guards.

          • While it’s certainly possible to wear a nightguard while wearing a CPAP (and it’s not a bad idea to do so) I wonder why the grinding is continuing if in fact your AHI is at zero. When you say your sleep apnea is fully treated, how have you verified this? Was it with a sleep study that verified your AHI is at zero? Just the CPAP itself telling you your AHI is at zero is not reliable information.

        • Iagree with you as I am having treatment to correct my bite from a serious accident as after initial surgery and movement of my teeth during and after accident I started chewing my teeth during the day and was diagnosed with bruxism at night. But I also sustained damage to my neck which makes it difficult to swallow. Wandering if there is a correlation with both.

    • Bruxism may very well be the problem, but I don’t believe it is the root problem. The root problem is likely parasites that are causing the bruxism.

  4. Anonymous says:

    My five year old does not snore but has ground down teeth. Thoughts?

    • You don’t have to snore to have some type of sleep-disordered breathing. Grinding, in general, is a good indication of a small airway. In fact, if you don’t snore, that means the airway is so closed that you cannot bring air through and make that noise. When you’re snoring, you know that at least some air is going through, since that’s what’s responsible for the sound of snoring. So grinding without snoring could mean that your five year old is further down the spectrum of sleep breathing issues. Having your child see an ENT and making sure your five year old is getting good sleep will be a tremendous gift you can give your child.

      • Dr. Ron Hsu says:

        Night time grinding and clenching for toddlers and children is actually quite common. Study has been done to try to find the cause of such grinding but result was inconclusive (too many possible causes). What was found is that children who have grinding issues typically stops on their own as they get older, and that in most cases there is no pain or discomfort associated with it, even though the teeth can look totally worn down. Since they are growing and teeth are changing and shifting, there is no point in making a night guard for them, and while it may be of use to visit an ENT or do a sleep study, in most cases there would be no significant finding. As a parent you can also watch your child sleep and see if there is any disruption in his/her breathing pattern.

  5. I use a bipap for sleep apnea, the pressure is almost at max for my Rx. I can’t tolerate a full face mask so I use the complete nose mask. I relax my jaw when I sleep and air rushes out and wakes me. I must wear a night guard for wear prevention on my teeth and to help seal my mouth from air blowout. Do they make a specific night guard for that, my dentist and pulmonary Dr. Are unaware of one. Thank you Larry

  6. Jake Adams says:

    This is a really great post. When I was really overweight, I would grind my teeth terribly, especially at night. I had no idea that it was actually for a good, more sub-conscious reason. My health is in a much better place now, but I still have problems with falling asleep and staying asleep. I started to discover that a lot of my friends were struggling with the same issues. Some of us (including myself) tried melatonin pills and other natural sleep supplements with only little success and a lot of reluctance to take anything orally. I would wake up feeling groggy and slow sometimes or the same as before. One of my friends found the best sleep spray on the market and I’d have to say that it works quite well! It only has 3 natural ingredients and I’m getting more sleep and falling asleep quickly. It’s been great!

    • Thanks for sharing your experience, Jake. What’s the sleep spray you’re using? I’d be interested in checking it out. Also, if you’re still waking up groggy in the morning, I’d recommend you talk to your doctor about a sleep study. It’s important to know your sleep ability!

    • Hello,

      I just happened to come across your article when investigating sleep guards for my adult daughter. Ever since I can remember, she has clinched and ground her teeth at night. She had jaw surgery two years ago to correct her jaw/bite. Her issue was that her top and bottom teeth set on top of each other. She was upset that she was not a candidate for veneers for the ever present worry of worn down teeth. She had braces which made her top teeth lay slightly over her bottom but felt like her teeth were being shoved into the correct position. She then opted for jaw surgery. Her top jaw was slightly moved forward and we were told that her bite was just about perfect. It is now two years later and her grinding and clinching at night has not improved, in fact, it may even be worse. A couple of months ago, she received a “heavy duty” night guard from her oral surgeon. She has had it adjusted by her dentist twice and then two days ago, by her surgeon to try to get a comfortable fit. Her surgeon and others say that her bruxism is from stress. She has just completed grad school and was very stressed and since, has started a demanding career, but her nighttime issues were a problem, long before this challenging period in her life. Would you suggest her being testing for sleep apnea? Does insurance pay for this?

    • Anonymous says:

      What is the brand and name of the sleep spray you are using?

  7. I clench while I sleep and have jaw joints that don’t work in tandem. With a night guard, I frequently wake up in the morning with lock jaw. A sleep study indicates that I do not have sleep apnea. My orthodontist has put me in a repositioner night guard at night that pulls out my lower jaw, but my joint pain is so bad that I can’t eat or chew anything for several hours after removing the device in the morning. It has also changed my bite which is decidedly off and uncomfortable causing frequent headaches. I have decided to stop wearing it as the cure is worse than the problem. Is there anything else to try that will protect my teeth and not cause lockjaw at night? I am at my wits end.

    • I’m sorry to hear you’re in pain. Regarding your sleep study — you might not have sleep apnea, but sleep apnea is a tiny extreme on the far right of the sleep breathing disorders spectrum. Ask your doctor if you might have UARS (Upper Airway Resistance Syndrome) which isn’t sleep apnea but does involve breathing interruptions during sleep and could be contributing to the clenching/lock jaw. Do you snore? A lot of times sleep apnea is very underdiagnosed or, you might not have sleep apnea, but other sleep breathing conditions are often overlooked. A great website to check out is — he’s an ENT (ear/nose/throat) doctor who specializes in this. You may be at your wit’s end, but keep going — it’s worth it to get to the bottom of this. Email me if there’s anything else I can help answer for you: [email protected]

      • I have been grinding my teeth for quite some time and in the past few years have started experience very negative consequences such as headaches, neck pain, muscle spams in my back and neck, etc.

        Although I haven’t had a sleep study done to test whether I could have a breathing disorder or not, I do believe that my grinding is only a result of simple stress combined with some poor bite mechanics.
        When I manage to go stress free for a few weeks or months (like when I quit my job or finished school), my symptoms all disappear and I feel fine when I wake up. When I’m stressed out (which is the normal case unfortunately), my symptoms return.
        Also, when I was taking amitriptyline nightly, which is an older antidepressant used off-label for muscle tension and stress, my symptoms also were significantly reduced.

        Long story short, if the amount of stress is directly related to my grinding symptoms, that would mean stress is directly related to breathing problems according to your article.
        Would you say that is true?

  8. Isn’t stress the main cause of grinding?


    • Damien-That’s what most dental professionals agree upon. This article has a bold headline & I think the overall message in this article is a little too bold as well. Bruxism or clenching habits place excessive force on the teeth. There is no magic cure for ending bruxism. While a person & his/her dental professional is trying to figure out how to stop this disorder, it would be wise to protect the teeth from direct tooth on tooth contact with the use of a night guard.

  9. I have used a CPAP for 10+ years for severe CSA and mild OSA. Since it’s not as much of an OSA issue, what options might there be for a patient like me to prevent further damage to my teeth?

    • In your case, since you have your diagnosis and you’re being treated, a nightguard shouldn’t be a problem for you. You don’t have to worry about interfering with the mechanism of grinding, since it’s not an issue for you — your airway is already taken care of with your CPAP. Go ahead and get that nightguard 🙂 Great question, Carol, thanks for asking!

  10. OK, what if you have an unusually SMALL mouth, with tori and a good sized tongue?
    I bite the sides of my tongue most of the time, even while awake. I want to use a guard at night because the back of my tongue gets chewed up. Problem is, they dont make these small enough for my mouth. They dont make childrens sizes and the adult “one size” gags me.

    • Cyndi, it sounds like you should get checked for sleep apnea as soon as you can. In the meantime, don’t worry about your tongue – other than being uncomfortable – there’s no long term damage. But of course, the damage of undiagnosed sleep apnea is significant.

    • Anonymous says:

      Cindy night guards are custom made. The lab should be able to make any size.

    • Tonya Clark says:

      They make them to fit ur mouth with impressions my mouth is super small they are custom so this isn’t true

  11. Hi – my mouth guard gave me an open bite and made the grinding/ clenching much worse so I gave up using it about a year ago. However now I’m quite worried about my teeth as I continue to grind. Should I start wearing a guard again whilst I look into sleep apnea? I don’t have any obvious symptoms for sleep apnea other than the grinding. Thank you very much for this article. It’s very frustrating that the band aid, mainstream solution to this problem does nothing to solve the grinding and actually makes it worse.
    Aoife, Ireland

    • Aoife, it’s hard, as you refer in your comment, to know if you have sleep apnea because most people don’t normally feel like they have it. I talk about this in my book. But, the fact that you grind a lot and have an open bite, I think warrants some level of discovery into whether you have sleep apnea or not. If you do have it, all those times you wore the night guard could have hurt your airway. The damage to the teeth is long term, but even one night of poor sleep can affect you in a greater way, so no, I would not wear the night guard and get a sleep study.

      • STEVEN VAZQUEZ says:

        I forgot to wear my NIGHTGUARD THE LAST 4 nights at bedtime . Last night I put my NIGHTGUARD on and i experienced a little Lightheadness some diffreculty breathing and some discomfort in my right ear could this be because I skipped a couple of nights not wearing the NIGHTGUARD

        • Dr. Burhenne says:

          Steven, it’s very possible. You may be sleeping better without the night guard in place. When you went back after 4 nights of better sleep to wearing the night guard your sleep was off and you were grinding more.

          Get checked for sleep apnea. I don’t recommend conventional night guards for people that have sleep apnea as it interferes with the primal instincts to rescue your airway at night.


  12. Sarah Adams says:

    Is clenching the jaws and so also the teeth the same as grinding in regard to concern for sleep apnea? Are there differences in treating clenching versus grinding?

    • Great question, Sarah, thanks for asking. When it comes to the reason we clench or grind, it essentially is the same — it’s to open the airway. Both clenching and grinding activate the muscles, pull the tongue forward and flatten it, helping to open the airway. However, clenching will not lead to as much damage to the teeth as grinding does, but the damage to the muscles is the same with clenching.

  13. I did a sleep study a few months ago due to headaches and tiredness during the day. I did an overnight stay and was diagnosed as mild or at lease under the insurance threshold for a cpap bipap etc. The last two dental checkups my dentist reccomended a nightguard because I had some grinding issues. So what should I do, Im still grinding, even though I’m not snoring very often at all due to excercising and losing weight. Is there a sleep appliance that will take care of both my problems?

  14. I may be an exception. I’ve been grinding since I had teeth. I started wearing a night guard made by my dentist last Tuesday evening. For the first time in YEARS, I don’t know how many, I woke up Wednesday morning and I didn’t feel tired like I wanted to go back to bed and get some more sleep! I thought it was a one time thing but now a week later and I still wake up refreshed and I have energy that I haven’t had for a long time! Another side effect? I’m drinking less! I didn’t realize I was using alcohol to knock myself out and keep myself knocked out.

    Though I haven’t had a sleep study I do snore loudly and excessively, it runs in the family. I can’t tell if that’s changed with the addition of the night guard.

    I’m counting my blessings and can’t believe what I’ve been missing, a good night’s sleep, all these years.

  15. My grinding was triggered by losing the curve in my neck. After heavy laptop usage and a whiplash, one day my neck went into spasm, followed by the jaw, face and shoulders. Since then I can’t engage in any task that involves bending my neck down or carrying heavy items on my back, like a rucksack or using crutches, as I get severe cervical pain and TMJ starts up. What cures it is putting a curved cushion behind my neck as this restores the curve, and when the curve is put back in, my jaws naturally separate. Unfortunately the medical system is not integrated and ENT and maxillo facial are completely separate departments and never the twain shall meet. Until they do, I can’t see much future for people with my cause of grinding as there is no incentive, at least in the UK, to try and restore the curve in the neck or treat disc bulges. I regret leaving Spain where I was living at the time, as their healthcare system used traction in physio,which was very helpful, something they used to use in the UK apparently, but stopped doing as if done incorrectly, it can be counter-productive.

  16. Hi there,

    I have been experiencing immense pain due to my grinding/clenching of my teeth. My dentist diagnosed me with Bruxism, he said it’s due to lack of sleep and stress levels. Honestly, I have been have sleep problems for a long time as I do have trouble getting to sleep and deep sleep. I do also get stressed a lot which causes me to experience depression from time to time. This teeth grinding has been going on for about 2-3 years. And it now has gotten so bad that my gums and jaw are inflamed and painful. At the moment I have been wearing a cheap night guard from the local pharmacy store. But it doesn’t seem to help stop my jaw pain.

    I am seeking advice because I want to find the root of this problem, and I am trying to avoid purchasing the $500 night guard from my dentist. I feel that they just want to make money off me, even though I have been a long-time customer over 10 years.

    Thanks you!

  17. I’ve worn a night guard for about 10 or 12 years. My teeth have cracked from the grinding. Every time I’ve had to get a new crown my night guard doesn’t fit. I just got a new slimmer night guard today. I came online to research the material its made out of and found your blog. I had a episode of what my doctor thought was sleep apnea over a year ago. We did a two night sleep study at home with a machine and I wasn’t found to have any significant apnea. That episode over a year ago was so scary I thought I was having a heart attack or something. It woke me up with very high heart rate and I was taken to the hospital in an ambulance for observation. Just the other night I had another episode which I’m sure was deep sleep that ended up waking me up thinking I was going to die from lack of air I guess. After reading your blog I’m sure I need another sleep study. Can you recommend what type I’d Doctor I should contact? Thank you. Debbie

    PS. No dentist has ever mentioned sleep apnea or a sleep disorder relate to my grinding issues. I was told by an anesthesiologist that I have a very small airway.

  18. Christina says:

    What about clinching? If someone clinches during sleep is that a possible sleep apnea symptom too?

  19. Article was too repetitive. Next time get to the point.

  20. Anonymous says:

    wish to receive Dr B’s tips every week . thanks

  21. Peggy Hinkle says:

    Restrictive lingual frenula (tongue tie) can be the underlying reason for the bruxism. The frenula causes the tongue to obstruct the airway. Parents who have had their babies’ frenula released, and then gone on to have their own frenectomy, have found that the grinding stops. I had no idea my grinding was caused by the tie and apnea. Disturbing.

  22. First of all thank you for the great article. I just recently had some dental work done and after the work was done a week later i was still having headaches and pain from the area that the work was done. I went back in for a follow up and my dentist did some adjustments and recommended a night guard for grinding. I told my dentist that i have never grind my teeth in the past and i feel like i sleep very well because i wake up refreshed. I feel if i were to get the night guard that my sleep will not be as good. So your article confirmed my decision for now on getting a night guard.

  23. So this is about night bruxism but what about day clenching ???

  24. Hello doctor! You write about soft or hard actilic guards?
    You wrote about flat hard acrilic guard or hard acrilic guards wits hols on occlusal side?

  25. Cleopatra Rivel says:

    Why are dentists allowed to ‘prescribe’ mouth guards to patients for their sleep apnea? We all know how serious sleep apnea is and that the best therapy is a CPAP machine. But somehow the companies who make mouth guards for snoring are allowed to make claims that it treats sleep apnea.

    • Actually, only a sleep specialist MD can prescribe a sleep apnea device, called the mandibular advancement device (not a mouthguard). The dentist is the expert in fabricating the device and delivering it. Clinical studies support the mandibular advancement device (not a nightguard or mouthguard) for sleep apnea.

  26. Don Elder says:

    Thanks for the article. I agree with you. We must be pro-active. My dentist prescribed a night guard which I admit was necessary but finally one day I asked my physician what if he prescribed me a muscle relax medication to take at night which could reduce the grinding and help me sleep. It does help significantly with or without the night guard which I use most of the time. However, I do want to know if I have sleep apnea so I am currently in prelim assessment for the University of British Columbia Sleep Clinic (my initiative) which entails keeping a journal for two to three weeks and completing a questionnaire.The muscle relaxant is cyclobenzaprine 10 mg once at bedtime.

  27. I am having a home sleep study this week to test for sleep apnea, which may partially be caused by a deviated septum. I snore and wake several times during the night, which leaves me tired during the day. When I wake, my mouth is in a forceful clench with my jaw receded. I previously wore adult braces for a significant overbite, and currently wear invisalign type retainers on both upper and lower teeth. The tops of the retainers have holes as evidence of my grinding. I have been grinding my teeth for over 30 years.

    I need to wear my orthodontic retainers for the rest of my life as my teeth move if I do not wear them. I actually should have had jaw surgery with the braces treatment to properly correct my jaw alignment and overbite, but did not have the surgery.

    Can a mandibular sleep appliance be used in place of my orthodontic retainers, to prevent sleep apnea, as well as maintain my teeth alignment from prior orthodontic treatment, and also protect my teeth from clenching or grinding?

  28. I personally enjoy these Blog pieces, absent of references and absence of science . Your delusional insight into this issue is completely unscientific. Do you have any evidence to support your idea that a night guard interferes with a “natural grinding response ” to sleep disordered breathing. You claim that this natural grinding prevents “airway collapse”. Again , so you have any science to support this ? You sound like a Chriopractor unjustly drawing conclusions from inadequate evidence. Please support your claims before you promote such a fearmongering piece , and have citations of you plan on giving advice to people . The lack of science in professionals is uphauling . Stick to doing fillings and dental repair, and leave the science to researchers that are not as eager to jump to wild , fallacious conclusions , empiricism or supportive evidence .

  29. Hello,

    I just happened to come across your article when investigating sleep guards for my adult daughter. Ever since I can remember, she has clinched and ground her teeth at night. She had jaw surgery two years ago to correct her jaw/bite. Her issue was that her top and bottom teeth set on top of each other. She was upset that she was not a candidate for veneers for the ever present worry of worn down teeth. She had braces which made her top teeth lay slightly over her bottom but felt like her teeth were being shoved into the correct position. She then opted for jaw surgery. Her top jaw was slightly moved forward and we were told that her bite was just about perfect. It is now two years later and her grinding and clinching at night has not improved, in fact, it may even be worse. A couple of months ago, she received a “heavy duty” night guard from her oral surgeon. She has had it adjusted by her dentist twice and then two days ago, by her surgeon to try to get a comfortable fit. Her surgeon and others say that her bruxism is from stress. She has just completed grad school and was very stressed and since, has started a demanding career, but her nighttime issues were a problem, long before this challenging period in her life. Would you suggest her being testing for sleep apnea? Does insurance pay for this?

    • Andreea UO asemenea frumusete este bitineneva la noi acasa! Ahhh, am retinut de anul trecut ideea cu ornamentul anului. Anul aceasta, cand l-am pus in brad, mi-am amintit si am zambit. Grozava idee!

  30. I’m having issues with clenching my teeth. This problem didn’t show up until after I was diagnosed with an anxiety disorder. I constantly clench my teeth, even during the day. It’s causing severe pain in my jaw along with my ears showing signs of inflammation, it is preventing me from sleeping and I also believe that it is causing me to not want to eat. My doctor actually recommended, based on my symptoms, that I go to the dentist and ask them to fit me for a night guard..

  31. I use a Cpap machine for my sleep Apnea and I still grind my teeth in my sleep. what else would you suggest for stopping it?

  32. Valentine says:

    Hello Dr. Burhenne – I am 37 and have been grinding my teeth since a child. While it has never been an issue in the past, it is now. I wake up with severe headaches and my jaw is sore. Recently I could feel in my mouth small pieces of my teeth as they must be chipping. My dentist has recommended that I see an Orthodontist for advise on invisiline or braces. She feels that if my slight over bite was corrected then the grinding can stop. What are your thoughts on that? I have yet to try a mouth guard as I feel they are uncomfortable and unattractive. Nonetheless, as a teen I had a retainer and that seemed to correct the grinding for a small period of my life.

  33. I’ve suffered from bruxism since childhood. I do not snore, am not, nor have I ever been over weight & I sleep soundly.

    My damage, prior to a diagnosis, are 8 crowns and 2 teeth busted completely out of my mouth. To tell every person their issue is sleep apnea is absurd. I wear a night guard and haven’t had additional damage since it was prescribed by my physician (not my dentist) over 8 years ago.

    My bruxism has always been worse during seasons of high stress; not apnea. I will continue to faithfully wear my night guard. Loosing more teeth is not an option!

  34. I have sleep apnea and use a cpap machine. While using the cpap I grind my teeth. I chipped a tooth from grinding and would wake up from pain from clenching/grinding. With cpap and night guard, I sleep well and don’t damage me teeth or wake up with sore teeth/jaw. Based on my experience, cpap didn’t stop grinding.

    • That’s unfortunate, because theoretically an open airway would stop the grinding and clenching. There’s nothing wrong with wearing a nightguard while you’re wearing the CPAP, I would just question whether you have even one apnea during the night, which can cause a grinding episode, and even one grinding episode could chip a tooth. A CPAP doesn’t necessarily reduce ALL apneas during the night…this is why it’s important to verify with a follow-up sleep study that you have reduced your AHI to 0. Keep wearing that nightguard!

  35. I do not grind but clench my teeth and dentist says they are cracking, after some more treatment wants to give me a splint. I have had a sleep test in the past as I do snore. It showed mild sleep apnea and no treatment was recommended. Does teeth clenching show similar to grinding that could be trying to open my airway. My dentist suggested I must have a lot of stress that sort of thing but I am not aware if that or really aware that at night I am clenching my teet.

  36. Margaret L says:

    My bruxism appeared during a time in my life when I was experiencing repressed anger … I was angry at my parents and repressing it rather than dealing with it head-on, so to speak. I had braces as a kid and following that wore a retainer for several years. Now, at age 65, I frequently awaken and find myself grinding my back teeth as I turn over or reposition myself while sleeping. I actually think the mouth guard helps… it just doesn’t extend back far enough in my mouth to cover the back teeth. That’s my assessment…

  37. I am a dental hygienist, and although this is very true for some people, it is not true for everyone as some people grind and clench their teeth because of stress and this does not apply. Dentists do not have the ability to diagnose sleep apnea, but most should suggest you ask your medical doctor to look into this on a client specific basis.

  38. Anonymous says:

    Dr. Burhenne,
    I have had a sleep study and do not have sleep apnea. My jaw cracks all the time – whenever I chew or yawn, and often locks when I’m about to open my mouth. Others have begun commenting that they can hear my cracking jaw when dining together. My dentist recently made a nighttime mouth guard for me – any chance this will reduce the cracking?

    • Yes, this should reduce the cracking in your jaw as you are most likely putting too much stress on your jaw when you are sleeping either grinding or clenching and the is why it cracks. It could also be an abnormality in your jaw, so if it doesn’t clear up with the night guard, ask your dentist about it again and he could take an X-ray to check for abnormalities.

  39. Dr Burhenne
    Came across your article while researching for a new mouth guard as my present one has broken.
    I have been diagnosed with moderate sleep apnea at a sleep clinic and have a CPAP machine with the pressure setting of 10. Been using CPAP for close to 15 years now. I love my CPAP machine and will not take a 20 minute nap without it. That being said my dentist keeps me using an expensive mouth guard as he claims that my teeth are wearing down from grinding. I’m not sure if I grind my teeth when sleeping but know that I grind when driving or get a little annoyed or grind on other occasions. Not sure why.
    Any suggestions on a type of mouth guard that would benefit me?

    • If you find yourself grinding during the day with stress, you are most likely grinding at night when stressed as well. Go for the night guard your dentist is recommending

  40. patricia lake says:

    this, to me, explains why I find my mouth guard intolerable. I wake up at night, desperately gasping for air, or I wake in the morning searching for a fitted, hard to remove, night guard that I have apparently ripped out of my mouth and thrown across the room.

  41. I am totally confused. I had a sleep study 8 years ago. With the results, I use a CPAP, wear a mouth guard, and was on restless leg medication. A doctor (after years on the medication) told me I had restless leg syndrome to wake me up so I would breath. He took me off the medication.
    You are saying in your article that I do not need the mouth guard. I was told during the study that I grind my teeth. My dentist has not seen evidence of teeth grinding. I am still using the original guard.
    Reading the comments you have told us we do not need to wear the guard. Which I understand your logic. But, in a reply you gave to Carol H, Aug. 11, 2015, told her it was OK to continue wearing hers.
    I had another study about a year ago because I lost 60+ pounds. The study showed no change in my diagnosis.
    Please advise.

  42. My daughters grind their teeth every night. I don’t know why, I’m worried. Is there something I can do? Thank you!

  43. I also would like to know the name of the natural sleep spray.

  44. Hi,
    I am a dentist and I read your article above. In my experience, most of the patients I see who grind their teeth are either children or people in their 30’s or 40’s who are healthy and have no signs of sleep apnea. While I agree that thorough investigation of the cause is important and I don’t jump to a splint for treatment straight away, I don’t agree that sleep apnea is the major cause of grinding. I have also seen a lot of cases of patients DEVELOPING severe grinding habits AFTER they have commenced CPAP treatment. These are patients I have seen for many years and formerly had very little to no attrition and have lost several mm in a matter of months after starting CPAP treatment. How do you explain this?

    Thanks, Dr Wood

  45. I have been grinding my teeth all my life and had a in-hospital sleep study completed a couple months ago. I do not have sleep apnea. No sign at all.

  46. I am a 30-year-old woman who is always grinding her teeth during sleep or while awake. I do NOT have sleep apnea, nor have I ever had any issues of sleeping. I highly doubt sleep apnea is the sole cause. Anxiety might be another, or even something else. Just a bad habit.

  47. I have apnea, and I have used a CPAP every night for 3 years now. My teeth are starting to wear away because I often wake up with clenched teeth. It’s stress. So now what?

    I feel like I need to add a night guard to the mix. Can’t wait til science can make me live as a brain in a jar. Much easier.

  48. My dentist recently prescribed a mouth guard as my teeth were showing minor signs I was grinding my teeth. I’ve worn it for 3 nights, and now my bite seems wrong, my jaw aches and I am over salivating. I had none of these problems before. I know I occasionally suffer from sleep apnea (I was particularly bad when I was pregnant- I’d wake up feeling like I was choking). I’ve never been diagnosed with this however. Not sure what to do next as I feel my dentist has made my problems worse.

  49. Hi doctor…I have a problem opening my mouth while sleeping and all started like a joke but now I noticed my teeth are growing forward which is disfiguring my mouth….I don’t want to use braces,can a mouth strap work. Please help me

  50. While I’ll give you that it’s possible one has to do with the other, what do you suggest to your patients that DON’T have sleep apnea? I do not. At all. But when stressed, I bite. Hard. My dentist wants to try a night guard, but I’m not sure that’s going to help. I don’t really grind, but clench…which one can do with or without a night guard. So what’s my answer?

    • I’m in the exact same boat!!!!

      • So frustrating, isn’t it? I’ve been trying some stress relief meditations before bed lately and it’s helping a lot. I’m also consciously relaxing my jaw throughout the day and that also helps. If you find a better answer, hit me up! [email protected]

  51. I got a night guard six months ago because I was grinding my teeth at night and clenching or grinding all day. It’s helped at night, but I am constantly clenching my teeth/jaw and I believe that it’s gotten worse. I’ve also almost worn holes in my night guard. I’m bringing it up at my next appointment, but I’m nervous. Two years ago I was advised to see an orthodontist, but got pregnant after the consult and never thought of it again. I don’t want to go that route. Could sleep apnea be behind this?

  52. What if I grind in the day time as well? More likely Bruxism?

    • Ken, yes, you are right. They are now making a distinction between sleep bruxism and awake bruxism due to their different etiologies. The thought is that at night we brux because of our small/consticted/collapsed airways. Awake bruxism could be stress, poor bite and other causes (like mechanical trauma).


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      • chris kelly says:

        Dr Mark,
        Have you heard of a device called a Bruxoff?
        This monitor is from spes medical in Italy.
        It accurately determines sleep bruxism.
        This means that for a small percentage of patients you can correctly prescribed a MAS AND stop the bruxism.
        Also it tell you what type of bruxism and how much so potentially a daytime splint can be prescribed that suits the bruxism.

  53. I appreciated reading your article. I stumble acrossed it by searching for the opposite relationship between OSA and teeth grinding. I have been using a CPAP machine for the last 3 years and it has effectively treated my OSA. My problem is that ever since using the CPAP I have started to clench my teeth. To the point that I have molar with 3 movement. I think this is so that I maintain a good seal on my mouth and I don’t leak air. Is this something you have come acrossed? Would this be a case where a mouth guard should be used? Thanks!

    • Hmm, interesting.

      I’m surprised you are clenching. Does the CPAP tell you what your AHI is in the morning? In other words, how effective is the CPAP.


      • My AHI averages .9 over the past six months. The treatment seems to be effective by the stats on my CPAP machine and by the alleviating of symptoms.

  54. I have severe bruxism that had worn down my molars significantly before I knew it, and began using a night guard at age 20, 15 y ago. I also clench during the day; I have anxiety, which is treated, but I still find myself clenching now and then.
    I had a sleep study done due to daytime sleepiness and it was negative. HAI was nearly zero. I have allergic rhinitis though, which I am treating.
    My molars being shorter, I have to draw BACK my jaw to connect them, and therefore guards that shift my jaw forward would put all pressure on my front teeth and cause muscle strain when I chew. My current guard has little to no structure, and the pressure on my front teeth has caused them to angle forward – I have a gap between my front teeth now.
    For this reason, I am looking for recommendations for a night guard. My dentist only does bite guards that shift the jaw forward. Should I see an orthodontist instead?

  55. What if you don’t have sleep apnea? You didn’t even touch on the ACCEPTED #1 cause – Stress. You seem to frame it as one and only one cause.

  56. Anonymous says:

    I don’t agree with this article. My girlfriend does not have sleep apnea. It is clearly and directly related to stress and anxiety.

  57. ??????? ????? says:

    I just like the helpful information you supply on your articles.
    I will bookmark your blog and test again here regularly.
    I am slightly certain I’ll learn plenty of new stuff proper right here!
    Best of luck for the next!

  58. I have epilespy. Can you confirm that bruxium is a symptom of this as well?

  59. Also, I ssen an endodontist today who said that i have moved my teeth grinding them and need two root canals. Can the bruxium be this severe??

  60. Anonymous says:

    I am a healthy young adult. I do not have sleep apnea, I do not snore, I’ve been cleared by my ENT, but I still grind my teeth and it has cost my oral health dearly – weakened teeth, chipped fillings, swollen gums, and general pain and sensitivity. Why should I not get a mouth guard? I feel like if anything I should’ve gotten one sooner.

    • it’s a great question:

      we now divide bruxism (grinding) into two categories, daytime and sleep bruxism, since they have different etiologies. it could well be that you grind during the day. have someone close to you observe you over a period of a few weeks to see if you do. and we really don’t know for sure why we grind during the day, stress and bite being the current mechanisms. problem with wearing night guard is that it does not deal with the root cause of grinding. if u can truly rule out sleep disordered breathing then a properly made night guard may be needed.

      have u had a sleep study? do u have any lingual erosions? scalloped and fissured tongue? gag reflex? neck pain and morning headaches? GERD? overbite, crowding teeth?

      thanks for being a reader!


  61. Jacqueline says:

    Hi, I’ve read through a lot of these comments, but not all so please forgive me if my question has already been asked. I clench my jaw during sleep and also while I am awake. I am pretty sure it’s due to stress and anxiety. Lately though, I have the feeling that not only am I clenching my jaw and/or grinding my teeth but also rubbing my tongue against the insides of my teeth. It’s also like I may have even sucking the saliva from my mouth. The consequence is that my tongue feels, swollen and glued to the insides of my teeth when I wake up. It’s also raw and inflamed throughout the day from rubbing the sides of my teeth and roof of my mouth during sleep. I was prescribed a very chunky hard plastic mouth guard, but was only able to use it for a short while as I found forced my cheeks to draw in which encouraged that sucking movement and I also found myself clenching my jaw even stronger. While I am currently seeking ways to work on my stress levels would you have any suggestions as to what I can do to relieve and remove the soreness and inflammation on my tongue?

  62. Hello!

    Thank you for this article. I’m 26 and I have a click on one side of my jaw and I know I clench and grind at night. I have chronic hip pain which I’m sure is connected. Anyways, I don’t feel good when I wake up, I feel puffy and have a headache. I generally do feel a bit better when I have a mouthgaurd. I did a sleep study a year ago and I showed no signs of sleep apnea. Any ideas? Thank YOU.

  63. I have been grinding for years. I have been using a cpap. Which isnt making a difference even though my numbers have improved. I must be syill grinding as i still get headaches and jaw pain. Im going to give the mouthguard a try. Is there anything else that i can try?

  64. I have the same problem as CT. My front teeth are shifting forward causing a gap . I have a guard made by my dentist. Now my (second) front crown is shifting downward. Now is longer than my other front teeth. My dentist seems not to care much about it. Should I stop using guard? Also I was diagnosed with sleep apnea last year. Any suggestions?

  65. This dentist is 100% dead on!

    About 5 years ago I was told I was grinding my teeth.
    My wife had always told me I quit breathing at night for several years.
    I was diagnosed with sleep apnea a few years ago but never got it treated because of the scary mask.
    Im now faced with thousands of dollars in dental restoration I can’t afford.

    Its causing me major depression

  66. I have severe bruxism and was diagnosed with mild sleep apnea. Problem was, I didn’t have the money to buy the cpap. So I went without. And now I don’t have the money for a new sleep study. It’s crazy that in order to get help it costs sooooo much money (where I live, it was thousands of dollars for the study and cpap).

    So, I grind my teeth to nubs and have headaches all day and worry about having a stroke. Note, I am not overweight and don’t have a terrible snoring issue. I am definitely not sleeping well and wearing out my teeth. I am sure they are related. Blah.

  67. steve berg says:

    Is sleep apnea the root cause of TMJ?

    • Good question. It can be, but not in all cases. Mechanical trauma or injury is another root cause. Aggressive/improper orthodontics. Aggressive oral surgery (i.e. opening mouth too far open while removing wisdom teeth). Malocclusion/poor bite/traumatic occlusion. And it can be a combo of the above.


  68. A few months ago I was given a splint for treating my “TMD” and I have also started therapy, but after a few therapy sections and wearing my splint I have started to snore and breathe loudly (I never did, I actually slept very very silently) My husband says that sometimes he feels like sleeping on our couch because I can get very loud. I am very sad about the fact that I started to snore and I feel like I should stop using my guard but my grinding is terrible I wake up with headaches and my jaw muscles hurt. I’m from Germany so the national insurance makes it difficult to try other methods if my doctor says that I must follow what he thinks is proper treatment.

    This article makes me think that my splint is the cause as I feel like I grind and clench even more, but also makes me have more questions as I never had any breathing problems before.

  69. Noel Caskey says:

    My dentist has just put veneers on my teeth and made me a mouth guard to protect them.
    But I hate wearing it. I feel claustrophobic with it in my mouth. He says I will get used to it but I am not convinced.
    Have I got other options?

    • I would suggest examining the mouth guard and see if there are areas that can be shaved away without taking away from the purpose of it. Many professional made mouth guards have more material than needed to be effective.

  70. My dentist studied my sleep and determined I had sleep apnea. They migrated me from a standard mouth guard to the passivator. It shifted my jaw forward, eliminates my overbite while the appliance is in my mouth and then my air passageway opened up. I feel the difference when I don’t wear and when I wear. Now I sleep deep sleep because I can breathe. I’m going to look into magnesium oil to calm my jaw area.

    • Gregory P Mazzola says:

      Hi Sonia, Can you please link what a passivator is? Sounds like we have some of the same issues

  71. There are lots of companies that send out mouth guard kits, the patient does the impression themselves, and the company makes a mouth guard and sends it back to the client via mail. No dentist is involved. The mouth guards are only for jaw clenching and teeth grinding – no other purpose.

  72. I supposedly clench my jaw in my sleep. My dentist was very excited to push me into buying a Tanner night guard which was very expensive. I’ve tried time and time again to wear this guard at night yet it’s tough to do this when it gives me jaw ache as it’s so tight in my teeth (lower) I’ve told him this and he said I’ll get used to it. A very expensive purchase if I cannot even use it. I literally hate it!
    I used to wake OCCASIONALLY with painful teeth I guess from clenching but wearing this Tanner is worse than that. What can be done about the tightness? I guess nothing as it’s a hard none pliable material. I’m so sad as I couldn’t really afford this yet was pushed into buying it. I think it’s a rubbish device in my option after wearing it. I don’t believe I’ll ever get used to it. Please can you recommend anything.

  73. Barb Kern says:

    While I definitely grind & clench my teeth at night, at no time during my reading of your articles do you mention “grinding” & “clenching” during the day! I wear my night guard ALL THE TIME except when I am eating…..& before I have the chance to brush my teeth & clean the “guard” & put it back in, I feel myself just grinding & clenching away……..Yes…I know…you would THINK if I felt myself doing these things I would find a way to stop…but to you people out there with such great self-restraint…I applaud you….however, I am NOT one of YOU. Before I have broken teeth in my hybrids, I felt it coming on & am unable to put a stop to it…………..maybe that’s WHY I “grind” and “clench”….thinking of all you perfect people out there who have such marvelous self control that enables you to “stop the madness”. Isn’t there ANYTHING out there that can help? I spent $25,000.00 on this hybrid & have had to have new teeth put in twice because I JUST CANNOT STOP! I will GLADLY be your “guinea pig” if you believe you have the answer!

    • Barb, that’s awful having to wear your night guard in the daytime. I saw on Dr.Oz a trick to relax the mouth and that is to hold a pencil between the lips. For me a pencil is too thick and has toxic lead so I use wooden disposal chopsticks that you get with take-out Chinese food. I look for thin ones and cut them into 5 inch lengths. Then I anchor one between my lips and behind my upper and lower front teeth. This will ensure that none of the upper and lower teeth can touch to grind and relaxes the jaw muscles to prevent clenching. The point is you can’t clench when you are smiling. This trick is only for daytime use and will train your jaw muscles to relax. I hope it helps.

  74. judy paolini says:

    I have been using a night guard for years, suggested by a dentist for my teeth grinding. I used a dentist-made one until I was diagnosed with TMJ. After being treated the night guard no longer fit correctly so I switched to an off-the-shelf one and have had several over the years. The latest one fit over only my front teeth and seemed to work well until I recently noticed that I have developed a slightly open bite. This most recent guard was thicker than the previous ones and am concerned it might have been the cause of the changed bite. In addition, I started to snore within the last several years. I have no other indicators for sleep apnea. In fact, I am fortunate that I sleep very soundly every night and have since I was a child. I wake up refreshed and never need a nap during the day. I’m female, 63, average weight, with a normal size neck – I have read that neck size is one indicator. I’m curious about the chances that sleep apnea could be the cause of my grinding when I have no other indicators.

  75. Louise Love says:

    I have been grinding in my sleep since I was a small child and recently tested NEGATIVE to sleep apnea. My splint makes me grind more. I have been using the Good Morning Snore Solution device for about a year, which holds the tongue forward in between the teeth. When I wear it, I don’t grind! $100 and no impression needed. I lost the device on vacation, and am
    now grinding again in my sleep – will be buying another. The only thing is, I still don’t know why I grind teeth. I have recently been diagnosed with ADHD, wonder if there is a link.

  76. I was recently in a near life ending car accident in which i suffered a traumatic brain injury and now i was informed by my dentist that I must grind my teeth because my lower teeth are lower and now my father says he can hear me at night before the accident never had this problem. I was in a coma for 3 months is it possible I started to grind while I was in a coma? And what are your recommendations?

    • patrick, sorry to hear about your accident

      so many ways to answer this question, but it is possible the brain injury has triggered something that makes you grind. Was your airway damaged (crushed in the accident) affecting your airway and sleep? has your sleep changed after the accident? Did your bite change after the accident?

      I’d see a sleep specialist and an oral surgeon to figure this out.

      Good luck


  77. I have painfull teeth on the daily now. I often clench my teeth vs grind at night. I dont even have stress so I dont know where it comes from. I do often have nightmares tho and I am also a sleepwalker and sleeptalker all my life. I dont snore and I had a sleep study done some years ago and they found nothing. I only stopped breathing a couple of times. i did sleep very badly during the sleep study tho; all those things strapped to my body…. The sleep study was done because I was often tired during the day and especially after dreaming heavily. They also measured my heart and breathing and such.

    Anyway, I now have pain every day in all my back molars and often my jaw as well. Sometimes my jaw makes a clicking sound when I open my mouth. Warm or cold food hurts my molars.all of my back molars… I have to eat all my food at room temperature. Biting hard thing hurts as well. I just had a dental checkup 3 weeks ago and he just had to do 2 minor cavities. I did one time in my sleep bit off a part of my back molar.

    i just dont know what to do and i have pain every day and I am only 30 years old 🙁 I am really thinking of buying a spint because I am ruining my teeth I feel. Also my gums often get a bit inflamed at certain spots and get these tiny absesses.
    My dentist said I should use sensodyne. I tried this but it have me blisters all over my mouth and made my teeth hurt badly :S So I had to stop immediately. I am at my wits end and I hate this pain every day.

  78. Jacqueline says:

    Well I have seizures and I have seizures in my sleep and Ive been grinding my teeth and got told to get a night guard because that will help me from grinding my teeth is that truth.

  79. Alyssa Lunsford says:

    I have struggled with TMD for almost a year now. For a while it was off and on but now I just have steady jaw pain. I had a sleep study done and I know for sure I do not have sleep apnea. My dentist had me get a night guard and my grinding was so bad, it broke the first night I had it. My dentist believes that I am grinding due to stress, yet I can’t identify the cause of my stress. The longer I wear my night guard, the more painful my jaw becomes. When I take it off in the morning, I cannot touch my teeth to anything for several hours without pain. The hard plastic of the back teeth has a hole scraped into on either side and I’ve only worn it once. Please give me an explanation of some sort!

  80. I do have sleep apnea and currently use a CPAP. I wear it religiously. I actually really like it and has helped so much. I didn’t used to have any problems with grinding or clenching until recently. I now clench my teeth and often find myself teeth hurt in the morning due to this. So while I do believe clenching and grinding to have a root cause for me it started AFTER I was using a CPAP for my sleep apnea. I am currently looking into a night guard to use in conjunction with the CPAP.

  81. I was dianoised with severe sleep apnea 2 years ago. I have faithfully prescribed to using the CPAP therapy. Recently I started experiencing pain in #17 & 18. My dentist has examined the affected teeth and feels I am grinding my teeth during sleep. He suggested “night bite” until his assistant shared that I have apnea. The teeth in question are both gold crowns. He slowly ground away the gold until he was satisfied with the bite result. Although the pain has lessened I am still experiencing discomfort. After reading your article, I’m not getting night bite and am somewhat at a loss in moving forward. Any thoughts?


  82. True, a nightguard isnt dealing with the underlying courses.

    But maybe it can be a temporary solution in lessening the damage to the teeth, while the underlying cause is corrected?

  83. Dr. Burhenne,

    For the last 4 years I have been through multiple night guards as a result of bruxism. I just got a new one made that seems better, as it holds my jaw more open, but I have suspected for some time that I have a form of apnea, probably obstructive based upon my individual research. More than one in the past I have experienced sleep paralysis, where I have woken up unable to breath for a minute or more and basically taken my dream with me into reality upon awakening, essentially hallucinations. Also… something else that is more embarrassing to mention here in a couple of extreme instances. My dentist I feel has been very good to me considering I am a major dental-phobe and avoided visiting one for many years since I was extremely young. I don’t have insurance, nor a lot of money, but I have spent quite a bit of money on fillings, night guards, etc, over the last few years, that I feel is mostly caused by the pressure I exert on my teeth and jaw at night. Last year I had a scan done at his office that revealed that my airway is about the smallest it can be, appearing as red/black on the chart indicators. I have mentioned that I believe I have apnea before, but didn’t seem to be taken too seriously because I don’t snore… maybe there is something I missed though. But I am 99.9% sure that I have it based on the sleep paralysis episodes, as well as the fact that I have been told by people sharing a room/bed with me that I sleep “like I am dead” and don’t even seem to breathe. Should I pushing this more with my dentist, or should I find someone else altogether? I would hate having to go somewhere else because I do trust him, but he is the conservative type. What woud you advise for me? I want to find the root cause of my bruxism, and thanks to your article I believe I may have found it as it makes perfect sense to me. Please get back with me… either via email or via response here. You can reach me at *********** I know that seems odd, but I use it for non-business related things or for forums for anonymity purposes.

    Thank you so much for a reply,

    • Hi Brandon,
      You should have a consultation with a Sleep Physician and have sleep study to evaluate for sleep apnea. It is possible that sleep deprivation related to sleep disordered breathing can be causing your sleep paralysis but depending on your symptoms you may also need to be evaluated for Narcolepsy. The presence of hallucinations/dream intrusion coupled with sleep paralysis is often associated with Narcolepsy.

  84. Yeah I don’t buy this. I am a clencher, not a grinder, and I have extensive enamel damage. My condition is entirely unrelated to sleep apnea. I don’t snore, don’t gasp, and have zero symptoms to indicate apnea.

    I thought apnea and snoring was more associated with mouth breathing, anyway? How exactly can you be grinding your teeth together when your mouth is hanging open? Everyone I know who has apnea is a mouth breather when they sleep at night.

    Have sleep studies ever shown any evidence to correlate grinding with apnea?

  85. I feel like grinding alone with or with out the typical product would cause wear regardless. I was certain there was a product out there similar to this but made with a softer material. Would that be more helpful?

  86. Bruno Vianna de Almeida says:

    My wife has bruxism and it´s harming her hearing. Actually she uses a device, but it has prejudicing instead reliefing the pain. We were going to buy this “protector” (that i coudn´t find in Brazil), however, after i read this wonderful article, we changed our mind. Now she is going to see a doctor and ready to question about the OSA.
    Thanks Dr. Burhenne´s for your brilliant advice.

  87. I have mild sleep apnea and wearing a night guard for clenching has actually improved my breathing and snoring. My night guard from my dentist looks somewhat dissimilar to ones I’ve seen online, it has a smooth surface, relatively thick, and just covers my bottom molars, so my jaw tends to be relaxed and slightly open. I don’t believe I was grinding my teeth due to sleep apnea, it was more consistent clenching. I have an app that records the audio of my sleeping and when I wear the nightguard I can hear clear breathing and very little snoring, but any night I go without it’s right back to loud snoring. I’m not sure why this is exactly but that’s what I’ve experienced.

  88. Vincent Clemson says:


    Thank you for the enlightenment. This is the exact kind of advice that we need MORE of out of health professionals (aka, when an accepted solution is merely a “bandaid” (a temporary fix … or just an incomplete picture of the healing process), the type of advice that keeps digging and keeps looking back to scientific community). I HATE bandaids; they rip off all of my hair!

  89. What about in children? I have a ten-year old who has been grinding for years. All her teeth are in now. Still grinds. May need braces (I am told). What could be her cause?

  90. Alexandrea Hess says:

    Hi, I’m 21 year old college student and I have problems with grinding my teeth at night. Now I do have TMJ, had shingles in my ears, and migraines that all contribute to my grinding. I’m also doing a healthy diet. Unfortunately I do have acid reflux and my teeth are definitely not in the best of shapes. I’ve tried to do a mouth guard; I got one from the TMJ specialist plus a piece that is supposed to align my jaw back in place because it pops out a lot. The worst part is when I sleep, I remove by chucking it out of my mouth on to the floor across the room.
    Is there a better way to keep it in my mouth or try something better to do? Thanks!

  91. I never saw this mentioned anywhere but my own experience is this: hyperthyroid (and also overmedication of hypothyroid, especially too much T3 meds) gives you sleep bruxism! I’ve had that problem and so has my mom.

    When my thyroid health is in balance, I do not have problems with bruxism.

  92. Vicki Taylor says:

    I have sleep apnea and have been on CPAP for 5 years, yet still grind my teeth and have the abfraction lesions to show for it. Taking care of one does not necessarily eliminate the other.

  93. sarah wilkins says:

    will the night guard make my teeth fall out compleaty or am i just getting worked up for nothing

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