Night Guard: Why I No Longer Prescribe One for Grinding

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

by Dr. Burhenne

Why I No Longer Prescribe a Night Guard for Grinding
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It’s frustrating to spend your nights gnashing your teeth together, only to awaken with sore jaws and damaged teeth.

It’s even more frustrating to be prescribed a night guard that only addresses the symptoms of grinding—and doesn’t 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. (1)

If you’ve been prescribed a night 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.

A new way of looking at the underlying cause of many cases of teeth grinding now allows us to better address the root cause of the issues, instead of just the symptoms.

I’ll explain this more in the article, as well as why I no longer prescribe a night guard for grinding.

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.

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.

There are several consequences of untreated teeth grinding. They include:

Premature loss of enamel: Constant grinding can remove layers of your enamel, making them more susceptible to sensitivity and tooth decay/cavities.

Fractured teeth: Teeth can cave to the unrelenting pressure of grinding and end up cracked or fractured, requiring professional treatment or even extraction.

Yellowed teeth: The best way to make your teeth look whiter is to prevent yellowing or discoloration from occurring. Grinding can prematurely age teeth, accelerating their yellowing and worsening their aesthetics.

Gum recession: Depending on your size, grinding can exert 400-600 pounds of force per square inch of tooth surface. This pressure can push the gums away from the teeth and cause irreversible recession that can then lead to decay as bacteria settles into the recessed space. Gum recession can also lead to sensitivity.

Temporomandibular joint disorder (TMD): Grinding teeth also puts a lot of pressure in the temporomandibular joint, which can lead to TMD. TMD is also sometimes called TMJ, and the disorder can cause ongoing pain in the joint, clicking or popping of the jaw, as well as difficulty chewing.

Common causes of grinding

While each case is unique, here are the most common causes of bruxism, or grinding:

Misaligned teeth: If your teeth aren’t lined up correctly, it can cause your jaw to be unstable and lead to teeth grinding. (2) Especially if you’ve recently had a tooth extracted or had other major dental work done, you may want to talk to your dentist about misalignment as a possible cause of your teeth grinding.

Medication: Certain medications, such as antidepressants and antipsychotics, seem to cause teeth grinding in some patients. (3)

Sleep apnea: Studies are beginning to link sleep apnea and teeth grinding. (4)

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 how the body reopens the airways.

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

Sleep apnea is such an important factor in grinding—the most important, in fact—that I cover it in more detail, below.

Sleep apnea and grinding (What a night guard can’t fix)

The old-fashioned method of treating bruxism was to cover the teeth with a night guard to protect the teeth from the strong vertical forces caused by grinding.

But there are problems with this method—namely that a night guard fails to treat the root cause of why we grind our teeth.

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

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 tend to occur simultaneously.

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

At worst, a night guard could interrupt this necessary response of grinding. 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.

Treating grinding without a night guard

As a dentist treating bruxism and TMD, and having read all the latest 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.

If a sleep test detects any sleep disordered breathing, you can then follow up with a doctor to discuss treatment or a more specific diagnosis.

Your doctor may recommend that you sleep with a CPAP machine at night, which will blow air down your throat so that your airways stay open, your body doesn’t need to grind to open your airways, and you’re able to access deep sleep.

If you’re opposed to sleeping with a CPAP machine, you may be a candidate for an oral appliance from your dentist.

An oral appliance is a device that you wear at night to keep your jaw pushed forward and your airway open, even as your muscles become paralyzed in deep sleep. Because it’s custom created to fit your mouth, it also functions as a retainer for your teeth.

It’s important to get a sleep apnea diagnosis before using an oral appliance, however, because if you have severe sleep apnea, oral appliance therapy is not recommended.

Again, to be clear, your dentist must look at all the root cause of your grinding.

This involves:

  1. Your participation in a sleep study or at-home sleep test to rule out sleep apnea (or assess its severity)
  2. Properly addressing your sleep apnea with a CPAP machine or oral appliance therapy. Your teeth grinding will be cured if you treat your sleep apnea because you will have taken away your body’s impulse to grind in the first place.
Bottom line:
If you’re grinding your teeth and or believe that you have diminished sleep quality, check out my bestselling book The 8-Hour Sleep Paradox. It discusses, in more detail, how to achieve your best night of sleep to protect your teeth, gums, and jaw from unnecessary damage, while also supporting total-body health.

Treating other causes of grinding

Following are tips on how to treat some other causes of grinding that are not related to sleep apnea:

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

Talk to your medical doctor about your prescriptions: If your medication is making you grind your teeth at night, work with your doctor to try a different medication or change the dosage until you find a solution that causes the grinding to subside.

Final thoughts on night guards

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.

Now, any thoughtful dentist should rule out sleep apnea and other causes of grinding before prescribing a night guard. Treating those root issue will stop the grinding altogether, which will protect the teeth, gums, and jaw from unnecessary wear and tear.

read next: Sleep Apnea: The Real Reason You Grind Your Teeth

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Dr. Mark Burhenne DDS

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