A night guard is usually offered as an obvious good idea. You grind, so you get a guard. It protects the teeth, it costs a few hundred dollars, and nobody thinks about it much after that.
We make them. We are not going to hand one to everybody who asks, and that is not us being difficult.
An appliance you wear for eight hours a night, every night, for years, is not a neutral object. It can change your bite. It can affect how you breathe while you are asleep. And it does nothing at all about whatever is making you clench in the first place. So it belongs after a diagnosis and a real conversation, not instead of one.
What we are usually using one for
Here is the part that surprises people, and it is worth stating early because it changes how the rest of this page reads.
Most of the appliances we make are to treat TMD, not simply to shield enamel. The appliance is a therapeutic and diagnostic tool in a jaw problem, rather than a plastic cover bought to stop teeth wearing down.
That is a different job, and it means something different is being asked of the appliance. When the purpose is to settle overloaded muscles and then find where your joints actually want to rest, the design, the adjustment and the follow-up all matter in a way they do not if the only goal is covering teeth. That pathway is described in full here, including why we start with something reversible.
So when somebody arrives saying they need a night guard, the first question is not which material. It is what the appliance is actually supposed to be doing.
Night guard, orthotic, retainer: three different things
These get used interchangeably and they are not interchangeable.
| What it is for | What it takes | |
|---|---|---|
| Night guard | Putting a layer between the teeth so force lands on plastic instead of enamel. Not a treatment for clenching, and not built to move or reposition anything | Usually two visits. Records at the first, then fit and adjust at the second |
| Orthotic | Settling overloaded muscles, then revealing where the joints want to rest. A diagnostic step as much as a treatment | Weekly to every other week for around three months. The adjustments are not aftercare, they are the treatment |
| Retainer | Holding teeth where orthodontics put them | Not designed to take grinding forces at all |
If you want the clearest way to tell which one you are actually being offered, count the appointments. A guard is a two-visit job. An orthotic for TMD runs weekly to every other week for about three months, because the point of it is to keep adjusting as the muscles settle and the jaw reveals where it wants to sit. An appliance sold as TMD treatment with no follow-up schedule attached is being sold as a guard, whatever it is called.
A patient wearing the wrong one of those three for their actual problem is a common reason somebody has been compliant for years and is still in the chair with the same complaint.
What a night guard does and does not do
Taking the honest version of both.
It does protect teeth. That is real and it is worth something. If you are grinding hard enough to be chipping edges or flattening cusps, putting a sacrificial layer in the way genuinely preserves tooth structure, and tooth structure does not grow back.
It does not stop you clenching. It was never designed to, and the evidence that splints reduce clenching activity is weak. The 2024 Cochrane review of occlusal interventions pooled 57 trials and 2,846 participants and judged only one of those studies to be at low risk of bias, rating every comparison it assessed as very low certainty. It could not establish that a stabilization splint reliably outperforms placebo or physical therapy.
Singh BP et al. Occlusal interventions for managing temporomandibular disorders. Cochrane Database of Systematic Reviews. 2024;9:CD012850.
And it covers eight hours out of twenty-four. Daytime clenching is at least as common as sleep grinding, and a guard is not in your mouth while you are braced at a desk. If you have worn one faithfully and the wear is still progressing, that is usually what is going on, and no appliance reaches it. The daytime side has its own article.
The three ways a guard can make things worse
This is the section that explains our position, and it is the part almost nobody is told before an appliance is made.
1. Your bite can change
This is the best documented of the three, and it is not rare.
A review in the British Dental Journal presented cases where night guard use produced an anterior open bite, meaning the front teeth stopped meeting, along with other occlusal derangement. Its conclusion was blunt: adverse occlusal effects linked to night guards may be more common than the existing literature suggests, follow-up is essential, and unintended occlusal changes can happen regardless of appliance type.
Bereznicki T, Barry E, Wilson NHF. Unintended changes to the occlusion following the provision of night guards. Br Dent J. 2018;225(8):715-722. This is a literature review with case reports rather than a controlled trial, so it establishes that the problem happens and is under-recognized rather than how often it happens.
The risk is considerably higher with an appliance that covers only some of the teeth. If a few teeth are held apart all night and the rest are free to move, they move. That is the same mechanism orthodontics uses deliberately, operating by accident.
2. Your breathing
This is the one we take most seriously, and it is the reason we ask about sleep before we make anything.
Start with an uncomfortable finding. A study sent thirty dental patients with tooth wear, all of whom had been treated with an occlusal splint, for proper sleep testing. Their mean apnea-hypopnea index was 32.4, which is the severe range. Only two of the thirty came back under five. Eleven were at thirty or above. Wear severity and apnea severity were significantly correlated.
Duran-Cantolla J, Alkhraisat MH, Martinez-Null C, et al. Frequency of obstructive sleep apnea syndrome in dental patients with tooth wear. J Clin Sleep Med. 2015;11(4):445-450. Thirty patients, 77% male, mean age 58, recruited from a dental practice rather than from the general population. That is a small and selected sample and the figures should not be read as a population rate. It is still a striking number of people who had no idea.
Now add what that means for an appliance. A critical review in the Journal of Prosthodontics describes managing co-occurring sleep bruxism and obstructive sleep apnea as challenging specifically in order to avoid compromising the oropharyngeal space and breathing efficiency. In other words, what you put in somebody’s mouth overnight can affect the space available to breathe through.
Dal Fabbro C, Bornhardt-Suazo T, Landry Schonbeck A, de Meyer M, Lavigne GJ. Understanding the clinical management of co-occurring sleep-related bruxism and obstructive sleep apnea in adults: a narrative and critical review. J Prosthodont. 2025;34(S1):46-61.
Being precise about what that review actually says, because this gets overstated constantly in both directions. It states that the literature does not support association or causality between sleep bruxism and sleep apnea. They are not the same problem and one does not cause the other. What it reports is that they co-occur in roughly 30% to 50% of adults, and that treating one without knowing about the other is where the trouble starts.
So we are not telling you that a night guard causes sleep apnea. We are telling you that if you already have undiagnosed apnea, an appliance is not a neutral addition, and that worn teeth are one of the things that should prompt somebody to ask about your sleep.
Which is why the questions come first: do you snore, do you wake unrefreshed, has anyone watched you stop breathing, do you wake with a dry mouth. If those answers point somewhere, that belongs with a physician and a sleep study before an appliance, not after it. What we do and do not do on that side is set out here.
3. The muscles and the joint
Here we are going to be careful to separate what is established from what is our own reasoning, because this one gets claimed more confidently than the evidence supports.
What is established is that appliance design matters and that partial coverage appliances need careful monitoring. What follows from ordinary mechanics is that an appliance changing where your teeth meet is also changing how load travels through the joints and the muscles that position the jaw, and that an appliance which repositions the jaw is doing something quite different from one that simply covers teeth.
Our own position, stated as a clinical judgment rather than a finding: an appliance put in without establishing whether the pain is coming from muscle or from the joint is a guess, and a guess that is worn every night for years. Telling muscle pain from joint pain is the whole treatment decision, and it is done with a hands-on exam rather than assumed.
About the ones you can buy online
Worth a plain warning, because the boil-and-bite versions are cheap and heavily sold.
A survey of over-the-counter bruxism splints checked the FDA adverse event database and found reports including choking hazards, tissue damage and occlusal changes. It also noted that none of the designs surveyed assured full occlusal coverage, which is precisely the feature that makes unwanted tooth movement more likely when something is worn for a long stretch.
Wassell RW, Verhees L, Lawrence K, Davies S, Lobbezoo F. Over-the-counter (OTC) bruxism splints available on the Internet. Br Dent J. 2014;216(11):E24.
If you are already wearing one and getting on fine, we are not going to tell you to throw it out unexamined. Bring it in and let us look at how your teeth are meeting. The thing worth checking is not the appliance. It is what it has been doing to your bite.
So what we actually do
Before any appliance, the same workup that precedes anything else here:
- Establish what is wearing the teeth. Grinding is one cause and acid is another, and they leave different marks. A guard is built for force and does nothing about acid. Which one you have changes the whole plan.
- Work out whether it is happening at night, in the day, or both. These are treated as separate conditions with different answers, and only one of them is reachable by something you wear in bed.
- A hands-on jaw exam. Palpating the muscles to find which are genuinely sore, and loading the joints to see whether that reproduces your pain.
- Ask about your sleep and your breathing, for the reasons above, and refer for a sleep study where the answers warrant it.
- Check whether you can breathe through your nose. If you cannot, that is its own problem and it is upstream of a lot of this. It affects considerably more than your jaw.
- Photographs and a 3D scan, so that a year from now we can compare rather than recollect. That is also how we would catch a bite quietly changing under an appliance.
Then a conversation about what the appliance would be for, what it will and will not do, how many appointments it involves, and what we would be watching for.
When we do make one
Often. This page is not an argument against appliances, and a well-made one in the right mouth is a good piece of dentistry.
When we make one, it is custom and it covers all the teeth in the arch, for the reason in the first risk above. It gets adjusted so it meets the opposing teeth evenly rather than on one or two points. And you come back, because an appliance nobody ever looks at again is the version that quietly changes a bite.
Follow-up is not an upsell, it is the safety step. The occlusal changes in that British Dental Journal review were found by somebody looking. Nobody notices their own front teeth drifting a millimeter apart.
And where clenching has already cost you tooth structure, that gets rebuilt on its own terms once the cause is under control. Depending on how much is gone, that means bonding, or a crown where a tooth has cracked or holds more filling than tooth. Restoring worn teeth without changing what wore them down means doing the same work again.
If you have been told you need one
Bring that recommendation in and we will tell you whether we agree, which is sometimes yes and sometimes not yet. Three questions worth asking whoever is making it: what is this appliance for, does it cover all of my teeth, and how many times am I being seen again to check what it has done.
Call 702-734-0776 or tell us what is going on.