Night guards usually get handed out as an obvious good idea. You grind, so you get a guard. It protects your teeth, it costs a few hundred dollars, and nobody thinks much about it after that.
We make them. But we won’t make one for everyone who asks, and that’s not us being difficult.
Something you wear eight hours a night, every night, for years, does more than just sit there. It can change your bite. It can affect how you breathe while you sleep. And it does nothing about whatever is making you clench in the first place. So it should come after a diagnosis and a real conversation, not instead of one.
What we usually make them for
This part surprises people, and it changes how the rest of this page reads.
Most of the appliances we make are for treating TMD, not just for protecting enamel. In those cases the appliance is a tool for diagnosing and treating a jaw problem, not a plastic cover to keep your teeth from wearing down.
That’s a different job. When the goal is to calm overloaded muscles and then find where your jaw joints want to rest, the design, the adjustments and the follow-up all matter in a way they don’t when you’re just covering teeth. Our TMJ page walks through that whole process, including why we start with something reversible.
So when someone comes in saying they need a night guard, our first question isn’t what material. It’s what the appliance is supposed to do.
Night guard, orthotic, retainer: three different things
People use these words as if they mean the same thing. They don’t.
| What it’s for | What it takes | |
|---|---|---|
| Night guard | Puts a layer between your teeth so the force lands on plastic instead of enamel. It doesn’t treat clenching, and it isn’t built to move or reposition anything | Usually two visits. Records at the first, then fitting and adjusting at the second |
| Orthotic | Calms overloaded muscles, then shows where your jaw joints want to rest. It’s as much a diagnostic step as a treatment | Weekly to every other week for about three months. The adjustments aren’t aftercare. They’re the treatment |
| Retainer | Holds your teeth where orthodontics put them | Not designed to take grinding forces at all |
The easiest way to tell which one you’re being offered is to count the appointments. A guard takes two visits. An orthotic for TMD means coming in weekly to every other week for about three months, because the whole point is to keep adjusting it as the muscles settle and your jaw shows where it wants to sit. If an appliance is sold as TMD treatment with no follow-up schedule, it’s really a guard, whatever it’s called.
Wearing the wrong one of these for your actual problem is a common reason someone has done everything they were told for years and still has the same complaint.
What a night guard does and doesn’t do
It does protect your teeth. That’s real, and it’s worth something. If you’re grinding hard enough to chip edges or flatten your back teeth, putting something in the way saves tooth structure, and tooth structure doesn’t grow back.
It doesn’t stop you from clenching. It was never designed to, and the evidence that splints reduce clenching is weak. The 2024 Cochrane review of bite treatments for TMD pooled 57 trials and 2,846 participants. It judged only one of those studies to be at low risk of bias, and rated every comparison it looked at as very low certainty. It couldn’t show that a stabilization splint reliably does better than a placebo or physical therapy.
Singh BP et al. Occlusal interventions for managing temporomandibular disorders. Cochrane Database of Systematic Reviews. 2024;9:CD012850.
And it only covers eight hours out of twenty-four. Clenching during the day is at least as common as grinding at night, and a guard isn’t in your mouth while you’re tensed up at your desk. If you’ve worn one faithfully and your teeth are still wearing down, that’s usually why, and no appliance can reach it. Daytime clenching has its own article.
Three ways a guard can make things worse
This section explains our position, and it’s the part almost nobody hears before a guard gets made.
1. Your bite can change
This is the best documented of the three, and it isn’t rare.
A review in the British Dental Journal described cases where wearing a night guard led to an anterior open bite, meaning the front teeth stopped touching, along with other bite changes. Its conclusion was blunt. Bite problems linked to night guards may be more common than the existing literature suggests, follow-up is essential, and unintended changes can happen with any type of appliance.
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, not a controlled trial, so it shows that the problem happens and is under-recognized, not how often it happens.
The risk is much higher with an appliance that covers only some of your teeth. If a few teeth are held apart all night and the rest are free to move, they move. It’s the same thing orthodontics does on purpose, happening by accident.
2. Your breathing
This is the one we take most seriously, and it’s why we ask about your sleep before we make anything.
Start with a finding that’s hard to ignore. One study sent thirty dental patients with tooth wear, all of whom had already been treated with a bite splint, for a proper sleep study. Their average apnea-hypopnea index was 32.4, which is in the severe range. Only two of the thirty came back under five, and eleven were at thirty or higher. The worse the tooth wear, the worse the apnea tended to be.
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, not the general population. That’s a small, selected group, and the numbers shouldn’t be read as a population rate. It’s still a lot of people who had no idea.
Now think about what that means for an appliance. A critical review in the Journal of Prosthodontics describes treating people who have both sleep grinding and obstructive sleep apnea as challenging, specifically in order to avoid compromising the oropharyngeal space and breathing efficiency. Put simply, what goes in your mouth overnight can affect the space you 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.
We want to be precise about what that review says, because this gets overstated in both directions. It says the literature does not support association or causality between sleep grinding and sleep apnea. They aren’t the same problem, and one doesn’t cause the other. What it does report is that they show up together in roughly 30% to 50% of adults, and that treating one without knowing about the other is where the trouble starts.
So we’re not saying a night guard causes sleep apnea. We’re saying that if you already have apnea nobody has diagnosed, an appliance isn’t a harmless add-on, and worn teeth are one of the things that should get someone asking about your sleep.
That’s why the questions come first. Do you snore? Do you wake up tired? Has anyone seen you stop breathing? Do you wake up with a dry mouth? If the answers point somewhere, that goes to a physician and a sleep study before an appliance, not after. Here’s what we do and don’t do on that side.
3. The muscles and the joint
Here we’ll be careful to separate what’s established from what’s our own reasoning, because this one gets claimed with more confidence than the evidence supports.
What’s established is that appliance design matters, and that appliances covering only some teeth need close monitoring. What follows from basic mechanics is that anything changing where your teeth meet also changes how force travels through your jaw joints and the muscles that position your jaw. An appliance that repositions the jaw is doing something very different from one that just covers teeth.
Our own view, and this is clinical judgment, not a study finding: putting in an appliance without first working out whether the pain is coming from the muscles or the joint is a guess, and it’s a guess you wear every night for years. Telling muscle pain from joint pain is what the whole treatment decision rests on, and we work that out with a hands-on exam, not an assumption.
About the ones you can buy online
A plain warning here, because the boil-and-bite kind are cheap and heavily advertised.
A survey of over-the-counter grinding splints checked the FDA’s adverse event database and found reports including choking hazards, tissue damage and bite changes. It also noted that none of the designs surveyed ensured full coverage of the biting surfaces, which is exactly the feature that makes unwanted tooth movement more likely when something is worn for a long time.
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 already wear one and it’s working fine, we’re not going to tell you to throw it out without a look. Bring it in and let us check how your teeth are meeting. What we’re really checking isn’t the appliance. It’s what it’s been doing to your bite.
What we actually do
Before any appliance, we do the same workup we’d do before anything else:
- Figure out what’s wearing your 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’s happening at night, during the day, or both. We treat those as separate problems with different answers, and only one of them can be reached by something you wear to bed.
- A hands-on jaw exam. We press on the muscles to find which ones are actually sore, and load the joints to see whether that brings on your pain.
- Ask about your sleep and breathing, for the reasons above, and refer you for a sleep study when the answers call for it.
- Check whether you can breathe through your nose. If you can’t, that’s its own problem, and a lot of this starts there. It affects a lot more than your jaw.
- Photos and a 3D scan, so a year from now we can compare instead of trying to remember. That’s also how we’d catch a bite slowly changing under an appliance.
Then we talk about what the appliance would be for, what it will and won’t do, how many appointments it takes, and what we’ll be watching for.
When we do make one
Which is often. This page isn’t an argument against appliances. A well-made one in the right mouth is good dentistry.
When we make one, it’s custom and it covers all the teeth in the arch, because of the first risk above. We adjust it so it meets the opposite teeth evenly, not on just one or two spots. And you come back, because an appliance nobody looks at again is the kind that quietly changes a bite.
Follow-up isn’t an upsell. It’s the safety step. The bite changes in that British Dental Journal review were found because someone looked. Nobody notices their own front teeth drifting a millimeter apart.
And if clenching has already cost you tooth structure, we rebuild it once the cause is under control. Depending on how much is gone, that might be bonding, or a crown when a tooth has cracked or is more filling than tooth. Restoring worn teeth without dealing with what wore them down just means doing the same work again later.
If you’ve been told you need one
Bring that recommendation in and we’ll tell you whether we agree. Sometimes it’s yes, and sometimes it’s not yet. Three good questions to ask whoever is making it: What is this appliance for? Does it cover all my teeth? How many times will you see me again to check what it’s doing?
Call 702-734-0776 or tell us what’s going on.