Bruxism night guard: how to protect your teeth from clenching and grinding

1 What is bruxism and what is the difference between clenching and grinding?

Bruxism is repetitive activity of the jaw muscles that includes clenching, meaning prolonged or repeated pressure between the teeth without movement, and grinding, meaning friction between the teeth during movements of the jaw. It may occur during sleep or while awake and is not always considered a disorder. It becomes clinically relevant when it causes excessive strain, pain or dental damage.

In sleep bruxism, also known as night-time bruxism, muscle activity may be rhythmic or non-rhythmic and occurs without conscious control. In awake bruxism, prolonged tooth contact, clenching and jaw tension are more common. Clenching and grinding are therefore different manifestations of the same condition and should be distinguished during clinical assessment.

2 What are the symptoms and signs of bruxism?

The main symptoms and signs of bruxism include tooth wear and sensitivity, jaw pain or stiffness, temporal headaches, and damage to teeth or dental restorations. In sleep bruxism, patients may be unaware that they grind their teeth, and the noise may be noticed by a partner or family member.

• Worn or flattened teeth: repeated friction may gradually alter the shape of the tooth surfaces.

• Cracks and fractures: excessive forces may damage teeth, fillings, crowns and veneers.

• Tooth sensitivity or pain: enamel wear may increase sensitivity to hot, cold and pressure.

• Jaw stiffness: the chewing muscles may feel tired or painful, particularly upon waking.

• Headaches: muscle tension may be associated with pain around the temples.

• Grinding noises during sleep: the sound may be noticed by a partner or family member.

• Neck tension: this may occur together with jaw pain, although it is not specific to bruxism.

These symptoms do not confirm the diagnosis on their own, because they may also result from tooth decay, gum disease or temporomandibular disorders. A dental assessment helps identify the cause of the symptoms and determine whether tooth wear is associated with bruxism.

3 How does a bruxism night guard work and which types of damage can it prevent?

A bruxism night guard protects the teeth and dental restorations by placing an occlusal surface between the upper and lower arches. This reduces direct tooth-to-tooth contact and distributes the forces produced by clenching and grinding more evenly. It may therefore limit enamel wear, chipping, dental fractures and damage to fillings, crowns, veneers and other restorations.

The appliance provides mechanical protection during periods when the teeth are exposed to repeated or prolonged pressure. In some patients, it may also help reduce strain on the chewing muscles and temporomandibular joints, but it does not necessarily stop bruxism or eliminate its underlying causes.

4 Which night guard should you choose: hard, soft, boil-and-bite or custom-made?

There is no single night guard suitable for all patients. The choice depends on dental conditions, tooth wear, existing restorations, occlusion, and the characteristics of clenching or grinding.

• Hard night guard: Provides a stable surface, offers greater resistance to wear, and allows more precise adjustment of occlusal contacts.

• Soft night guard: May initially feel more comfortable, but tends to wear out and deform more easily and offers less precise control of occlusal contacts.

• Boil-and-bite or preformed night guard: Is adapted by the patient or manufactured in standard sizes, but may offer a less precise fit and lower accuracy compared to a custom-made device.

• Custom-made night guard: Is fabricated to fit the patient's specific dental arch and adjusted by the dentist to achieve stability, comfort, and controlled occlusal contacts.

A night guard purchased without a professional assessment is not necessarily suitable for an individual's occlusion. The choice should therefore be based on an individual dental assessment.

5 How is a custom-made night guard fabricated and adjusted?

A custom-made night guard is fabricated based on an intraoral scan or an impression of the dental arch. Before designing the device, the dentist assesses the teeth, gums, restorations, occlusion, jaw movements, and the condition of the chewing muscles and temporomandibular joints. Based on this information, the most suitable device is determined, including the dental arch, shape, and characteristics of the night guard. The device is then fabricated and tried directly in the mouth.

At the time of delivery, the dentist checks its fit, stability, comfort, and contacts between the dental arches, making any necessary adjustments to the occlusal surface. Subsequent check-ups allow the fit to be assessed and further modifications to be made if the device requires them.

6 How many hours a day and for how long should a night guard be worn?

A night guard for sleep bruxism is generally worn during sleeping hours, every night, according to the dentist's instructions. In cases of clenching while awake, any daytime use must be determined individually. There is no single duration suitable for everyone. The night guard may be used for prolonged periods when clenching, grinding, excessive dental loading, or the risk of damage to teeth and restorations persists. During check-ups, the dentist assesses symptoms, device wear, dental conditions, and response to treatment, determining whether to continue, modify, or discontinue its use.

7 How to clean and store a bruxism night guard?

Proper cleaning helps keep the night guard hygienic and preserve its material over time.

• Rinse the night guard after each use with cool or lukewarm water.

• Clean it daily with a soft toothbrush and a mild cleaning product recommended by the dentist.

• Avoid abrasive toothpastes, bleach, alcohol, and harsh products, which can scratch or damage the material.

• Do not use hot water or heat sources, as they can deform the device.

• Clean the teeth and interdental spaces before reinserting the night guard.

• Store it in its rigid, ventilated case when not in use.

After cleaning, the night guard should be allowed to dry before being stored. Proper maintenance helps limit plaque accumulation, unpleasant odours, deterioration, and loss of stability.