GENERAL DENTAL TREATMENTS
Teeth Grinding & Night Guard
An appliance that protects the teeth from wear — it does not treat bruxism
Provided at our clinic in Altunizade, Üsküdar (Istanbul).
IN SHORT
Bruxism is the involuntary contraction of the jaw muscles and the clenching or grinding of the teeth. It can occur while awake (usually clenching) or during sleep (usually grinding). A night guard is a protective appliance that prevents the teeth and restorations from wearing and fracturing; it does not treat or stop bruxism. Bruxism during sleep can occur together with snoring and sleep apnoea; in this case a sleep-medicine evaluation may be needed.
What is bruxism?
Bruxism is the involuntary activation of the chewing muscles. It has two forms, and these are different conditions:
Awake bruxism. This is usually in the form of clenching. The person is often aware of it, or can be made aware of it. It can increase during periods of concentration, stress and anxiety.
Sleep bruxism. This is usually in the form of grinding. The person is not aware of it. It is most often noticed by the sound the bed partner hears, or during a dental examination.
Bruxism is defined not as a disease in its own right, but as a muscle activity. It is addressed when it damages the teeth, restorations or the jaw joint, or when it leads to pain.
What causes it?
A single, definite cause of bruxism is not known. The associated factors that have been reported are:
Stress and anxiety. These are particularly associated with the clenching seen while awake.
Sleep disorders. A link between sleep bruxism and snoring and sleep apnoea has been reported.
The use of caffeine, alcohol and cigarettes.
Certain medications. In particular, this has been reported as a side effect of one group of antidepressants.
For many years bite disorders were thought to cause bruxism. Current scientific evidence does not strongly support this link. For this reason, grinding down the teeth or altering the bite in order to treat bruxism is not an appropriate approach.
Symptoms
Fatigue, pain or tension in the jaw muscles in the morning
A morning headache, particularly in the temple area
Flattening and wear on the cutting and chewing surfaces of the teeth
Increased hot-and-cold sensitivity in the teeth
Frequently fractured or lost fillings, crowns and veneers
Sound, pain or restricted mouth opening in the jaw joint
A white line inside the cheek, level with the teeth
Tooth marks along the edge of the tongue
The jaw muscles becoming prominent, with widening of the lower part of the face
The grinding sound heard by the bed partner
What DOES a night guard do?
It prevents the teeth from rubbing against one another; it prevents wear.
It protects fillings, crowns, veneers and implant-supported prostheses from force.
It distributes the chewing force over a wider area.
It can reduce the load on the jaw muscles and the joint.
What does a night guard NOT do?
It does not treat bruxism. The clenching and grinding behaviour continues; the guard merely keeps the teeth apart.
It does not stop teeth grinding.
It does not remove the stress or the underlying cause.
This distinction is important, because when a night guard is presented as “teeth-grinding treatment”, the patient stops using it after a while and does not realise that the teeth are left unprotected. The guard is a protective appliance and protects only for as long as it is used.
Why is tooth wear important?
Enamel is the hardest tissue in the body; however, it is not living and does not renew itself. Enamel that has worn away does not come back.
As the enamel wears down, the dentine tissue beneath it is exposed. Dentine is softer and wears away much faster. The process speeds up.
In advanced wear the teeth become shorter, sensitivity increases and the height of the tooth is lost. At this point the treatment requires the teeth to be rebuilt with crowns or onlays — that is, a situation that could have been prevented with a night guard turns into a much more extensive treatment.
The link with snoring and sleep apnoea
A link has been reported between bruxism seen during sleep and sleep apnoea, a disorder in which breathing stops during sleep. If the following symptoms are present together, an evaluation in the field of sleep medicine is recommended:
Loud and irregular snoring
Breathing stopping during sleep being noticed by another person
Excessive daytime sleepiness and fatigue
Waking in the morning with a feeling of choking or shortness of breath
When sleep apnoea is left untreated, it can affect heart and vascular health. In addition, in these patients the type and design of the night guard must be assessed separately; some guard designs can narrow the airway.
Types of night guard and the process
Examination
The pattern of wear, the jaw joint, muscle tenderness and the existing restorations are assessed.
Impression
Taken with a conventional impression or an intraoral scanner.
Making the guard
The guard is prepared individually for the person. A hard acrylic material is usually preferred; it has been reported that soft guards can increase muscle activity in some patients.
Fit check
The guard needs to make balanced contact in the bite. A poorly fitting guard can create a problem in the jaw joint.
Regular check-ups
The guard wears over time and its fit deteriorates. It should be checked every six months.
Botulinum toxin application
The application of botulinum toxin to the chewing muscle (masseter) is an option that can be considered in selected cases. What should be known:
It does not treat bruxism. It reduces the contraction force of the muscle. The clenching behaviour continues.
Its effect is temporary; it needs to be repeated at set intervals.
It does not replace the night guard. It does not protect the teeth from rubbing.
The reduction in muscle strength can affect the chewing function.
The first-line approach is the night guard. Botulinum toxin may come onto the agenda, following an assessment by the dentist, in cases where a sufficient result cannot be obtained with the guard and where muscle pain is pronounced.
Supporting approaches
Reducing caffeine and alcohol consumption
Applying warmth to the jaw muscles before going to bed
Becoming aware during the day that the teeth are not in contact and consciously relaxing them. At rest the upper and lower teeth do not touch one another.
Stress management. If anxiety is pronounced, obtaining support in the relevant field
Reviewing the medications being used with the doctor
Risks and points to pay attention to
When the guard is not used, tooth wear continues and is irreversible.
Poorly fitting or ready-made guards can damage the jaw joint.
If the guard is not cleaned, bacterial and fungal growth can occur.
In the first days there may be an increase in saliva and a feeling of a foreign body; this usually settles within a few days.
In patients with sleep apnoea the design of the guard must be assessed separately.
Frequently Asked Questions
No. A night guard is a protective appliance; it does not treat or stop bruxism. The clenching and grinding behaviour continues. By preventing the teeth from rubbing against one another, the guard prevents wear and fractures of restorations. It protects for as long as it is used; when it is stopped, the protection ends.
The most common symptoms are: fatigue or pain in the jaw muscles in the morning, a morning headache in the temple area, flattening on the chewing surfaces of the teeth, increased sensitivity, frequently fractured fillings and crowns, a white line inside the cheek level with the teeth, and tooth marks along the edge of the tongue. Grinding during sleep is most often noticed by the bed partner.
A single, definite cause is not known. Stress and anxiety, sleep disorders, the use of caffeine and alcohol, and certain medications are reported as associated factors. The view that bite disorders cause bruxism is not strongly supported by current scientific evidence; for this reason, grinding down the teeth in order to treat bruxism is not an appropriate approach.
Ready-made guards are not individually fitted and do not make suitable contact with the bite. Instead of providing protection, a poorly fitting guard can create a problem in the jaw joint. The guard needs to be prepared individually and its fit checked by the dentist.
A link between bruxism seen during sleep and sleep apnoea has been reported. If there is loud snoring, breathing stopping during sleep being noticed, excessive daytime sleepiness, or waking with shortness of breath, an evaluation in the field of sleep medicine is recommended. In these patients the design of the night guard should also be assessed separately.
No. Botulinum toxin applied to the chewing muscle reduces the contraction force of the muscle; it does not remove the clenching behaviour. Its effect is temporary and it does not replace the night guard — it does not protect the teeth from rubbing. The first-line approach is the night guard.
Protection continues for as long as the guard is worn. On the nights it is not worn, the teeth are left unprotected. The guard wears over time and its fit deteriorates; a check-up every six months is recommended.
No. Enamel does not renew itself; enamel that has worn away does not come back. In advanced wear the teeth may need to be rebuilt with crowns or onlays. For this reason it is important to stop the wear at an early stage.
Related treatments
The content on this site is for information only and does not replace a clinical examination. The suitability, duration and scope of treatment are determined after a clinical assessment.
This content was prepared by Dt. Mevlüt Yazıcı.
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Altes Diş Kliniği
Altunizade, Üsküdar, İstanbul
- PHONE+90 533 474 43 94
- EMAIL[email protected]
- ADDRESSAlperen İş Merkezi, Valide-i Atik Mahallesi, Altunizade, Nuhkuyusu Cd D:191/B, 34664 Üsküdar/İstanbul
- WORKING HOURSWeekdays 10:00–19:00 · Saturday 10:00–16:00 · Sunday closed