Teeth grinding (or bruxism) — which is caused by clenched jaw muscles — can happen day or night. But sleep bruxism is much harder to treat since many of us don’t even know we’re doing it. The condition is also often only detected when seeking treatment for symptoms like headaches, facial or jaw pain, or worn-down teeth — or if a bed partner notices the grinding sound. And ignoring it won’t make it go away — instead, that will oftentimes lead to serious oral issues, including loss of enamel, tooth sensitivity, and a proclivity for cavities, according to Dr. Rashmi Ambewadikar of Astoria Smiles Pediatric Dentistry.
Although teeth grinding was thought to be the result of jaw or teeth misalignment, Dr. Brent Larson, director of the division of orthodontics at the University of Minnesota School of Dentistry, says, “We’ve learned that’s really not the case. People are wired to be grinders, and if they’re grinders, there are certain things that can make it worse.” Among these exacerbating factors are stress and anxiety, caffeine, alcohol, and certain medications. Dr. Michael Gelb, who treats patients with TMJ, headaches, or sleep disorders at the Gelb Center, says there is new research that an airway disorder could also cause clenching. Cosmetic dentist Dr. Lauren Becker shared the same sentiment, explaining that the lack of oxygen in airway obstruction or sleep-disordered breathing “causes the body to activate the sympathetic nervous system, causing the clenching or grinding to occur.” That’s why before going the night-guard route, it’s routine to check patients for breathing-related sleep disorders like sleep apnea or snoring since clenching could be a symptom of those things, too, according to Gelb.
If you do suspect that you’re grinding your teeth at night, the best thing to do is visit the dentist for a full evaluation. In the meantime, or if your grinding is a problem associated with periods of high stress or poor sleep, dentists say over-the-counter mouth guards can be used as a short-term solution — our experts say two weeks to a month — but are not recommended for long-term use. As Dr. Joseph Salim of Sutton Place Dental Associates puts it, the one-size-fits-all approach doesn’t always work — especially as these aren’t made for your mouth — so an over-the-counter mouth guard only helps temporarily until a proper diagnosis. “The intent is certainly not to treat anything of complex nature,” says Dr. Donald Tanenbaum, a board-certified TMJ and orofacial pain specialist. “If somebody has a true problem within the joint itself — a click, a pop, a lock, a profound inflammation — these devices really have no usefulness and they really shouldn’t be used.” What they can do is “diminish the impact to the teeth.” With all that in mind, these are dentist-approved mouth guards to give you some relief before you book an appointment.
Only a doctor can fit you for a custom mouth guard, but for the best-fitting OTC alternative, look for a “boil-and-bite” guard that molds to your teeth. These tend to be the most popular since they’re comfortable and easily found in drugstores, according to board-certified pediatric dentist Dr. Danielle Lombardi. To use it, you just have to put it in hot water to soften and bite into it, which will help set it, says New York City dentist Dr. Lana Rozenberg. “When it sets, you can trim [the excess material], and now you have a semi-custom-fitted guard.”
One of Rozenberg’s favorite boil-and-bites is this one from Oral-B, which has a pleasant, minty flavor and can also be softened in the microwave. Dr. Tannenbaum prefers the microwaveable ones to traditional boil and bite because they are made from a “thinner, lighter, more moldable material.” Dr. Brijesh Chandwani, a dentist specializing in facial pain and jaw-joint disorders, and Ambewadikar also recommend the Oral-B guard. Ambewadikar points out this guard’s sturdiness and size, explaining that the thinness won’t feel bulky inside your mouth.
This mouth guard also covers all the teeth, which makes it a safer option to partial appliances, because there is less of a chance that your teeth will shift – one of the risks of wearing an OTC guard long term, says Dr. Nojan Bakhtiari, a board certified TMJ and facial pain specialist. “Teeth are stupid,” he explains. “Teeth don’t know when to stop growing unless they touch something. One of the reasons your teeth don’t keep drifting out of your jaw bone is because they touch each other at nighttime. So when you wear partial coverage appliances, your teeth could potentially start shifting on you.”
Because they’re ready to use right out of the box, one-size night guards, like these Plackers ones chosen by Salim and Rozenberg, are a quicker solution than boil-and-bite guards — as long as they’re a comfortable fit for your mouth. Designed to be worn on either the upper or lower teeth, these are disposable but can be cleaned with Efferdent tablets, toothpaste, or soap and water between uses. Dr. Bakhtiari says soap, water, and a soft toothbrush is preferable as “toothpaste is just gonna scratch it up and then it’s gonna accumulate bacteria faster.”
With a slimmer design than some of the other popular guards, Rozenberg says this DenTek model offers just as much protection while possibly feeling more comfortable. And even though you can’t boil it or warm it up in the microwave to conform to your teeth, it does come with a five-point adjustable band for a better fit. However, if you have a sensitive gag reflex, it’s best to go with a professionally-made guard, as even these low-profile OTC versions still come into contact with the roof of the mouth, which can be irritating. Also, Dr. Bakhtiari warns that a partial guard that doesn’t conform to your teeth (ahem, this one) can become dislodged during the night, and back sleepers “have a risk of it moving it around to the back of the throat.”
Chances are you probably don’t mind how a mouth guard looks after dark. But in the light of day, you might want one that’s a little less noticeable. Cosmetic dentist Dr. Lilya Horowitz of Brooklyn-based Domino Dental says this mouth guard “does not cover the front teeth, so it may be better for during the day” and “will keep your back teeth apart and may prevent you from grinding into your front teeth.”
[Editor’s note: This guard is only available on Amazon through a third-party seller, so you might be better off buying directly from Target.]
Horowitz has noticed that many patients who clench or grind tend to have a lot of overall teeth sensitivity, echoing what other dentists told us: “When enamel is lost, teeth have lost their protective layer and the nerve becomes more exposed.” So you’ll want to choose a guard to “cover as much of your teeth as possible,” she says. This guard, which she recommends, comes in a pack of four with two different sizes for a more personalized fit.
Chandwani likes this microwavable guard because it only covers the back teeth and won’t bother sensitive front teeth. The snug fit prevents the guard from moving around during the night, which can make it uncomfortable to wear and disrupt sleep.
Teeth grinding can affect all age groups, which can be made even more difficult by baby teeth and braces in the way. Mouth guards are generally safe for tweens and teens, but a discussion with parents, a dentist, and an orthodontist should be had first before buying one, advises Lombardi. The good news is that while bruxism is fairly common in kids, it’s usually “self-limiting and does not persist into adulthood,” Lombardi mentions. For the tween or teen that insists on one, Ambewadikar recommends this pack. “This pack comes with different thicknesses for varying degrees of grinding, so one can pick the one that is most comfortable for their individual mouth,” she says. But adults can use them, too, Ambewadikar says. Horowitz also recommends these guards for adults since they can protect teeth well.
Sometimes teeth grinding and clenching is more than just a sign of stress. “There’s an association that we’ve made recently between clenching at night, and a potential airway problem or sleep disorder,” says Gelb. If you think that the cause of your bruxing might be sleep apnea or snoring, Gelb recommends a mouth guard designed specifically for that, like this SnoreRx guard, which he says “potentially gets more at the root cause for their clenching and actually that would be better for their overall health.” Unlike the others on this list, this guard covers both the upper and lower teeth “which is great so you won’t wear down your teeth.”But it also prevents the lower jaw from dropping back during the night. “When your jaw doesn’t drop back at night it maintains more of an open airway, which hopefully would also reduce the bruxism,” he says. In addition to being a boil-and-bite guard, SnoreRx is also adjustable for even further customization, which means that “if you are snoring or you are clenched in one position, it has up to six millimeters of adjustability so the patient can find the most comfortable place to sleep for their jaw.”
This VitalSleep guard works very similar to the SnoreRx. It holds your jaw and tongue forward and covers all the upper and lower teeth. It also is a boil-and-bite design, but it has even more adjustability — the brand says it can be remolded and readjusted accordingly multiple times. With any of these guards that aim to fix an airway issue, Gelb recommends wearing them for only a month before seeking professional help.
This isn’t a guard exactly, as it doesn’t cover any of the teeth, but if your grinding is snoring-related, this tongue retention device will help keep your airways open. “It pulls the tongue forward at night, and by pulling the tongue forward, it opens the airway,” Gelb says. He also suggests a mouthpiece like this for people with large tongues or dentures.
The Zyppah mouth guard combines both the traditional guard and the tongue retainer. “It controls the jaw and primarily the position of the tongue,” Gelb says. The guard has a tongue strap “that acts as a seatbelt and prevents your tongue from blocking your airway.” This is also customizable with boil-and-bite technology, but no further adjustments can be made.
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