Why are night guards recommended?
How can a night guard help me? Why should I worry about clenching or grinding? How do you know when a night guard is needed?
Why we recommend them and why you should consider one.
A nocturnal para-functional limiting device, commonly referred to as a Night Guard (NG), is custom designed to protect the teeth, gum tissue and TMJ - jaw joint.
Why are night guards recommended?
Night Guards are recommended based on a suspicion that teeth, gums, and/or TMJ are under greater-than-average force from clenching and/or grinding. These para-functional habits are called bruxism. Without a sleep study, no one can prove that a person is bruxing. Night guard recommendations are always made from indirect evidence that bruxing is occurring. Bruxing can occur during the day or night and can begin or end at any point throughout life. Bruxism is often, but not always, most acute when people are under increased stress.
What is the indirect evidence that we look for before recommending a night guard?
Teeth that have advanced wear/aging will be flattened, shortened and may have "potholes" on their biting surfaces from the splintering of enamel. This results from increased pressure. Gastroesophageal reflux disease (GERD), diet, unusual habits and/or a poor bite can also result in advanced wear.
Teeth may develop gum recession and simultaneous "notches" at the gum line called abfraction lesions. These may or may not be sensitive when under excessive forces. Abfraction lesions result from excessive pressure which fractures the enamel at the gum line. Traditionally, abfraction lesions are explained to patients by saying they are brushing "too hard." This is a remote possibility, but the most common causes of abfraction lesions and gum recession is orthodontics and excessive force on the teeth. Teeth can become looser than normal. All teeth can be moved slightly, however, the excessive movement of teeth may indicate excessive pressure on them.
Gums can develop periodontal pockets and can bleed as the result of excessive pressure. The TMJ may be sore. Symptoms of temporomandibular dysfunction (TMD) are usually described as mild to moderate discomfort around the ear, increased numbers or severity of headaches, upper or lower teeth that "hurt" or are sensitive, popping or clicking with or without pain in the joint itself, or muscle pain in the cheek areas near the molars.
Excessive force on teeth (clenching) is generated from the contracting muscles that close the upper and lower jaw together. These muscles fatigue due to excessive contracting and often become sore. Additionally, the joint is compressed and the cartilage in the joint may become physically distorted and/or damaged.
Night guards are custom fit to the teeth. They physically protect the teeth and prevent the muscles from contracting by opening the mouth slightly (i.e. top and bottom teeth are not in contact). By preventing the muscles from being in their "happy place," or the spot they like to contract, the NG encourages the muscles to relax and relieves the excessive pressure in the joint.
Night guards must be hard. Hard night guards allow the lower teeth to slide around freely when the lower jaw is in motion. The problem with soft night guards, commonly found at local drug stores, is that they exacerbate bruxism because the jaws naturally want to chew soft things. Soft night guards protect teeth but can lead to even worse symptoms in the muscles and joints as a result of these muscles working more and not less. Soft night guards make bruxism worse simply because they are soft and we want to use the very muscles and joints we should be relaxing to "chew" them!