Every once in a while we field calls out of the blue from folks wanting a ‘night guard’. Some have been told that they need a ‘night guard’ to prevent tooth grinding while asleep. There are similar devices to treat ‘bruxism’ (grinding of the teeth) and ’TMJ’ disorders (disorders of the jaw joints). So what’s the difference? All of these devices are basically a piece of plastic that fits over the upper or lower teeth. The decision as to the position of the jaw (a guess at best) and the type of appliance is arbitrarily and left to chance. An upper one would look something like this:
Here is a sampling of appliances that a patient presented with a few years ago, none of which solved the patient’s perceived problem even after multiple adjustments. There are upper and lower devices. Three of the devices were fabricated by ‘specialists’ and were no better than the other two.
These are all ‘custom’ appliances in the sense that custom impressions are made to make appliances that fit the teeth comfortably. If you Google ‘night guard’ you can find a whole variety of devices quite cheaply that claim to help with grinding and TMJ problems. For many patients they can be ‘effective’ in the sense that they can help. However, both custom and off-the-shelf appliances can create significant problems that can be life threatening. When presenting with worn teeth, sore jaw muscles and a myriad of other signs and symptoms, it is not plastic that is needed but a diagnosis. We need to figure out why the patient is grinding, having pain or having any number of other symptoms, often inter-related. One major reason is sleep disordered breathing. If the tongue is restricted due to crowded teeth or the jaws are too overclosed it falls back and blocks off the airway during sleep. Grinding is an adaptive mechanism to open the airway. What do you think happens when you stick a piece of plastic into an already compromised airway? A study done at McGill University shows that these devices can create or exacerbate an existing sleep disorder including OSA (obstructive sleep apnea). It can also further exacerbate an existing ‘TMJ’ disorder. So as a first step we need a proper diagnosis, best performed by a dentist trained in ‘TMJ’ and dental sleep medicine. Many of the same signs and symptoms are common to both conditions and more often than not they co-exist. Often, as in the case above where the patient presented with five nightguards, they all missed the diagnosis; that being a major sleep disorder. I can tell by just looking at the appliances that the jaws are very narrow restricting the tongue. The patient also had many signs and symptoms of a sleep disorder too long to list here. (That needs its own blog post). The standard of care in this case is to refer to a medical specialist for a sleep study called a PSG (polysomnograph). Often resolution of symptoms occurs just with a CPAP unit which provides pressurized air to the lungs and keeps the airway open. An oral appliance specially fitted and calibrated using objective measurements of jaw muscle function by a specially trained dentist, can be used but only by prescription from the sleep specialist. The bottom line is that the current standard of care requires a comprehensive exam and definitive diagnosis before ANY plastic is put in the mouth. Hopefully this explains the rationale. Instead of asking for a night guard, the question should be why am I grinding my teething and what is the most appropriate treatment? This question can only be answered after a thorough assessment.