Why Every Dentist We Spoke to Said to Avoid Over-the-Counter Night Guards
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A night of solid sleep is supposed to mean you leap out of bed, twirl around your bedroom and breeze out the door to conquer the universe.
But if the main thing you notice as you stagger to the coffee maker is that your jaw or teeth ache, or that you have a headache, you might be clenching your jaw or grinding your teeth in your sleep, a condition known as bruxism. Not everyone has these symptoms of bruxism, but your dentist may call it out: Tooth damage, unusual wear on your enamel, white scars on the inside of your mouth or half-moon shaped "scallops" around the edge of your tongue are all tipoffs, says Nojan Bakhtiari, DDS, FAAOP, a dentist in New York City who specializes in temporomandibular joint (TMJ) and orofacial pain.
It can be tempting to pick up an over-the-counter night guard at the pharmacy, but hold up! The ones you’ll find hanging there near the floss picks may cause more harm than good if you wear them for any length of time, according to every dentist Good Housekeeping spoke to for this piece. So, let's get to the bottom of this.
What is a night guard?
Also called an occlusal splint, a night guard is “a removable appliance that can be used in either the upper or lower jaw and covers the surface of the teeth,” explains Sercan Akyalcin, DDS, MS PhD., head of orthodontics at Harvard School of Dental Medicine. They’re usually made of plastic or harder acrylic, and are used to treat sleep bruxism, certain jaw disorders and obstructive sleep apnea (OSA) which is a sleep disorder where your throat muscles relax and block your airway, causing you to wake up gasping for breath. Because you stop breathing multiple times in the night, sleep apnea is related to host of chronic illnesses, including high blood pressure, diabetes and it ups your risk of heart attack and stroke.
Is it good to sleep with a night guard?
A well-fitting night guard made of the right materials can be helpful in managing several conditions. It can protect your teeth if you’re prone to grinding and clenching in your sleep, and some doctors use them as part of treatment for jaw-joint related disorders to help manage pain and headaches, says Dr. Akyalcin.
There is also a particular kind of sleep guard that temporarily repositions your jaw to help keep your airway clear while you sleep, used to treat mild to moderate obstructive sleep apnea. Your dentist won’t diagnose OSA, but may give you a referral. “Sleep apnea is a medical condition and should be diagnosed with a sleep doctor,” says Kami Hoss, DDS, M.S., an orthodontist in Chula Vista, CA and author of If Your Mouth Could Talk. The sleep specialist may then send you to a dentist who specializes in fitting a device particular to your anatomy, he says. A night guard like this may be a one-two punch: Research shows that many people who grind their teeth also have OSA, though they haven’t nailed down exactly why; these devices can manage both.
But while dentists and specialists recommend night guards, “the literature lacks robust evidence to support or deny their usefulness,” says Dr. Akyalcin. Whenever possible, says Dr. Hoss, the ideal solution to the symptoms caused by teeth grinding, jaw problems and sleep apnea is to address the root causes of these conditions.
As to whether a night guard is inherently good for your teeth, the answer is no — there is no added benefit to sleeping with a night guard if you don’t have a condition that requires treatment, and because any night guard can trap bacteria against your teeth if not properly cleaned, if you don't have a medical need for one, it's better not to wear one.
Types of night guards
Night guards are made differently depending on what they’re meant to treat, but broadly, there are three types.
Over-the-counter night guards.
These are inexpensive, and often come with instructions to boil or microwave the device to soften the material, and bite down on it to fit it to your teeth; others are one-size-fits-all. They cost between $18-$30.
Over-the-internet night guards.
There are a slew of companies that manufacture night guards in a lab. These types of guards usually involve you taking an impression of your own teeth with a kit they provide, then sending the impression in to the company, which then makes your night guard from that impression. These run between around $100 and $200, depending on what comes included with your night guard.
Dentist-fitted custom night guards.
Your dentist or specialist (sometimes working with a sleep specialist if OSA is the problem) takes an impression of your teeth, and sends the mold off to a specialty lab, where your device is made. Your dentist then has you try it on to make sure it fits properly, is comfortable and that your bite is aligned exactly right so your teeth bear the weight evenly, adjusting it as needed. These are more expensive, between $300 to $1000 for a simple mouth guard for bruxism, to around $2000 or more for a more complicated mouth guard for OSA, before insurance.
So what type is best? Hands down, a custom mouth guard overseen by your dentist or specialist is the best. “I never, ever recommend an over-the-counter night guard,” says Dr. Hoss. “I would absolutely want to get a custom-fitted one, since you’re going to wear this in your mouth for hours at a time.”
Risks of OTC or OTI night guards
The dentists we spoke to want you to hear one thing loud and clear: The mouth is a sensitive place, and even small shifts in your bite or muscle imbalances can lead to bigger problems with your teeth and jaw. “Any time you introduce something in your mouth overnight, you can potentially cause harm,” says Dr. Bakhtiari. “It can benefit you, but it can also affect the homeostasis of your jaw and mouth and have a negative impact.”
That's why when it comes to night guards, a precise fit and the right materials are crucial. “Issues with over-the-counter guards relate to the nature of their fit, material quality, durability and the environment they can create in place,” says Dr. Akyalcin.
But before you think, Of course dentists don't like OTC night guards, since they make bank if I pay for a custom guard, check out their reasoning, below.
Here are a few potential risks.
You may have OSA and not know it.
As many as 90% of people who have it are not aware that they do, according to Johns Hopkins Medicine. Snagging a night guard at the drugstore or over the internet means there is no one to look into your mouth. “With any of these night guards, you should do an airway check first — if the person may have OSA, a guard can make the problem worse,” says Dr. Hoss. “If you’re at risk of sleep apnea, tongue space is very important,” adds Dr. Bakhtiari. “Any mouth guard that takes up tongue space can be a problem.”
Your bite can be thrown out of alignment.
Fitting your own night guard means some of your teeth may not be covered; wearing it for any length of time may cause your teeth to shift, says Dr. Bakhtiari. Michael J. Wei, DDS, DIADFE, a cosmetic dentist in New York City, agrees. “Constantly wearing a mouth guard that doesn't fit properly can weaken the jaw muscles and contribute to orthodontic issues, like shifting of teeth or changes in the bite pattern,” says Dr. Wei.
Too-soft material leads can lead to muscle pain.
You bite down, and the device bounces back. “It’s like chewing gum — your jaw muscles become stronger due to resistance training,” says Dr. Bakhtiari, who says that many of the drugstore models are made of too-soft material. “Think of a bicep curl: If there is resistance, the muscle is going to get stronger.” Stronger muscles mean you'll be grinding harder.
They can lead to TMJ pain.
The temporomandibular joints, up by your ear, are responsible for the movement of the jaw. A poorly fitting mouth guard can place uneven pressure on the TMJ, leading to discomfort and possibly temporomandibular joint disorder (TMD),” says Dr. Wei. You don’t want TMD, the symptoms of which include pain, headaches, jaw locking and difficulty opening and closing your mouth.
There’s no one to catch any of these problems.
“Dentists are trained to take accurate impressions and ensure the mouth guard fits properly for the specific needs of each patient,” says Dr. Wei. “You will run into problems and issues like not fitting accurately in your mouth, not comfortable to wear, and no protection of your teeth because there is no supervision from a dentist.” A dentist takes up to 45 minutes to fit and adjust a mouth guard, says Dr. Bahktiari, to make sure the entire mouth-and-jaw system are working harmoniously.
To be clear, many people will have no problem at all with an over-the-internet or OTC night guard. “The question is, how do you know if you’ll be one of those?” asks Dr. Hoss. “If it were my son or daughter or me, I would not take the risk.”
Other FAQs
Does insurance cover night guards?
It depends on your policy, and what medical issue the night guard is meant to treat. If the night guard is considered medically necessary (as for sleep apnea or bruxism) your insurance may cover a percentage of the night guard. Your dentist or doctor should let you know how much, if any, of your night guard will be covered.
Can a night guard be worn with braces?
For people with metal braces, an over-the-counter guard or internet night guard, aside from all the risks listed above, might not be comfortable and could damage the hardware. “If you use the boil-and-bite guards over brackets, that could cause harm,” says Dr. Bakhtiari. If you have wired braces, the best thing to do is speak to your orthodontist, who may be able to construct a solution. “But that is a challenging scenario,” he says.
Kelly Suralik, D.M.D., M.S., a prosthodontist at the Mayo Clinic in Rochester, MN, agrees. “Wearing bite guards with braces proves difficult as teeth are moving in orthodontic therapy and not stable to keep the guard in place.”
One option might be to switch to clear aligners, says Dr. Akyalcin, but because they're so thin, grinding could wear them out quickly. When the braces come off, however, it’s possible to get a retainer that both keeps your teeth straight and protect against grinding. “I always recommend that my patients have custom occlusal sprints fabricated using hard materials that can simultaneously serve as night guards and retainers,” he says.
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