Occlusal splints and night guards

Most people who grind their teeth do not know they do it. Grinding and clenching — bruxism — happens largely during sleep, and the force involved is many times greater than the force used in normal chewing. The damage accumulates quietly over years.

A custom occlusal splint is a hard, precisely fitted appliance worn over the upper or lower teeth. It takes the load that would otherwise fall on your enamel, and it can reduce strain on the jaw joint and the muscles around it.

From $950.

Signs you may be grinding

• Waking with a dull headache, aching temples, or a tired, tight jaw
• Sore jaws while eating, particularly at breakfast
• Teeth that are flattening, chipping at the edges, or wearing shorter
• Chips or notches at the gumline
• Teeth that feel loose, or fillings and crowns that keep failing
• Sensitivity to hot and cold as enamel thins
• Ear ache with no ear infection
• A partner who can hear it
• A scalloped edge to the tongue, or ridged lines along the inside of the cheeks

Clenching and grinding are frequently linked to stress. They can also follow from missing teeth, worn teeth, or a bite that does not meet evenly.

Night grinding and daytime clenching are not the same problem

Worth separating, because the treatment differs.

Teeth should only touch when you swallow or chew. If yours are together as you read this, that is awake clenching, and no appliance fixes it as well as noticing does.

How wear progresses

Why it matters

Enamel does not regenerate. Wear is cumulative and permanent, and by the time front teeth are visibly shorter a great deal has already gone. Severe wear is one of the more expensive things to correct, because rebuilding worn teeth often means crowns or onlays across many of them at once.

A splint is cheap by comparison, and it is preventive rather than restorative. That is the whole argument for having one made before the damage is obvious rather than after.

Grinding, or acid?

They are often confused, and they are managed differently. Grinding leaves flat, matched facets on opposing teeth, with sharp enamel edges. Acid erosion leaves rounded, scooped, glossy surfaces — typically on the inner surfaces of the upper front teeth and the biting surfaces of the lower molars — and it does not match up between the arches.

Many people have both. A splint addresses one of them; the diet, reflux or timing addresses the other. Guessing wrongly means treating half the problem.

Something worth mentioning to your doctor

Sleep bruxism is associated with obstructive sleep apnoea. If you snore heavily, wake unrefreshed, stop breathing in your sleep according to a partner, or are sleepy during the day, mention it to us and to your GP.

This matters for two reasons. Apnoea is a health issue in its own right and worth diagnosing. And where grinding is driven by disturbed breathing, treating the breathing often helps the grinding in a way that no appliance can.

We are not sleep physicians and we will not diagnose it. We will tell you when it is worth asking about.

What a splint does — and what it does not

A splint is a protective appliance. Worn as directed, it absorbs and distributes the force so it is spent on the appliance rather than your teeth, and it stops opposing teeth grinding against one another.

It is honest to be clear about the limits: a splint does not stop you grinding. It protects the teeth while the grinding continues. Many patients also find their morning jaw pain and headaches ease, because the appliance changes how the muscles load, but relief varies between individuals and is not guaranteed.

It also does not treat sleep apnoea, does not rebuild teeth already worn, and is not a treatment for a clicking joint on its own.

Types

Hard acrylic full-coverage splint. The standard and the one we usually make. Durable, adjustable, covers all the teeth in the arch so nothing is left to over-erupt.

Soft splints. More comfortable initially and cheaper. They can make grinding worse in some people, because a soft surface invites chewing, and they cannot be adjusted precisely. We generally do not recommend them for bruxism, though they have a place for some patients.

Partial-coverage appliances that cover only the front teeth are sometimes sold for headaches. They carry a real risk of the uncovered back teeth over-erupting and the bite changing permanently if worn long-term without supervision.

This is one of the reasons the appliance should be prescribed and reviewed rather than bought.

Three appliances that look similar and are not

A retainer does not protect against grinding and will wear through. A sports guard worn nightly can make grinding worse. If you need more than one, you need more than one appliance — see sports mouthguards.

Why it must be dentist-prescribed and dentist-fitted

Several websites will post you an impression kit and mail back an appliance. We do not recommend it, for a specific reason.

Casting an appliance that sits over your teeth is the straightforward part. Adjusting it so that your bite meets evenly across it is the part that matters, and it cannot be done remotely. An appliance that contacts on only a few points can load those teeth heavily, move them over time, or aggravate the jaw joint — producing exactly the symptoms it was meant to relieve.

At the fitting appointment your practitioner adjusts the biting surface until contact is even, and checks how your jaw moves across it. That is why the appliance is prescribed, fitted and reviewed rather than simply supplied.

What is involved

1. Assessment. Examination of the wear on your teeth, your jaw joint and muscles, and your bite. Radiographs where indicated.
2. Records. Impressions or a digital scan of both arches, plus a record of how your teeth come together.
3. Fabrication. Your splint is made to those records by an Australian dental laboratory. We work with local labs, which keeps turnaround short and materials to Australian Standards.
4. Fit and adjust. The appliance is seated and the bite is adjusted until it is even and comfortable.
5. Review. A short follow-up to check comfort and make any final adjustment as you settle into wearing it.

Most people adapt within a week or two. Increased saliva and mild awareness for the first few nights is normal.

Getting used to it

The first few nights are the hardest. Some people find it easier to wear it for an hour or two in the evening before attempting a full night.

Expect more saliva at first, and a slightly odd bite feeling for a few minutes each morning after you take it out. That morning sensation should settle within minutes. If your bite still feels different an hour later, come back and have it checked.

If you take it out in your sleep without noticing, that is common early on and usually stops as you adapt.

Come back rather than persevere if

• A single tooth feels sore after wearing it
• Your bite still feels wrong more than an hour after taking it out
• It rocks, or clicks in on one side only
• Your jaw pain is worse rather than better after a few weeks
• It makes you gag every night rather than settling

All of those are adjustments, not reasons to abandon the appliance in a drawer.

Caring for it

• Rinse under cold water and brush gently with a soft brush and a little liquid soap each morning. Toothpaste is abrasive and scratches the surface
• Let it dry before storing it in its ventilated case
• Never use hot water, and never leave it in a car. Heat warps acrylic permanently
• Bring it to every check-up so we can inspect it and check the fit
• Keep it away from pets
• Soak it occasionally in a denture-cleaning tablet solution if it develops a film — not in mouthwash, and never in bleach

Lifespan

A well-made hard splint commonly lasts several years. Heavy grinders wear through them faster, and a splint that is visibly worn through in places is doing its job and needs replacing.

The appliance also stops fitting if your teeth change — new fillings, crowns, extractions or orthodontic movement. Bring it in after any of those so the fit can be checked.

Children and teenagers

Grinding is common in children and most of them grow out of it. Because their teeth and jaws are still changing, a rigid splint is rarely the answer, and an appliance made this year may not fit next.

What is worth doing is mentioning it at check-ups so the wear can be monitored, and raising snoring or mouth breathing with your GP, since disturbed sleep is part of the picture in some children. Where a teenager is grinding heavily with visible wear, an appliance becomes a reasonable conversation.

Alongside the splint

A splint protects. These may reduce the grinding itself:

• Addressing stress, which is the commonest driver. Exercise, sleep routine, and whatever works for you
• Reducing caffeine and alcohol in the evening, both of which fragment sleep
• Treating any underlying sleep-disordered breathing, as above
• Physiotherapy for the jaw muscles, where muscle pain is prominent. See jaw pain and TMD
• Reviewing medications with your doctor, since some antidepressants are associated with bruxism
• Simple daytime awareness — lips together, teeth apart, tongue resting on the palate

Botulinum toxin into the chewing muscles is sometimes discussed for heavy clenching. It is not provided at this practice, and it is a prescription medicine decision rather than a dental appliance one.

Cost and claiming

From $950, with the final figure quoted after assessment. You receive a written plan before anything begins.

Splints usually fall under major dental on extras policies, with annual limits and waiting periods that can run to twelve months. Ask us for the item numbers so you can check with your fund first. HICAPS on-the-spot claiming; Afterpay and Zip accepted. See payment options.

Questions we are asked

Upper or lower? Either works. Upper is more common; lower is often better tolerated by people who gag.

Will it stop my headaches? It often helps, and it is not guaranteed. Tell us if there is no change after a few weeks.

Do I wear it every night? Yes, unless told otherwise. Intermittent wear gives intermittent protection.

Can I use a chemist mouthguard instead? A sports guard is not designed for this, is too soft, and cannot be adjusted to your bite.

Will it fix my worn teeth? No. It prevents further wear. Rebuilding what has already gone is separate treatment.

My partner says I have stopped grinding — can I stop wearing it? Most bruxism fluctuates rather than resolves. Keep wearing it and let us assess the wear at your check-ups.

Will it move my teeth? A full-coverage splint that is fitted and reviewed properly should not. Partial-coverage appliances worn unsupervised are the ones that do.

Can I wear it with a retainer? Not at the same time. Tell us you wear a retainer so the splint is designed around it and your teeth are not left to drift.

I grind but my teeth look fine — do I need one? Not necessarily. If there is no wear and no pain, monitoring is reasonable. The point of checking is to catch the change early.

Can I wear it when I travel? Yes, and take the case. More splints are lost in hotel rooms wrapped in a napkin than anywhere else.

Victorian Dental Group is a general dental practice in Malvern East and holds no specialist registration. Where jaw joint problems need specialist or medical input, we will say so and refer you.

Victorian Dental Group — 291 Wattletree Road, Malvern East VIC 3145 · (03) 9088 5808 · Monday to Friday, 8:00am–5:00pm · book online

This page is general information and does not replace advice from a registered dental practitioner about your own circumstances. Please see our Disclaimer.