Not All Nightguards Are The Same

There are many different philosophies when it comes to constructing a nightguard. In its simplest form, the primary function of a nightguard is to protect the teeth from the destructive actions of clenching and grinding during sleep. Upper nightguards with a flat surface are a popular and simple solution to to this problem. However, after more than 30 years of studying and treating bites, joints, and airway issues, I have found that while many upper nightguards may protect the teeth from tooth-on-tooth damage, they often disregard important elements of a balanced bite and an open airway.

Traditional upper nightguards are generally made by taking a single impression of the top teeth and palate, and then sending that single impression to a laboratory to have a simple nightguard made. Little attention is given to the physiology of the joints and muscles, resulting in many upper nightguards that actually shove the lower jaw backwards, causing pain and compression in the joint space. Many of these nightguards are also constructed with a flat biting surface for the bottom teeth to slide against. The idea is that the teeth are grinding around anyway, so why not give them full freedom to do so?

The problem with that concept is based on a fundamental misunderstanding of why people clench and grind in the first place. Stress can certainly play a role, but nighttime clenching and grinding can also be a physiological effort to open the airway or to find a more comfortable resting place for the teeth that better supports the joints and muscles. A flat plane that the teeth literally skate around on can actually causing grinding to increase as the muscles and joints struggle to find any resting place at all.

Upper nightguards can also exacerbate breathing problems, especially for those people who already snore, suffer from allergies, or have any form of sleep apnea. Most upper nightguards are fairly thick across the palate. This construction crowds the tongue further back into the throat, constricting the airway. When this happens, patients will often stop wearing the nightguard even if they don’t know why because it feels claustrophobic or simply “too big”.

In my practice, I always recommend and construct lower nightguards for my patients. Even if a patient has no known joint or breathing issues, my goal as a neuromuscular dentist is to always protect the balance that already exists. A lower nightguard allows more room for the tongue and, when constructed properly, holds the lower jaw in a neutral, relaxed position to support the joints and muscles.

When we make a lower nightguard, impressions of both the upper and lower jaw are taken, and a bite registration is used to determine the ideal relationship between the upper and lower teeth when the joints and muscles are at rest. A bite, or resting place, is carefully constructed into the surface of the nightguard. This bite is not a locked position, but rather a subtle suggestion to the teeth to settle into a more relaxed position when not engaged in a grinding activity. Full freedom of movement is still possible and careful attention is paid to potential interferences when the jaw moves forward and side-to-side during the final fittings.

A nightguard is a simple device in theory, but like any other treatment or device that introduces a change in the body, great care must always be taken to reduce or eliminate any unnecessary and unwanted changes to other systems. If you are considering a nightguard, or you have questions about the construction and efficacy of your current nightguard, I encourage you to seek out an opinion from a neuromuscular dentist. Current patients or individuals who would like to become patients within my practice are always encouraged to call or schedule and appointment to further discuss my approach to nightguard construction and to determine if a nightguard is the correct appliance to address all your functional needs.

Martha (Signature)

Clenching and Grinding

In my 31 years of dental practice, I have seen all kinds of wear and damage to the teeth from a variety of accidents and oral habits. But the most common – and the most damaging – activities seem to be the ones that people are the least aware of. I’m talking about clenching and grinding your teeth, and many people clench and grind far more often than they think they do.

The exact causes for these habits are not known, but we do know that stress is often a contributing factor, and there is some evidence that airway problems and severely misaligned bites may also play a role. But many people who have none of these problems still clench and grind regularly either out of habit or some other cause we don’t yet understand.

The muscles that control your bite can generate huge amounts of force – more force, in fact, than any other muscle system in the body. Certainly, teeth can crack and break under that kind of pressure, and the muscles will often go into spasm and cause all kinds of facial pain. But these immediate symptoms can also be compounded by the slow wearing of the teeth caused by years of unconscious grinding. As the teeth are ground shorter and flatter, the bite collapses. The space that those teeth once held open for the joints and muscles to function properly closes, and chronic pain can set in for many people.

It is always sad for me when I see a new patient who has obviously worn away several millimeters of tooth structure through some kind of long-term grinding habit and seems to be completely unaware of it. “Why didn’t anyone ever tell me this was happening?” is such a common question from new patients in this situation, that I find myself asking the same question: Why aren’t we communicating the importance of this information to our patients more clearly?

Protecting your teeth, muscles, and joints from the wear and tear of an unconscious clenching or grinding habit can be as simple as wearing a nightguard appliance during sleep and becoming more aware of whether or not your teeth are pressed together during the day. Stretching during the day – especially when you notice yourself clenching or grinding – can alleviate muscle spasms, headaches, and help break daytime habits.

If you suspect that you may have a habit of clenching or grinding during the day, or at night – and certainly if you suddenly notice in recent photographs that your teeth just don’t seem to be as tall as they used to be – I encourage you to speak with your dentist about what you can do to protect your teeth from further damage.

There is no question that the best teeth you can have for the rest of your life are the ones you were born with. Anything you can do to protect them from damage and avoid the need to replace them with implants, partials, or dentures will always be worth it for the long-term health of your mouth and your body.

Martha (Signature)