Just about everyone clenches and grinds at least a little during sleep, and up to 20% of us do it often or vigorously enough to notice the results, including worn-down teeth, jaw pain, headaches and exasperated bed partners.
Dentists and orthodontists have tried many approaches to stop severe grinding, also known as bruxism. Biofeedback, hypnotherapy, sedatives, jaw exercises and other approaches seem to be mildly helpful at best.
Get developments in medicine, nutrition and fitness delivered to your inbox with our The Health Report newsletter. Sign up »
Even if you can't stop grinding, you can try protecting your teeth with the help of a night guard. In theory, a good-fitting guard that keeps your teeth from touching during the night should stop the wear-and-tear.
For $400 to $800 or so, your dentist can set you up with a rigid, custom-fitted night guard made out of a hard acrylic resin. But there's a cheaper option: Soft, plastic night guards that you fit yourself at home. You can buy a package of two DenTek Custom Comfort Nightguards for about $25. The Doctor's NightGuard sells for around $20 apiece. A SleepRight Dura-Comfort dental guard from Splintek costs about $70.
Both the Custom Comfort and Doctor's night guards use boil-and-bite fitting. Users drop a U-shaped mold into boiling water, quickly remove it and bite firmly into the hot plastic to create an impression of their teeth. The SleepRight Dura-Comfort guard, which doesn't need to be boiled, has soft, adjustable bite pads that fit between the upper and lower molars.
Users are instructed to wear their night guards every night and check them regularly for wear. The fitting instructions for the Custom Comfort say it should last an average of six months. According to their respective websites, the Doctor's NightGuard will last six months to one year with normal wear, and the SleepRight Dura-Comfort guard can supposedly last "indefinitely" but only if users can teach themselves not to clench and grind at night. Splintek offers replacements on guards that wear out before six months.
The DenTek website says the Custom Comfort Nightguard offers "custom-fit protection" that will help keep teeth from "cracking, wearing or breaking." The Doctor's NightGuard site says the guard "is a simple and affordable solution for protecting your teeth and jaw from the detrimental effects of nighttime teeth grinding." The Splintek site says the "state-of-the-art technology" in the SleepRight guard "is specifically designed to protect teeth from bruxism."
The bottom line
"Any mouth guard is going to protect the tops of teeth," says Dr. Gary Klasser, an assistant professor in the Department of Oral Medicine and Diagnostic Sciences at the University of Illinois at Chicago. Although high-quality bruxism studies are few and far between, he says, "that's one thing we know almost 100% for sure."
Store-bought guards will be better than nothing, Klasser says, but they fall short of more expensive, professionally fitted rigid guards. Durability is one issue. While the soft, store-bought models claim to last six months or more, really committed grinders can often break through them faster than that, he says. A rigid guard can last for several years. And, he adds, no over-the counter guard can match a dentist's model for fit. "It's the difference between taking an Armani suit to a tailor and going to Wal-Mart and getting something off the rack."
A few studies suggest that soft mouth guards actually encourage grinders to chomp down even harder than usual, Klasser says. "The brain thinks it's a chew toy."
As long as the mouth guard stays intact, the teeth will be protected no matter how hard a person clenches, says Dr. Jeffrey Okeson, chairman of the department of oral health science at the University of Kentucky College of Dentistry in Lexington. But complications of bruxism can go beyond worn-down teeth, he adds.
Some grinders wake up with sore jaw muscles, "as if they'd been chewing on a giant wad of bubble gum for four hours," Okeson explains. If a soft night guard encourages them to clamp down extra hard, the pain could be more intense, he says. So, he says, while soft guards may be worth trying, users should definitely talk to their dentist if they notice new pain or clicking in their jaws.
The Healthy Skeptic has chewed through three over-the-counter guards in the last couple of years. They were all a little uncomfortable -- especially for the first few nights -- and inserting the steaming hot mold into my mouth was definitely not the high point of my day. But I feel like the guards protect my teeth, and Mrs. Skeptic no longer complains about the sounds of crushed gravel in the night.
My dentist has offered to fit me with a rigid guard. But as long as my jaws don't feel sore in the morning, I think I'll stick with my chew toys.