24 Sep
Custom-fit nightguard that fits the teeth perfectly.

Custom vs Over-The-Counter Night Guard

Depending on the application, mouthguards can have different names like occlusal guard, nightguard, mouth protector, gumguard, bite splint, or bite plane. This post discusses occlusal guards (more commonly referred to as nightguards) and why custom-fitted nightguards are the best option if you are looking for superior fit, comfort and more protection. Learn more about the advantages of getting a custom-fit dental guard made specifically for your unique mouth and teeth shape vs the over-the-counter, one-size-fits-all guards that do not align well and often create more problems for your mouth as result.

A dental occlusal guard or splint is a mouth piece worn over the teeth, typically at night. It is used to protect the teeth or dental restorations from the forces of bruxism, such as clenching and grinding, and to treat certain jaw joint issues known as temporomandibular disorders or TMD.

Some of the signs and symptoms suggesting that you may benefit from wearing a custom occlusal guard at night include:

  • wear facets on the teeth;
  • acid erosion wells on the teeth;
  • craze lines (crack lines) on the teeth;
  • chipped, cracked or broken teeth or restorations;
  • cervical abfractions at the gumline of the tooth;
  • gum recession;
  • bone loss;
  • tooth mobility;
  • overly sensitive teeth;
  • teeth that are not fitting well when biting together;
  • supra-eruption of teeth due to wear;
  • scalloped tongue;
  • clicking or popping in the jaw joint;
  • limited mouth opening;
  • deviation of the lower jaw when the mouth opens;
  • jaw locking;
  • hypertrophic and or tender chewing muscles;
  • facial pain;
  • ringing in the ears;
  • frequent headaches.

When Should I Get a Night Guard From My Dentist?

Notice that the majority of the signs and symptoms in the list of above are 'quiet' (asymptomatic) and you can be completely unaware you have them.

The most common reason your dentist will recommend an occlusal guard is if they suspect you clench and grind your teeth. A night guard will protect your teeth from the damage of wear. It is important to understand that wearing a custom guard may not prevent you from continuing to brux your teeth, but the damage will be on the guard acrylic surface, not the teeth. The appliance design will depend on whether you are clencher, grinder or both and whether you have other symptoms.

Our office occasionally will recommend an over-the-counter guard for patients who are completely asymptomatic and have wear facets with no accompanying symptoms, so they can somewhat experience what wearing a splint may feel like. This is done on a limited basis, for few weeks or months only, and should always end with a custom-made guard.

The other reason your dentist will recommend you wear a custom fitted occlusal splint is jaw joint pain and discomfort aka TMD. The appliance design will depend on whether there is joint or muscle pain and other diagnostic factors. Patients who have TMJ pain and discomfort, or even asymptomatic clicking or popping in the jaw should never wear anything but a closely fitted, custom dental night guard.

On many occasions, a custom fitted splint is recommended to be worn by patients who have bone loss and recession, even in the absence of active gum disease.

And finally, a custom fitted guard may be recommended to create an 'occlusal experience'. This means that when the teeth and the bite are not fitting well together and braces are recommended, a diligently developed bite on the appliance can give you an idea of how the mouth, the muscles and the jaw joint may feel once the bite is aligned. A common problem with misaligned teeth is that the bite creates unfavorable forces on the teeth that can have repercussions on the whole mouth.

What Are Other Types of Mouthguards That a Dentist Could Recommend?

Other types of dental guards include sports guards which are specifically made to be worn for teeth protection while playing contact sports.

A snore guard, on the other hand is beneficial if you find yourself snoring and/or have mild sleep apnea issues, while a sleep apnea device is great for patients with moderate or severe sleep apnea disorders.

As mentioned previously, most occlusal guards are worn at night and during sleep. However, for those of us who find themselves clenching their jaw during the day, a day guard is a great option or supplement to a nightguard.

What is the Difference Between a Custom Occlusal Guard vs Over-the-Counter/Store Bought Guard?

Not all occlusal guards are created equal. There is a myriad of boil-and-bite guards that can be purchased online or at the store, and they are one size fits all. Stock mouth guards do not fit as accurately as custom dental guards, they often are uncomfortable to wear and interfere with our sleep.

When not molded correctly, over-the-counter mouth guards do not stay on the dental arch, so you need to clench on it in order to keep it in place. In addition, if you have molded the bite inaccurately, the guard could cause more damage than good. Store bought guards are often much bulkier to wear and typically only fit on the upper teeth.

What Are the Benefits of Wearing a Custom Fitted Occlusal Guard?

A custom fitted occlusal guard does not only mean that an impression or a scan of your teeth has been taken to create the best possible fit. It also means that your dentist has examined your TMJ, muscles, teeth and gums, discussed your medical and dental history, took into consideration your signs and symptoms, and has chosen a splint design and material that best fits your needs.

Custom guards can be made out of hard or soft acrylic, they can be fitted on the upper or lower teeth, they can cover the whole arch or a part of it, they can be completely flat or have a small raised incline in the front, etc. There is no one size fits all. One of the most important aspects of customizing a guard is how your dentist designs your bite on the guard - the way your lower jaw and your teeth bite down on the guard influences the muscles and ligaments of the TMJ and can have a huge impact on the outcome of your symptoms.

How Long Can I Expect My Custom-Fitted Night Guard to Last?

A custom fitted night guard can last you for years. Proper care of the appliance will reduce the amount of build up and bacteria that can accumulate on it. A custom guard can be relined if the bite has changed due to new restorations and some chips, cracks or fractures can be fixed as well.

How Do I Properly Care For My Custom-Fitted Night Guard?

This will depend on the material chosen for the guard, but a good rule of thumb is to make sure you always brush and clean your guard, after taking it out of the mouth in the morning. Nonabrasive toothpaste, or soap and water will work well. You can occasionally use commercial cleaner and soak it in it for few hours. Keep your guard away from pets, as it can be an excellent chew toy for them.

Always bring your guard to your routine dental appointments for hygiene or restorative dental work. A dentist can tell a lot about your bruxing habit by looking at your guard.


Heni Tufa

Dr. Tufa is a general dentist in Acton, MA who is also an Invisalign Provider and certified Botox dentist.