Procedures

Occlusal guards

Procedure overview

Alternate terms: Bite guards; Bite splints; Bruxing appliances; Night guards; Orthotic; Splints.

Occlusal guards are made of rigid or semi-rigid materials like laboratory-processed acrylic. They are generally made to be worn over the biting surfaces of either the upper or lower teeth, and are easily inserted and removed by the patient.

Occlusal guards accomplish three main functions:

• Evenly distribute bite forces to protect the teeth from stresses that can crack or wear them abnormally
• Protect the temporomandibular joints (TMJs) from excessive bite stress that can produce pain and dysfunction
• Reduce the heavy forces generated by the jaw-closing muscles.

Occlusal guards can prevent the destruction of teeth and dental restorations in patients who truly need them, saving the time, expense and potential discomfort of fixing problems that result from clenching the jaw muscles and grinding the teeth. They can also be used to treat patients with temporomandibular joint (TMJ) dysfunction and pain, and people suffering from jaw/facial muscle discomfort and fatigue. It is important to understand whether you are a patient who might benefit from the use of an occlusal guard.

Occlusal guards are prescribed to treat patients who actively clench or grind (i.e. "brux") their teeth.

It is important to establish that a patient has a current bruxism or clenching habit before prescribing an occlusal guard. Patients who have undergone episodes of clenching or grinding their teeth in the past may have teeth that exhibit significant signs of wear. However, they may no longer have the habit. Prescribing an occlusal guard for such a patient would be overtreatment, and would incur unnecessary cost for the patient and their dental plan.

Diagnosing bruxism and clenching

If you have any of the following signs or symptoms, you may be grinding your teeth ("bruxing"), or clenching your jaw muscles. The result can be catastrophic, but early intervention with an occlusal guard is easy and effective:

• Tired or sore jaw muscles ("myalgia")—frequently on awakening
• Clicking, popping, locking or grating in your jaw joints (Temporomandibular Joint Dysfunction, or TMD)
• Pain in your jaw joints when you bite or close
• Chipped or worn teeth, or dental restorations that keep breaking
• Craze lines, cracks, or flat spots ("wear facets") that are visible in your teeth, and get noticeably worse over relatively short periods of time. Your dentist may be able to track it with photographs of key wear spots at each visit.
• Teeth that have notches ("abfractions") at the gum line
• Teeth that are generally sensitive, and other causes have been ruled out.

Was bruxing or clenching in your past?

Bruxing can be episodic, meaning it can follow the patterns of your life. For example, you may have experienced a stressful childhood, stressful job, school-related stress, child-rearing, or another high stress time of your life, when you DID grind your teeth; but perhaps you no longer do. Teeth show the signs of a bruxing history (cracks, wear facets, chips, broken restorations). But without a time history showing the progression of the signs, it's impossible to say (in the absence of symptoms) if you currently have this problem. Here are a few things you might discuss with your dentist before undergoing treatment for bruxism in the absence of symptoms. Especially if you've been told after one visit that you need a nightguard:

• See if your dentist can photograph the wear marks ("facets") and other wear signs (e.g. craze lines) on your teeth and evaluate them for changes for a few successive checkups. Often there will be at least one good landmark (e.g. the tip of a canine tooth) to compare from one visit to another. If no symptoms are present, and the signs that suggest bruxing don't progress, you may not need treatment. But the damaged teeth may need to be restored.
• Conduct an honest appraisal of your stress level history. For example, childhood bruxism may show up as wear facets in the six-year molars and incisors, but not in the twelve-year molars. If the wear planes on your upper and lower teeth no longer line up, your bruxing period may have occurred prior to orthodontic tooth movement, or before your jaw growth and development was complete.
• Pay attention to your symptoms—do you have tired or sore jaw muscles? Clicking, popping, locking or grating jaw joints? Pain when you bite or close (from the teeth or joints)? If the answer to each of these is "no", bruxing might have been in your past.

What else causes tooth wear?

Bruxing isn't the only cause of wear. Teeth that don't mesh properly can wear at an accelerated rate, even under normal function. If you have this problem, Ask you dentist if orthodontics might be an option.

Factitious habits: Repeatedly chewing on hard or abrasive objects, biting your nails, grinding sunflower seed husks and other habits like these can accelerate the formation of wear facets (flattened planes) and chips on your teeth. An occlusal guard won't help with this, but you may need the chipped or worn teeth repaired with bonding, fillings, or crowns. And you should try to quit the habit to avoid re-occurrence.