What is a nightguard?

Many dentists provide “nightguards” for patients who clench or grind, and there is a general understanding that they protect the teeth.

However, this is not necessarily true, and there are many different bite splint designs used for different purposes. Bite splints are therapeutic, if and only if they are properly made for the right reasons, with the appropriate design, and at the appropriate time in dental therapy.

Nightguards and athletic mouthguards are often made of soft thermoplastic materials, custom made by a dentist or even purchased over-the-counter.

The rationale is that a soft, rubbery material cushions the teeth and that they are economical.  However, these materials can actually make muscle symptoms and headaches worse because they give the patient something to chew on, and they are not therapeutically stable.  The result can be joint injury, loosening or fracture of teeth, and an increase in the frequency and intensity of tension-type headaches.

There is one type of bite splint that is appropriately made out of soft materials: custom-fit athletic mouthguards.

Athletic mouthguards should only be used to protect the teeth during athletic events from blows to the chin.  Since the most important part of a mouthguard is where it covers the farthest back tooth in the mouth, a dentist should always be involved in the selection of an appropriate mouthguard.

Therapeutic bite splints, or oral orthotic appliances, are custom-made of hard plastic and intimately fit the teeth, typically to manage TMJ problems, some types of headaches, and bite issues.

There should not be significant movement of the bite splint.  The way the teeth fit together on top of the plastic is specific to the diagnosis being treated, and usually several adjustments and modifications are necessary for effective therapy.  Whether bite splints are made to fit the upper teeth, the lower teeth, or even both arches is based on the purpose of the treatment and clinician preference.

Fees for bite splints are actually for the therapy, not necessarily for the piece of plastic used.  Sometimes, variations in the shape of the splint and the amount of teeth that are covered are indicated, depending on the purpose for the splint.