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When Is A Night Guard Not Enough?

In my first years as a practicing dentist, the only real tool I had in my tool belt for helping patients with “TMJ,” clenching their teeth or grinding was a good old fashioned “night guard.” If you have been to the dentist at regular intervals and are an adult, maybe it has been suggested to you at one point or another? Night guards are a great tool and have their place when given to the right patients. However, there are limitations to what it is able to do for management of pain and TMJ-disorders. A night guard will have a limited impact on popping/clicking, joint and muscle pain. And if you’re clenching or grinding because you don’t breathe well, a standard night splint can actually make your symptoms worse.

What a nightguard can do- protect your teeth from damage in the event you are clenching, which can be a huge benefit for many patients. Some people are not even aware they clench their teeth and become aware only when the enamel on their teeth becomes damaged. Stress to the teeth can lead to the need for crowns, root canals, and even lead to tooth loss. Night guards can have a minimal impact on decreasing the force applied to the muscle and joint by preventing the teeth from coming together all the way.

What a nightguard will NOT do- decrease the pressure generated in the muscles you use to clench/chew; decompress the joint space allowing an aggravated joint space to heal; minimize damage to the disc in the jaw; or prevent further deterioration of the jaw joint.

When do you need more than a night guard? And how is a TMJ orthotic or Sleep Appliance different?

If you experience headaches in the morning- specifically in the temples, the neck, the back of the head, or behind the eyes, you may need more than a nightguard.

If you snore, have obstructive sleep apnea, or suspect you might, you may need more than a nightguard.

If you have pain in the joint (pain directly in front of the ear) limited opening, or popping and clicking in the joint, you may need more than a nightguard.

If you have any of the above symptoms, proper diagnosis is key. Finding out the root cause of why you may be clenching and getting a true diagnosis is critical to proper treatment. If you are diagnosed with a TMJ-D issue or a sleep breathing issue, a properly trained clinician will place your jaw in a specific position to minimize the damage to your joint, allowing healing, or take pressure off your muscles by not allowing them to contract, or position the jaw forward to open the airway space to help you breathe. While the appliances appear the same, their function is completely different. Closely monitored follow ups are also recommended to adjust the appliance over time to maintain the proper positioning.

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