Tell me about night guards

March 28, 2024 1:00 PM

My husband is a clencher and it's a problem.

He has run out of people to complain about this to, as he has told every GP, dentist, endodontist, and rheumatologist he's seen, all of whom are like, "nothing is obviously wrong, get a night guard."

So he's gone to drug stores and gotten whatever night guard is there, and for two nights he's like yeah, that definitely helped but by like the fourth night he's like I don't think it's working anymore.

And then we're back to him trying anything he can think of to relieve the tension and pain in his jaw - CBD ointment, unguents and liniments, heat, cold, massage gun, sometimes he just puts his own thumb between his teeth to force his jaw open for a while. He already takes a mag-cal-zinc supplement to relax more when he sleeps, sleep meds don't help any, and he doesn't want to take the amount of nsaids it would require to get any relief (and it's not full relief).

When I google "night guard", there is CLEARLY an entire world of night guards out there, so this sort of feels like a bunch of doctors going "your feet hurt? get some shoes!" Like, why is nobody falling over themselves to sell him some kind of overpriced appliance? Because it appears there's a market.

So, clenchers of AskMe: do you have any strong advisories about particular night guards? Or any other clench-adjacent treatments, maybe some different positioner for his head/neck when he sleeps? Is there a secret specialist nobody wants to refer him to? He's so sad when it hurts, and it's been especially bad lately and he's miserable.

posted by Lyn Never to Health & Fitness (37 answers total)

Not sure if this helps, but Colgate's website recommends placing the tongue by the teeth to reduce grinding. I've been worried about clenching at night so I've started resting my teeth on my tongue and letting my tongue stick out a little from the teeth. What is his tongue position when he falls asleep?
posted by DetriusXii at 1:06 PM on March 28 [1 favorite]

Slightly confused--no one's offered him a custom-made night guard, which should (in theory, anyway) fit better?

(Sorry he's in such discomfort. It must feel rotten!)
posted by praemunire at 1:07 PM on March 28 [22 favorites]

I have an NTI style night guard that fits onto just my two top front teeth. It's my ride or die, I will evangelize about this thing at any opportunity. It changed my life in re my clenching and terrible TMJ.

Mine was made and fitted by a dentist 15+ years ago. I have no idea how you get one, but if something happened to mine I'd tell my dentist "I need a new NTI style night guard" and if I had any push back I'm not sure exactly what I'd say but I wouldn't hesitate to make it ugly. It is the only style of night guard that has ever given me any long term relief.
posted by phunniemee at 1:10 PM on March 28 [7 favorites]

My dentist made a custom bite guard for me by taking a mold of my teeth. It's great. It's way better then the off the counter stuff you can get at Target or whatever.

I don't know if it will help and it cost some money but it's definitely something to consider.
posted by kbanas at 1:10 PM on March 28 [10 favorites]

Surely a dentist will offer a custom night guard that will partially covered by any dental insurance you all might have? I had one, and it was much better than the drugstore version.
posted by bluedaisy at 1:14 PM on March 28 [7 favorites]

But also I'd say that amount of clenching can be related to anxiety, medications, etc. So the bigger picture might be something annoying like "Reduce stress." Which is why so many of us have custom night guards.
posted by bluedaisy at 1:15 PM on March 28 [3 favorites]

so the dentist absolutely should have made him one by now. it will be very expensive and insurance may or may not cover it. this is 1 of 2 things that has ever worked for me. they are custom molded and thick and i grind thru one in a year.

one time, when money was very tight i tried pro teeth guard. it was literally exactly the same as i got from my dentist at a mere fraction of the cost. and when i thought i messed up the impression, they sent me another kit just in case. i did this maybe 6-8 years ago, so i'm sure prices have gone up, and maybe service has gone down, but i highly recommend you check them out if for some reason you don't want to do the dentist.

either of these will work way better than off the shelf at big box store.

edit: i got the "hard night guard"
posted by misanthropicsarah at 1:15 PM on March 28 [4 favorites]

My understanding (IANAD) is that the night guards don't specifically reduce clenching and grinding, they reduce tooth damage from clenching and grinding. I have a guard and I can tell I still clench my jaws at night sometimes. If he's still clenching then he's still using those jaw muscles and putting pressure on the joints, so yeah, that's probably why it still hurts. Not sure what to do other than, you know, stop clenching. (Easier said than done, obviously.)
posted by number9dream at 1:19 PM on March 28 [11 favorites]

Mouth guards are not the only option - see also.
posted by Tandem Affinity at 1:21 PM on March 28 [2 favorites]

Here's some information on how and why an NTI guard is different.
posted by phunniemee at 1:26 PM on March 28 [3 favorites]

Just as a data point, I had an NTI nightguard and it totally screwed up my bite (if I ever want my front teeth to touch again, I'll need orthodontia AGAIN.) I now have a traditional (custom) nightguard that fits over my bottom teeth, and that's been great for me for 5+ years. It has stopped the damage to my teeth, improved my TMJ, and helps my sleep quality.
posted by juliapangolin at 1:30 PM on March 28 [5 favorites]

I've never used a night guard because yeah, it doesn't stop the clenching it just prevents tooth damage, and since I don't grind and my teeth are fine it is not worth it.

When I am in a bad TMJ cycle, it's always triggered by higher-than-baseline stress which is annoying but true. And what sucks is once it starts, it gets harder and harder to even know what a relaxed position IS for my jaw. I become hyper-aware of my jaw position and am capable of clenching muscles while my jaw is still open, so that's no cue. When this happens, the best relief for me is stress reduction (easier said than done) and self-massage.
posted by misskaz at 1:32 PM on March 28 [1 favorite]

I am perplexed as to why his dentist isn't falling all over themselves to make him a custom night guard. It's true that it won't totally prevent him from clenching and jaw pain, but it's a pretty standard intervention.

He should also talk to his GP about it, who can likely refer him to a physical therapist who treats bruxism.
posted by desuetude at 1:33 PM on March 28 [7 favorites]

Echoing number9dream. I’ve had multiple types of custom night guard made by dentists and they haven’t helped much with the muscle tension. The guard just gives my jaw something to clench on. On the other hand I know people who have seen real improvement with those guards, so the first step is still probably to try a custom one from a dentist.

Years ago I went to a TMJ specialist. He prescribed muscle relaxant meds to take before bed (didn’t really help) and some stretching/self massage exercises (helps a bit when I remember to do them consistently.) The proposed next steps were Botox injections and a custom top-and-bottom guard. The quote was high ($3000ish for the guard, $1500ish for the Botox iirc, both unlikely to be covered by insurance) so I didn’t proceed. I tried PT, went to a massage therapist certified in intra oral massage, and was lucky to switch to a lower-stress job. Things improved for a while but lately I’ve been having issues again, and my current nightguard now hurts to wear. Last time I went to my regular dentist I asked about replacing it. She suggested I check back in with the TMJ specialist since the muscle tension is my main issue. I’m mulling it over though I can only assume the cost will be even higher now.
posted by doift at 1:43 PM on March 28 [2 favorites]

My dentist offered 2 types of custom night guards, one was about $100 and the other considerably more. Not having insurance but I took the cheaper of the two and figured I'd see how long it lasts since he said it's different people grind them down at different rates.

When I was having terrible stress and was really clenching, I had online acquaintances who had pursued getting boxtox for bruxism. At the time (this was probably mid pandemic) I couldn't find a lot of evidence that it would help, but when I google it now it certainly seems to have increased in popularity. So that might be a treatment (not a cure!) he considers.

It's good to take it seriously, my father's clenching and teeth grinding eventually resulted in nerve damage, terrible tinnitus and significant hearing loss.
posted by snowymorninblues at 1:44 PM on March 28 [2 favorites]

My husband's been using this SleepRight guard for the last several months. He wears it every night and notices/misses when he forgets to put it in. As a data point, he worked in the dental field for 20+ years and never wore a nightguard during those years but this is definitely something that your dentist should've talked to you about if you've brought it up.
posted by jabes at 1:47 PM on March 28 [2 favorites]

Okay, this has a high risk of coming off wrong since you're writing for help for your husband, but here goes. I used to grind my teeth so much that I cracked two molars doing it. My dentist did make me a custom night guard, which is definitely what you should pursue when it comes to night guards.

But also: Maybe your focus should not be solely on the night guard. Because as soon as I got out of my unhappy marriage, the grinding stopped all on its own and has never come back in all these years. I'm not saying you are the source of his teeth grinding!! I'm just saying that it may be situational (even long-term) and it's worth spending some time on this aspect.
posted by HotToddy at 2:29 PM on March 28 [1 favorite]

Response by poster: Yeah, this is concurrent with and absolutely exacerbated by some personal development work, which is well-supported by professionals for that sort of thing but the mention of Physical Therapy has set off some lightbulbs. I love PT and that's a damn good idea.
posted by Lyn Never at 3:08 PM on March 28 [5 favorites]

When I got a CPAP and started sleeping with my mouth closed / breathing through my nose, my teeth clenching basically stopped. Maybe because now my tongue is near my teeth, as DetriusXii says? I don't suppose you could get a CPAP prescribed just for this, but if there's a chance he also has sleep apnea and could/would/should get one for that, it might also help with this.

(It also has vastly helped my allergic rhinitis, presumably because it blows humidified filtered air into my face all night)
posted by librarina at 3:19 PM on March 28 [1 favorite]

In terms of mouth guards - my dental hygienist, when I expressed surprise about the cost of my dentist’s recommended mouth guard, on the sly, passed me a post-it with the name of an online mouth guard company that mails you the material to make your own mould at home that you mail back in and they use that to send you back a custom fit mouth guard that as far as I know is just as legit as the ones the dentists do in the office. It was hundreds of dollars less than what my dentist was quoting me. I’ve been using it for a year and it’s been great.

In regards to the clenching. . . Has he considered seeing a therapist to generally address issues of stress/anxiety/trauma? If he’s really interested in just the clentching/jaw area it could help to meet with a good somatic psychotherapist who can really focus on what, if anything, psychologically/emotionally he might be “holding” in his jaw.
posted by flamk at 3:41 PM on March 28 [3 favorites]

My dentist kept urging me to get a night guard. I was skeptical and kept declining. Finally, my jaw hurt enough that I accepted a custom-made night guard from him. It cost $600. Half was paid by insurance, so my out of pocket was $300. That was a few years ago. I still have the same night guard and I absolutely adore it. No more waking up with a painful, sore jaw every morning. It was practically life-changing.
posted by SageTrail at 4:12 PM on March 28 [3 favorites]

One more note: It took me a while to adjust to wearing the night guard, but once I did, it really paid off!
posted by SageTrail at 4:34 PM on March 28

Your husband should look up pterygoid muscle massage. It hurts like the dickens, but reduces TMJ pain immensely. You do have to shove your hand in your mouth, which some people don't like.

Also, nthing dentist night guard. The ones from the dentist and the ones you get in the drug store are not in the same ballpark.
posted by Geckwoistmeinauto at 4:51 PM on March 28 [1 favorite]

I also tried all sorts of drugstore night guards and they were all garbage. A night guard made by my dentist for $400 was much better. It doesn’t keep you from clenching but absorbs the impact and for me this has adequately solved the problem. My endodontist recommended physiotherapy, which I haven’t tried.
posted by frau_grubach at 5:55 PM on March 28 [1 favorite]

I clench/grind and have a custom night guard from my dentist. It protects my teeth but makes the clenching even worse (bc I have something to bite I guess?) so I stopped using it.

The one thing that has helped is acupuncture - if I go regularly, I rarely wake up with a sore jaw. If I stop going for a few months, I start waking up with jaw pain again.
posted by maleficent at 6:06 PM on March 28

Would your husband consider masseter Botox? It’s been a godsend for my clenching, which also gets worse at times of high stress. My dentist does it in-office and actually recommends it over an NTI style of nightguard because an NTI can change your bite in undesirable ways. And although YMMV I always felt like my NTI made things worse, maybe for the reason maleficent suggests.
posted by stellaluna at 6:31 PM on March 28

The thing I’ve had the most success with is taking a couple of magnesium (glycinate or citrate, specifically) before bed. I know that sounds too simple but I was a serious, life-long clencher (tooth damage over here too!) and it’s made a significant difference. For me it greatly reduces night-time clenching, which means I don’t wake up with a tension headache (which would then cause me to clench during the day, somewhat counterintuitively).Would be a relatively cheap experiment so it’s worth a shot.
posted by lovableiago at 7:35 PM on March 28 [3 favorites]

I used to chew through custom mouth guards in less than a month. I cracked 4 molars and ground what was left into smooth little porcelain disks before I finally found a specialist who fixed me forever and seriously changed my life. He made me a rigid (not chewy) acrylic mouth guard and then over about 18 months time, slowly aligned my bite by grinding down certain points of that mouth guard. It was magical. Feel free to memail me for more info and I can pass on his contact info. He does talks all over the US teaching the technique, which I don't think has an official name.
posted by mezzanayne at 9:09 PM on March 28 [1 favorite]

Coming in late but solid vote for a custom fitted from a dentist. Also what mezzanayne said re: small adjustments that once made, in my case have not anything additional done for 10+ years. Same mouthguard too!
posted by erebora at 11:07 PM on March 28

Botox injections in the masseter muscles will prevent clenching. It's a few hundred dollars but it's worth it. At first you go twice a year and it's so nice not to wake up with jaw pain and headaches. Eventually you will train yourself not to clench at all and you can drop down to yearly or every other year injections.
posted by ananci at 3:59 AM on March 29 [1 favorite]

I use a SleepRight Custom Dental Guard because it's about $25 at Publix and I can replace it as needed.

I had a custom guard from a dentist but that was much more expensive (over $1K?) and when it broke a year or two later I didn't care to go back and get a replacement. The dental guard was probably more expensive because it was pulling the lower jaw forward to treat sleep apnea but after it broke I ended up with a CPAP (get the one with the hose connected at the top of your head).
posted by Awfki at 5:47 AM on March 29

There is also a biofeedback headband called SleepGuard that can teach you to not clench and grind. I have bought them 2x over the years and had some success with training not to do it and relieve TMJ. It basically beeps softly when you clench.
posted by mortaddams at 8:34 AM on March 29

N-thing a custom night guard from the dentist. I started grinding my teeth during the pandemic and was prescribed a rigid one that actually somehow relaxes my jaw muscles and prevents me from biting down very hard. Without it I'm pretty sure I would have broken at least one tooth. The drugstore ones are not in the same league at all.

I also found that yin yoga to relax the neck and shoulder muscles helped. If that hadn't worked I was going to try the Botox route, which has done wonders for several friends. Although it can be expensive, apparently the combination of retraining the muscles and weakening them slightly means you might not need more than a few courses of treatment.
posted by rpfields at 10:41 AM on March 29

I'm a clencher for years. I started using the thinnest option from cheeky, which is cheaper than dentist but much much better than drugstore. But I recommend getting the thin ones vs anything (for me it's hard, upper, .76mm). I've done botox which helps but it wears off and is very $$$. Nothing else I've tried has really helped.
posted by ch1x0r at 5:10 PM on March 29

Similar to some above I made mine at sportingsmiles.com and it’s amazing — my dentist flat out told me that he could make me one only slightly better than a drugstore one (terrible) for like a billion bucks, so I found this site.
posted by knownassociate at 7:33 PM on March 29

A relative who’s a dentist says mouth guards don’t do much for TMJ per se, they’re more about protecting tooth surfaces. If the teeth aren’t being worn down there’s no point. Should be properly assessed in case there’s some other cause (eg rheumatoid arthritis), or if there’s clicking as well as pain (can have either or both). Relative recommends muscle relaxants, massage, anti-anxiety stuff in general, and an ergonomic pillow.
posted by cotton dress sock at 8:58 PM on March 30

My best night guards, and the one I currently use, are just cheap mouth guards from the sporting goods store. I cut them down to the bare minimum and mold them, just barely covering my front teeth. (I hate having excess stuff in there, touching my tongue and gums and... ack.) A couple bucks, highly moldable to your own needs, and sturdy. When I replace one it's because it won't re-mold well anymore, not because I've chewed through it (like I did with a $$$ one from my dentist).
posted by booth at 7:58 AM on March 31