Teeth clenching and night guard

What is teeth clenching and night guard treatment?

A night guard is a custom-made, removable intraoral appliance designed to prevent teeth from directly rubbing against each other during clenching and grinding (bruxism). In medical terminology it is also called an occlusal splint. The NHS states that a dentist may recommend a guard or splint worn at night to protect the teeth from damage (Source 1).

According to international consensus, bruxism is not a disease in healthy individuals but a behavior that may be a risk factor for certain clinical outcomes (Source 2). For this reason, the purpose of a night guard is not to "treat" the behavior but to limit possible consequences such as tooth wear, fracture and restoration damage. We have covered the differences between sleep and awake bruxism in detail in bruxism and teeth clenching.

Who is it suitable for, and who is it not suitable for?

A night guard may be suitable for people who are known to grind or clench their teeth during sleep and show tooth wear, who experience jaw fatigue or muscle pain in the mornings, or whose fillings or restorations repeatedly fracture. It may also be planned to protect restorations in people with crowns, laminate veneers or implant-supported restorations who clench their teeth.

If there is no symptom or damage related to clenching, a night guard is generally not necessary. The 2025 consensus report states that management of the negative consequences of bruxism should be planned in a way that does not disrupt the possible positive effects of the behavior (Source 3). If untreated tooth decay, advanced gum disease or loose teeth are present, these issues are addressed first. If symptoms such as snoring, breathing pauses during sleep or excessive daytime sleepiness are present, evaluation for a sleep disorder may be needed before planning a guard.

Treatment steps

1. History and examination: Questions are asked about whether the clenching occurs during sleep or during the day, whether a bed partner has noticed grinding sounds, morning symptoms, and medications used. Tooth wear, restorations, chewing muscles and the jaw joint are assessed.
2. Grading the assessment: The 2018 consensus report defines an assessment based only on self-report as "possible," one supported by clinical examination as "probable," and one measured with a device as "definite" (Source 2). In daily practice, history and examination usually provide sufficient information.
3. Impression or digital scan: An impression of the teeth is taken; if needed, the relationship between the jaws is recorded.
4. Laboratory stage: The guard is prepared according to the individual's mouth.
5. Delivery and adjustment: It is checked that the guard fits comfortably, that the teeth make balanced contact on the guard, and that there is no interference during jaw movements.
6. Check-ups: The surface of the guard, symptoms and teeth are reassessed at regular intervals.

For guard types (hard, soft, repositioning) and the differences between them, see splint therapy.

How long does it take?

The process is usually completed in 2–3 appointments; the time between the impression and delivery may range from a few days to a few weeks depending on the laboratory process. A check-up appointment is scheduled after delivery for getting used to the guard and for initial adjustments; further check-ups are scheduled based on symptoms and wear of the guard.

Risks and limitations

The most important limitation of the night guard is that its protective effect has not been demonstrated by strong studies. The Cochrane team's 2020 review found no study measuring tooth wear in people who clench their teeth and reported that the evidence is insufficient to determine whether splints reduce wear (Source 4). The same review also notes that side effects have not been adequately reported in studies.

In the first days of use, increased saliva, a sensation of a foreign object in the mouth, or mild tightness in the teeth in the mornings may occur. A poorly adjusted guard can cause discomfort; if you notice a change in your bite sensation, increased pain, or a crack in the guard, you should pause use and consult your dentist. Because off-the-shelf guards are not individually adjusted, bite control cannot be performed with them.

A guard does not eliminate the clenching behavior itself; therefore, working on stress, sleep habits and routines is also part of the plan. The NHS recommends relaxation techniques, regular sleep times, and avoiding smoking, excess alcohol and caffeine (Source 1).

Alternatives

A 2025 review examining 14 systematic reviews on botulinum toxin reported that the methodological confidence of the reviews was "critically low" or "low" and that no conclusion could be drawn about the certainty of the evidence; the same study also draws attention to possible side effects (Source 6).

Care and longevity

The longevity of a night guard depends on the severity of clenching, the material and care; people who clench intensely may wear out the guard faster. The following recommendations apply for care:

• After removing it in the morning, rinse it with cold or lukewarm water and clean it gently with a soft brush.
• Hot water and abrasive toothpastes can damage the material.
• Brush your teeth and clean between them before wearing the guard; the recommendations in oral care also apply here.
• Store the guard in a dry, ventilated case, out of reach of pets.
• Bring your guard to your check-up appointments; if punctures or cracks have formed on its surface, it may need to be replaced.

From a prosthodontist's perspective

From a prosthodontist's perspective, clenching is a risk factor taken into account when planning restorations. The consensus report states that bruxism may be a risk factor for certain clinical outcomes (Source 2); in prosthetic treatments, the foremost of these outcomes are fracture, chipping and wear of restorations. For this reason, in people known to clench their teeth who are planned for laminate veneers, crowns or implant-supported restorations, material selection, restoration design and a protective guard after treatment are evaluated together.

The assessment generally seeks to answer these questions: Is the wear active, or did it occur in the past? Does the clenching occur during sleep or during the day? Is it accompanied by jaw pain? If so, extensive treatments are postponed until symptoms are controlled, and the reversible steps described on the jaw joint treatment page are applied first. For a general overview of the topic, see the jaw joint guide page.

The definitive decision on whether a night guard is necessary for you and which type is suitable is made after examination and, if needed, radiographic assessment.