Well-crafted night guards are a thing of beauty to me, and I love making them. Unfortunately, so many night guards or what we dentists call occlusal guards are poorly made that they are often given a bad rap. In order to have a great night guard, I feel that there are three steps. First, it must fit to the teeth perfecly.. Second, it should be comfortable to bite into when you are sleeping. Third, it must be adjusted after making the night guard to make sure that it is dialed into your mouth properly.
Step 1: Choosing the Right Night Guard
When a dentist starts making a night guard, the first decision is whether to fit the night guard to the top or bottom jaw. My personal preference is to make a night guard that fits the bottom jaw because I find that my patient’s find breathing to be easier when the night guard is covering the bottom teeth. However, I make night guards for the top jaws when we are specifically protecting certain teeth such as top front teeth that have had veneers placed. I will also make night guards that are placed on the top when my patient has worn a night guard that fitted onto the top teeth in the past. When fabricating a night guard, the night guard is made to grip onto the teeth evenly by slightly engaging the natural undercuts around the teeth so that it locks into place but is still easy to remove. Occasionally, I will make a person a top and bottom night guard for my patients who have very powerful jaws and have broken night guards quickly before. I don’t do this in every case because the more “things” I have a person wear at night, the more difficult it can be to adapt to wearing a night guard.
Step 2: Taking an Impression
Next, an impression of the opposing jaw is taken as a putty model that shows how the teeth bite together. If a person’s bite is already comfortable, I will simply make the putty model of the bite where the person normally bites. If a person’s bite is not comfortable to them, I help guide the jaw into a comfortable position and use both a wax and a putty model to show the lab technician who is fabricating the night guard how I want the teeth to bite together. The goal of doing this is to make all teeth bite evenly into the guard when biting and only have front teeth biting when grinding side to side or front and back. Having only front teeth biting when grinding is important because this action engages a reflex that relaxes the jaw muscles. It is possible for you to try out this reflex by biting only on your front teeth. If you do this, you will notice that you cannot bite down with nearly as much force as you would be able to if you bite down on back teeth.
Step 3: Getting the Right Fit
The final part of the treatment is fine-tuning the night guard to the individual’s mouth. Teeth and the gums are always moving slightly which is important because the models of the teeth that were taken at the appointments are slightly different from the teeth themselves. I personally prefer the night guards to fit too tight than not tight enough because it is easier to loosen a night guard by removing the part that is too tight than to tighten it by adding to it. When I fabricate a night guard, I will try it in the mouth and if nothing is bothering the wearer, I will leave it alone. Night guards on the first day will always feel “big and weird” because it is something new to the mouth. I have the patient come back after one day to make sure nothing is bothering the person with the fit and that there is no soreness around the teeth, gums, or jaw muscles. I will do the same for a one week visit and a one-month visit as I find these to be the crucial visits to make sure everything is feeling well. If a person is having difficulty at any one of these three appointments, then I have the patient return weekly until the night guard feels good. Most people learn to love their night guard as it starts feeling as natural as buckling your seat belts when entering a car. It seems strange at first, but after a few weeks, it does start to feel natural.
A well made night guard can last a patient quite a few years, but just like tires on a car, it depends on how much wear and tear is on them. I have some little old ladies who have worn the same night guard for 30 years and love it. I have some big guys who break their night guard yearly because their muscles are so strong that they can probably break through steel with their teeth. For those that do break the night guard, I would rather a person breaking an acrylic night guard and having to fix it or replace it regularly than break his teeth and having to fix or replace the tooth regularly. It is much easier and cheaper to replace a night guard than to replace a tooth.
If you are in need of a night guard due to clenching and grinding or if you have difficulty with your current one, please call us at NOLA Dentures and General Dentistry so that we can help you.