Medically reviewed by Brittany Ferri, PhD
Different Types of Mouthguards
Mouthguards are known by a wide variety of names such as: intraoral appliance, stabilization appliance, stabilization splint, occlusal splint, occlusal appliance, interocclusal appliance, repositioning splint, bruxism splint, night guard, mouth guard, etc. Here’s our detailed look at whether they work against teeth grinding.
There are also several distinct types of splints:
- Stabilization or flat plane splint. This mouthguard covers all of the upper or lower teeth (or sometimes both) and has a flat surface. It’s usually made from clear, hard acrylic material. The splint is custom-made to fit precisely over either the upper or lower teeth (sometimes both) from a mold impression of your teeth.Sometimes it can be made from softer plastic which can be more comfortable. However, dentists generally caution against soft splints, because the force during grinding may change occlusion. And one study has shown that it aggravates bruxism in 80% of participants.
- Anterior biteplane. This hard acrylic splint fits on the upper jaw and covers only the front teeth, creating a physical barrier to prevent the back teeth (molars) from contacting each other.
- NTI-tss (Nociceptive Trigeminal Inhibition Tension Suppression System).Similar to the anterior biteplane, this appliance fits on the upper front teeth and is designed to prevent the back teeth from touching. However, because it fits on even fewer teeth than the anterior biteplane, it puts a lot of force on the front teeth. It is theorized that these pressure provides nociceptive feedback that stops patients from clenching their teeth. However, this force can also change your teeth alignment when worn over time, especially if you’re a severe grinder/clencher. Other side effects include increased mobility of the front teeth, and hypersensitivity of the lower front teeth. Furthermore, because of its small size, if it comes off during the night, there is danger that it could be swallowed or aspirated.
- Mandibular Advancement Device (MAD). This specific type of mouthguard is designed for obstructive sleep apnea, a condition where you stop breathing in your sleep. MAD prevents airway collapse during sleep by positioning the lower jaw forward and has been shown to be more effective in reducing sleep bruxism and improving sleep quality compared to regular mouthguards, probably by reducing microarousals (sleep disruptions) associated with breathing issues during the night. However, jaw muscle and joint discomfort, pain, as well as tooth sensitivity, uncomfortable sensation and drooling were often noted as side effects, potentially due to its bulkier size.
- Biofeedback Splint. A newer type of mouthguard that vibrates when grinding / clenching is detected. It is not yet widely available, and often only available in research settings. Several studies have shown biofeedback splint to be better and more durable in reducing bruxism activities.
- Over-the-counter (OTC) mouthguards. These are “boil-and-bite” mouthguards that are sold in brick-and-mortar, as well as, online stores. Often chosen because it is lower cost than professionally-made mouthguards. They are molded to your teeth by immersing the plastic boiling water and fitting them to your teeth while they’re soft. Dentists generally caution against using these types of OTC mouthguards because it’s difficult to get an exact fit and often don’t provide sufficient coverage which might end up causing change in teeth alignment especially when worn for long periods of time. In addition, they tend to be made of softer material, which has been shown in one study to aggravate sleep bruxism.
- Clear Orthodontic Aligners. Created as alternatives to orthodontic braces, these custom-made, removable trays are made from transparent plastic and fit snugly over your teeth. Studies show them to be comparable to occlusal splints. Their thin and transparent features make them ideal for wearing during the day for awake bruxism.
- Sport mouthguards. Similar to OTC mouthguards, these are “boil-and-bite” mouthguards you can buy in (online) stores. They are designed to protect the teeth, gums, and soft tissues of the mouth from sports-related injuries. These are not designed for long-term wear or for sleep, therefore it is not recommended to use these for bruxism.
- Repositioning splint. This mouthguard is intended to be a first step in a multi-step procedure to change your teeth alignment and jaw positions, which will require some form of major dental treatment, such as orthodontics, crowning teeth, etc. to establish a new permanent jaw position. Given the conclusion that occlusion is not the cause of bruxism, the use of splint to establish new jaw position / teeth alignment is no longer supported by scientific evidence.
How much does a mouthguard cost?
The cost of a mouthguard can vary widely. The least expensive option is an over-the-counter boil-and-bite mouthguard, which costs under $50, though dentists usually don’t recommend this type as they can change your teeth alignment. Custom-made mouthguards from a dentist can range from a few hundred to several thousand dollars, depending on the complexity and type. Additionally, there are costs for multiple appointments, including initial and follow-up exams, impression taking, and fittings.
Some dental insurance plans cover mouthguards, but they typically reimburse only a limited amount, usually a few hundred dollars, every year or every 2-3 years. It’s always a good idea to check with your insurance carrier beforehand to understand your coverage.
What type of mouthguard is right for me?
There is currently no evidence supporting one mouthguard design over the other. Having said that, most dentists recommend a full coverage stabilization splint, i.e. mouthguards that cover all your teeth. This type helps spread the load evenly and prevents changes to your bite.
Individual responses can vary with some patients finding it effective in reducing their grinding/clenching habits as well as their pain symptoms, while others see no change or see increase in their behavior.
Hard mouthguards are preferable for their durability and also because they spread the pressure evenly which makes it less likely to affect the person’s bite. Soft mouthguards may feel more comfortable but have been shown in some studies to aggravate bruxism. Additionally, if you have/suspect you have sleep apnea, a mouthguard might affect your breathing and increase the risk of apnea during sleep, which could increase bruxism. For these patients, mandibular advancement devices (MADs) are typically recommended.
On a similar note, if you have small mouths, wearing bulky mouthguards may affect your ability to breathe easily during sleep, which could create sleep disruptions and worsen bruxism. As a general rule of thumb, if a mouthguard causes pain, affects your sleep quality, or increases clenching and grinding, it’s recommended to stop its use and consult the provider who made it.
Finally, some patients may find that intermittent use of occlusal splints is more effective than continuous use. Continuous use can lead to habituation, reducing the splint’s effectiveness over time. Intermittent use, on the other hand, might take advantage of the novelty effect, maintaining the splint’s efficacy in reducing muscle activity and bruxism episodes.
Conclusion
Mouthguards are primarily prescribed to protect your teeth from damage caused by teeth grinding and clenching. However, tooth wear can also be influenced by factors like diet, medical conditions (acid reflux), and medications. If tooth wear is your main concern, it’s essential to look into these aspects as well. Additionally, knowing when you grind or clench your teeth—whether during the day or at night—can help you decide when to wear your mouthguard for maximum benefit.
The effectiveness of mouthguards in reducing grinding, clenching, or related symptoms can vary widely among individuals. While some people experience significant relief, some see no change or see their bruxism increased. Those who experience benefit might also see improvement only in the short term. Intermittent use of mouthguards might help maintain their effectiveness by leveraging the “novelty effect,” which is believed to reduce grinding and clenching more effectively than continuous use.
There is no definitive evidence showing that one type of mouthguard is superior to another. However, for those with or suspected of having sleep apnea, mandibular advancement devices (MAD) are often recommended. It’s crucial to consult with a dental professional to determine the best type of mouthguard for your specific needs. Regular follow-ups and adjustments may be necessary to optimize your treatment’s effectiveness. Remember, personal comfort and response to the mouthguard should guide your choice.
Ultimately, managing bruxism often requires more than just a mouthguard. Increasing your awareness of the behavior, understanding triggers, and incorporating stress management and behavioral therapies can all play a significant role. Mouthguards are just one part of a comprehensive strategy to manage and reduce bruxism effectively.
