Buying Guide – How to Shop for the Best Mouthguards for Teeth Grinding
Roughly 10% to 20% of adults in the U.S. experience bruxism, or chronic nocturnal teeth grinding and/or jaw clenching (although some surveys put the figure at more than 30%). Bruxism is also fairly common in children, with one-third of parents reporting at least one child in their household who grinds their teeth on a regular basis. Bruxism can lead to potentially painful complications such as chronic jaw soreness, headaches, and chipped teeth. Additionally, new sleep research suggests a link between nighttime teeth grinding, also known as sleep bruxism, and sleep apnea, a condition characterized by temporary loss of breath during sleep.
Many people with bruxism utilize mouthguards to help reduce nighttime teeth grinding. Some night guards are customized models prepared in a dental laboratory; these are designed for the unique dimensions of the wearer’s mouth. Other mouthguard options include custom-fit models that do not require an impression (making them less expensive than custom dental models), ‘boil and bite’ over-the-counter mouthguards, and non-customized stock mouthguards that are designed to fit any wearer’s mouth.
This guide will take a closer look at common mouthguard designs, as well as tips for first-time mouthguard buyers and our picks for the top-rated brands and models (according to customers and owners). First, let’s explore the causes — and effects — of chronic bruxism.
Bruxism and Sleep
There are two types of bruxism: sleep bruxism and awake bruxism. Both are associated with the same types and levels of physical damage, but there is one key difference: sleep bruxism typically ends when the individual wakes up, and symptoms gradually improve over the course of the day; while awake bruxism usually does not occur until the individual wakes up, and then worsens throughout the day.
Although bruxism activity varies by patient, the average person with sleep bruxism experiences nightly episodes. Each episode consists of ‘rhythmic masticatory muscle activity’ (RMMA), or jaw muscle activity, at an average rate of once per second, as well as sporadic tooth grinding throughout the night. Most sleep bruxism episodes occur during periods of sleep arousal.
Symptoms and Diagnosis of Bruxism
Bruxism can be a very serious and painful condition which can cause damage over time. That’s why it’s important to recognize symptoms and to seek an accurate medical diagnosis as soon as possible.
Common symptoms of chronic bruxism include:
- Loud tooth grinding and/or jaw clenching. In many cases, these activities are loud enough to wake the person’s sleep partner.
- Damaged teeth. This may include chipping, flattening, fracturing, and/or loosening.
- Worn tooth enamel. Enamel is the substance that acts as the tooth’s outer coating. In severe cases, internal layers of the tooth will be exposed.
- Extreme tooth pain or sensitivity.
- Chronic jaw soreness. This can lead to locked jaw symptoms, characterized by one’s inability to completely open and/or close their jaw.
- Neck and/or face pain. Some people with bruxism may also experience what feels like an earache, even though the issue is not isolated to their ear canal.
- Chronic dull headaches. For most, these headaches begin at the temples and slowly move inward.
- Cuts and sores from biting the inner cheek.
Dentists check for signs of bruxism during routine dental exams. If signs of bruxism are detected, the dentist will normally schedule follow-up appointments to determine if the condition is progressing or not by checking for:
- Extensive tooth damage, including cracked or missing teeth
- Extreme pain or tenderness in the jaw
- Damage to bones and cheek muscles in the interior of the mouth
For patients with sleep bruxism caused by or linked to other sleep disorders (such as sleep apnea), their dentist may refer them to a sleep medicine specialist. Likewise, those with psychological disorders (such as severe anxiety) may be referred to a counselor or licensed therapist.
Most adults with bruxism do not require treatment, and children typically outgrow their symptoms. In severe cases, dental therapy and/or medication may be prescribed. Mouthguards are the often the first dental approach used to address bruxism. If mouthguards are ineffective or insufficient, then corrective dental surgery may be required.
Causes of Bruxism
Bruxism is classified as a ‘parafunctional activity,’ which refers to the habitual use of any body part that is not the part’s intended primary function. However, sleep experts continue to debate whether bruxism is a subconscious habit or an involuntary activity (similar to a muscle spasm). The cause of bruxism has yet to be determined, but most experts agree that multiple factors may lead or contribute to bruxism. Two or more of these factors may be present in individual patients, and multiple factors may exacerbate the effects of sleep bruxism. These factors include:
- Nervous system abnormalities: Every person sleeps in stages that are controlled by their circadian rhythm , or natural sleep cycle. The central nervous system controls the neurotransmitters and mechanisms that affect sleep arousal episodes, which occur when someone experiences changes in the depth of their sleep. People with abnormalities in their central nervous system are more susceptible to bruxism episodes, since these episodes normally occur during periods of sleep arousal.
- Age: Many adults experience bruxism, but the condition is most common in children — and the majority of children with bruxism will recover from their symptoms by age 18.
- Heredity: A substantial number of people with bruxism have also noted the condition in at least one of their parents and/or at least one of their children. Although the specific genetic markers have not been pinpointed, people with sleep bruxism are much likelier to have children with sleep bruxism compared to those with no bruxism at all or awake bruxism.
- Smoking: Nicotine has been proven to affect how dopamine — an organic chemical that acts as a neurotransmitter for brain activity — is released within the body. People who smoke cigarettes regularly are twice as likely to develop bruxism symptoms as non-smokers.
- Prescribed medication: Certain drug classes — including dopamine agonists and antagonists, selective serotonin reuptake inhibitors, and amphetamines — are believed to exacerbate the symptoms of bruxism. In some cases, reducing the daily dosage of these drugs can decrease bruxism-related symptoms.
- Recreational drug use: Some drugs that act as stimulants have been linked to bruxism. The most prominent example is Methylenedioxymethamphetamine, also known as ecstasy or MDMA. People who consume this drug frequently experience bruxism episodes for several days. Some studies have also noted a connection between cocaine use and bruxism.
Some causes of bruxism are strongly suspected but have not been conclusively identified. For example, chronic teeth grinding has long been associated to stressful lifestyles, but a direct link between stress and sleep bruxism has not been conclusively identified. Similarly, researchers have noted a tentative link between alcohol consumption and bruxism development, but more studies are needed to establish a direct connection.
Additionally, other medical and mental health disorders are associated with bruxism. These include the following:
- Sleep apnea: Sleep apnea is a disorder characterized by temporary loss of breath during sleep. People with sleep apnea may experience hundreds of episodes per night, though most do not last more than a few seconds. With bruxism patients, obstructive sleep apnea (OSA) — caused by a physical obstruction that hinders circulation in breathing passages — is more common that central sleep apnea, which is caused by miscommunication between the brain and breathing muscles.
- Night terrors: Also known as pavor nocturnus, night terrors are sudden awakenings that can trigger irrational feelings of fear or panic. Night terror attacks typically occur between 30 minutes and three hours after the individual falls asleep. This condition is much more common in children, but some adults experience night terrors as well.
- Parkinson’s disease: Parkinson’s is a progressive nerve disorder that typically begins with light hand tremors and eventually leads to an inability to control speech and/or motor functions. There is no cure for Parkinson’s Disease, although some patients report improvements through prescribed medication and surgical procedures.
- Dementia: The term ‘dementia’ refers to a group of progressive medical symptoms that affect memory through cognitive and psychological changes. Alzheimer’s disease is the most common form of progressive dementia.
- Gastroesophageal reflux disease: Known as GERD for short, this condition is characterized by stomach acid entering the esophagus, which causes the backwash (acid reflux) to irritate the stomach lining. Most people with GERD experience acid reflux at least once per week.
- Epilepsy: Epilepsy is a disorder of the nervous system that leads to frequent seizures. These seizures range in intensity from momentary loss of awareness to loss of motor functions and severe twitching in the arms and legs. Most physicians will not diagnose patients with epilepsy unless they have experienced at least two unprovoked seizures.
- Attention-deficit/hyperactivity disorder: Also known as ADHD, this condition is primarily found in children, though it can also affect adult patients. Common side effects of ADHD include an inability to concentrate, impulsive behaviors (often negative), and hyperactivity.
It’s also important to note that malocclusion — physical contact between teeth that occurs due to imperfect proportions between the upper and lower jaw — is not considered a primary cause of bruxism. Although some people with malocclusion may grind their teeth, most do not experience the chronic, night-to-night grinding associated with sleep bruxism.
Mouthguards for Sleep Bruxism: Common Designs and Characteristics
People with night bruxism can choose from a wide range of mouthguard models to meet their individual preferences. Generally, three types of mouthguards are available.
- Custom impression: Custom dental mouthguards are created using a detailed impression of the patient’s mouth. Prescription mouthguards require a dental visit, but other custom designs allow purchasers to send their dental impression to the company’s manufacturing facility; they will receive their customized mouthguard in the mail. These mouthguards tend to produce the best results due to their specific designs, but they also tend to be the most expensive — hundreds of dollars in some cases.
- Boil-and-bite: These mouthguards utilize a similar technology as athletic mouthpieces used in sports like football, basketball, and wrestling. They are made from thermoplastic material that softens in boiled water; once the mouthguard is sufficiently softened, the owner bites down to create a customized impression. Boil-and-bite mouthguards are not as sophisticated as custom dental models, but they are much cheaper.
- Stock: Unlike the other two types, stock mouthguards are usually ‘one size fits all’ and do not utilize a customized impression. They are fairly inexpensive, but user ratings are somewhat mixed.
Mouthguards are usually designed for either the top or bottom layer of teeth, but not both; people with bruxism should only use two guards together if their dentist recommends doing so. Mouthguards typically consist of two layers: a softer top layer that cushions the teeth and reduces discomfort, and a more rigid bottom layer for effective teeth-grinding prevention. Some are slanted at the front to reduce contact between the mouthguard and the lips, gums, and other sensitive areas of the mouth, as well as frenulum tissue that connects these areas. Dimensions vary, but mouthguards rarely weigh more than 10 ounces.
Mouthguards for night bruxism should be kept clean whenever they are not in use. Most designs come with a sterilizing tray or case for hygienic safekeeping during the day. In terms of composition, most mouthguards sold today are made from rigid material that won’t crack or deteriorate quickly. They are almost always free of BPAs, latex, and other potentially harmful materials — but purchasers should double-check the composition to be sure.
In addition to preventing bruxism, some mouthguards may also be used as athletic mouthpieces and/or teeth whitening trays.
Important Considerations for Mouthguard Shoppers
Now that we’ve gone over the designs and functions of mouthguards for teeth clenching, let’s look at some key factors to keep in mind when comparing different brands and models.
- How much does the nightguard cost? This factor typically comes down to the shopper’s budget. A custom mouthguard based on a dental impression may cost as much as $500, while boil-and-bite and stock models may cost as little as $20 or less.
- Does the product include multiple guards? Some mouthguards are sold individually, while others come in packs of two to four — and multiple sizes may be included.
- Is the mouthguard molded or one-size-fits-all? Although satisfaction varies by customer, most people with bruxism find that moldable mouthguards are the most effective and the most comfortable option.
- Is the mouthguard trimmable? Some boil-and-bite and stock mouthguards may be trimmed with scissors at the edges in order to achieve a proper fit for the wearer’s mouth. Most custom dental mouthguards should not be trimmed since they are designed with unique specifications.
- How much does the mouthguard weigh? Most mouthguards weigh less than 10 ounces, but some users may be more comfortable with models that weigh four ounces or less.
- Does the brand offer different designs for males and females? Some mouthguard manufacturers offer different tray sizes based on whether the wearer is a male or female. Male mouthguards tend to have larger trays than female mouthguards. Be sure to check the product information to ensure the mouthguard is designed for you and not the opposite gender.
- What is the mouthguard’s material composition? Custom dental mouthguards are usually made with two layers: a softer layer made from materials like acrylic, and a more rigid bottom layer made from materials like laminate. Cheaper models often consist of one layer. Customers should also ensure the mouthguard is BPA- and latex-free.
- Is the mouthguard transparent? Some people would rather wear a transparent mouthguard that is not as obvious as a model that is opaque and easy for people to see. For others, this factor may not be as important.
- How is the mouthguard supposed to be cleaned? Most mouthguards require little more than a daily rinsing and storage in a sterilized container. However, cleaning some specialty models may be more expensive and/or time-consuming.
- Does the mouthguard perform functions other than reducing teeth grinding? Models that serve as athletic mouthpieces and/or dental whitening trays may be a good investment for some purchasers.
- If the mouthguard requires a mailed impression, what are the costs and timeline? Generally, mouthguards that require purchasers to make an in-home impression and then mail it to the company’s manufacturing facility will offer free shipping — but this is not always the case. Most will create the mouthguard and deliver it to the owner within 10 business days or less.
- Is there a trial period? Many mouthguards offer trial periods that allow purchasers to return the product for a full refund within a given timeframe. With few exceptions, this timeframe ranges from 30 to 365 nights.