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Nightguards, Clenching and Bruxism

Updated: Mar 15

Do you find yourself waking up with a sore jaw or sensitive teeth? Perhaps you suffer from Bruxism, the condition in which you unconsciously grind, clench or gnash your teeth during sleep. Bruxism can cause a range of dental issues, including worn-down teeth, jaw pain, and headaches. Fortunately, Occlusal Stabilization Splints, commonly known as mouth guards, can be an effective solution to protect against the effects of Bruxism.


In this article, we'll delve into the topic of Occlusal Stabilization Splints and Bruxism, exploring the different types of appliances available, their functions, and how they compare in terms of different features. Whether you're a long-time Bruxism sufferer or just starting to experience its effects, read on to learn more about how Occlusal Stabilization Splints can help you protect your teeth and improve your quality of life.


What Are Occlusal Stabilization Splint (OSS) Appliances?


Occlusal stabilization splint (OSS) appliances are oral devices used by dentists to help stabilize a patient's bite and relieve symptoms of teeth grinding or clenching, also known as bruxism. These appliances are custom-made to fit over the patient's upper or lower teeth, and they work by reducing the forces placed on the teeth and jaw muscles during grinding or clenching. OSS appliances can also help alleviate symptoms such as headaches, jaw pain, and tooth sensitivity that are commonly associated with bruxism.


What is the Purpose of an OSS Appliance for Bruxism?


young lady with bruxism pain related headache
courtesy of laserskinandvein.com.au

The purpose of an OSS appliance for bruxism is to stabilize the patient's bite and reduce the negative effects of teeth grinding or clenching. Bruxism can cause significant damage to the teeth, jaw joints, and surrounding muscles, leading to pain, sensitivity, and other oral health problems [1]. The OSS appliance helps to distribute the forces of biting and chewing evenly across the teeth, reducing the strain on individual teeth and the jaw muscles. By doing so, OSS appliances can help alleviate the symptoms of bruxism, including jaw pain, headaches, and tooth sensitivity. In addition, OSS appliances can protect the teeth from further damage caused by bruxism, allowing the patient to maintain good oral health.


Types of Appliances for Bruxism

various types of dental occlusal stabilization splint appliances for managing bruxism

There are several types of appliances for bruxism that can be found over-the-counter or prescribed by a dentist. These include:

  1. Nightguards: Nightguards are the most common type of appliance for bruxism, and are designed to prevent the teeth from grinding or clenching during sleep. They are typically available at most pharmacies and many large convenience stores.. While typically referred to as nightguards or mouthguards, these are also considered occlusal splints.

  2. Occlusal splints: More often the name given by dentist and doctors, occlusal splints by common definition tend to be custom-made by a dentist or dental professional. They also are designed to adjust the patient's bite and reduce the strain on the jaw muscles. Typically, a single guard is made for the upper teeth, but sometimes a guard is made for the bottom teeth and sometimes both upper and a lower guards are made when deemed appropriate for a patient’s bruxism condition.

  3. Bite guards: Bite guards are similar to nightguards, but they are designed to be worn during the day. They can be purchased over-the-counter or prescribed by a dentist and are made of a soft, pliable material that conforms to the shape of the teeth.

  4. Mandibular advancement devices (MADs): MADs are typically used to treat sleep apnea, but they can also be effective for patients with bruxism. They are designed to hold the lower jaw in a forward position, which can reduce the tendency to clench or grind the teeth during sleep.

  5. Over-the-counter appliances: There are several over-the-counter appliances available for treating bruxism, including nightguards, mouthguards, partial guards and repositioning appliances. Not all are custom-made and may not fit as well as those prescribed by a dentist, but they can be a more affordable option for some patients.

1. Occlusal Appliances


Occlusal appliances, also known as mouthguards or occlusal splints, are dental devices designed to protect the teeth from contact by the "occlusal" surfaces of one's teeth. The occlusal surfaces are the parts of the teeth that come into contact with the opposing teeth when biting and chewing.


Bruxism, or teeth grinding, can cause damage to the teeth and surrounding structures, and occlusal appliances are often used to prevent this damage. The appliance is placed over the upper and / or lower teeth providing an occlusal barrier between the upper and lower teeth to prevent contact and reduce the forces of grinding or clenching. This can protect the teeth from wear, chips, fractures, and other damage.


Occlusal appliances can be custom-made by a dentist to fit the patient's teeth precisely, or they can be purchased over-the-counter in a "boil-and-bite" style. Custom-made appliances are generally more effective, comfortable, and durable, but they are also more expensive. Over-the-counter appliances may not fit as well, but they can be a more affordable option for some patients [2].


Occlusal appliances can also be used for other purposes, such as to treat temporomandibular joint (TMJ) disorders or to adjust the patient's bite. They can be worn during the day or at night, depending on the patient's needs [3].


a) Boil and Bite


blue colored nightguard boil and bite before and after
courtesy of dentagama.com

Boil and Bite, also known as moldable mouthguards, are a type of occlusal appliance that can be purchased over-the-counter to protect the teeth from grinding or clenching. These appliances come in a pre-formed shape that can be molded to fit the patient's teeth.


To use a boil and bite mouthguard, the patient boils the appliance in water to soften the material. Once the material is soft, the patient bites down on the appliance to mold it to the shape of their teeth.


Boil and bite mouthguards are generally less expensive than custom-made appliances, with prices ranging from $15 to $140 depending on the brand and features. They may not fit as well as custom-made appliances, but they can still provide significant protection against teeth grinding and clenching.


b) Fixed or Adjustable Molar Guard


A fixed or adjustable molar guard is another type of over-the-counter occlusal appliance that can be used to protect the teeth from grinding or clenching. This type of appliance is designed to fit over the molars, which are the large teeth in the back of the mouth that are most commonly affected by bruxism.


These are made of a hard plastic material that can be molded to fit the patient's teeth. The appliance is typically designed to fit over the upper molars, and it provides a barrier between the teeth to prevent contact and reduce the forces of grinding or clenching.



non-adjustable molar mouth guard for bruxism
courtesy of fruugo.com

Fixed or adjustable molar guards are generally less expensive than custom-made appliances, with prices ranging from $20 to $35 depending on the brand and features. However, they may not fit as well or provide as much protection as custom-made appliances or other types of over-the-counter mouthguards.


c) Unmalleable


Unlike boil and bite or moldable mouthguards, unmalleable occlusal appliances are pre-formed and cannot be molded to fit the patient's teeth. This type of appliance is designed to fit over the molars, which are the large teeth in the back of the mouth that are most commonly affected by bruxism.


 
 

These appliances are usually made of a soft or hard plastic material and are designed to cover the upper teeth. They provide a barrier between the teeth to prevent contact and reduce the risk of dental injuries during contact sports or other activities.


Unmalleable occlusal appliances are available over-the-counter and can range in price from $8 to $125, depending on the brand and features. Some models may have extra cushioning or other features to provide additional protection.



better teeth without pain from bruxism can be achieved using an unmalleable occlusal splint
courtesy of drroze.com

It's important to note that unmalleable occlusal appliances may not provide the same level of protection as custom-made appliances or other types of mouthguards. Patients should consult with their dentist to determine if an unmalleable occlusal appliance is appropriate for their needs and to ensure that they are using the mouthguard correctly to prevent dental injuries.


2. Mandible Appliances (Repositioning)




The Mandibular Protraction Appliance mounted to the front center upper teeth
courtesy of pearldentalclinic. co ukresearchgate .net

Mandibular appliances are a type of device used to reposition the lower jaw during sleep. These appliances are typically used to treat sleep apnea, a condition in which a person's breathing is interrupted during sleep.


The mandibular appliance works by holding the lower jaw in a slightly forward position, which helps to keep the airway open and prevent the collapse of soft tissues in the throat. By keeping the airway open, the mandibular appliance can reduce snoring and improve breathing during sleep.


a) Repositioning Splint


Repositioning splints, also known as Farrar, Modified Farrar, or Ferrari splints, are a type of dental appliance that is used to reposition the lower jaw and provide relief for temporomandibular joint (TMJ) disorders.


The TMJ is the joint that connects the jawbone to the skull, and TMJ disorders can cause pain, discomfort, and difficulty moving the jaw. Repositioning splints work by repositioning the lower jaw to a more natural position, which can help alleviate the symptoms of TMJ disorders.



young lady demonstrating how not using a repositioning splint can make TMJ disorders worse
courtesy of symmetryhealthchiropractic.com

Repositioning splints are custom-made by a dentist and are typically made of a hard plastic material that fits over the upper and lower teeth. The appliance is designed to guide the lower jaw into a more natural position and prevent the upper and lower teeth from coming into contact.

b) Gelb


The Gelb appliance is a type of dental splint that is used to treat temporomandibular joint (TMJ) disorders and related conditions. It is a repositioning splint that aims to reposition the lower jaw to a more natural position to relieve the symptoms of TMJ disorders.


The Gelb appliance is custom-made by a dentist and is made of a hard acrylic material that fits over the upper and lower teeth. The appliance is designed to hold the jaw in a more natural position and prevent the upper and lower teeth from coming into contact.


The Gelb appliance is named after Dr. Harold Gelb, who developed the device in the 1960s. The appliance has been used to treat a wide range of TMJ-related symptoms, including jaw pain, headaches, and neck pain [4].


Like other repositioning splints, the Gelb appliance is typically worn for several months to allow the TMJ to heal and the jaw muscles to adjust to the new position.


c) NTI OSS


The NTI OSS (occlusal stabilization splint) is a type of dental appliance used to treat bruxism. The NTI OSS is also sometimes referred to as an NTI-TSS appliance.


The NTI OSS is a small, custom-made device that fits over the front teeth, typically the upper front teeth. It is designed to prevent the back teeth from coming into contact, which can help reduce the force of clenching and grinding. The appliance is made of a hard acrylic material and can be worn during the day or at night.


NTI style dental splint used for Bruxism treatment
courtesy of downtownpittsburghdentist.com

The NTI OSS is often used as an alternative to traditional occlusal appliances, which cover all of the teeth and can be more bulky and uncomfortable to wear. The NTI OSS is also available over-the-counter (OTC) in some stores, but it is recommended that patients seek the advice of a dentist to ensure that the appliance is appropriate for their needs and that it is fitted correctly.


While the NTI OSS can be effective at reducing the symptoms of bruxism, it is important to address the underlying causes of the condition, which may include stress, anxiety, or other factors [5]. Patients should consult with their dentist to determine the best treatment approach for their individual needs.


d) Dental Impression Splints




young lady happy to use dental impression splints for better teeth without pain
courtesy of freepik.com

Dental impression splints are custom-made dental appliances used to treat bruxism, temporomandibular joint (TMJ) disorders and other related conditions. The splint is designed to reposition the lower jaw into a more natural position to alleviate the symptoms of TMJ disorders.


To create the dental impression splint, the dentist takes an impression of the patient's teeth and sends it to a dental laboratory. The laboratory uses the impression to create a custom-made splint that fits over the upper and lower teeth. The splint is typically made of a hard acrylic material.


Occlusal Vs. Mandible Appliances


When it comes to treating Bruxism, there are several options available, including Occlusal Stabilization Splints and Mandible Appliances. While both types of appliances serve the common goal of protecting teeth and relieving pain, they have distinct differences in terms of their design, function, and effectiveness. We will compare and contrast the two types of appliances, breaking down their differences when it comes to time involved, degree of control, repair, budget impact, and we will discuss the potential for gum and nerve damage.


• Time involved


When it comes to time, occlusal appliances and mandibular appliances can differ depending on the type of appliance and its intended purpose.


For over-the-counter (OTC) type appliances, both occlusal and mandibular appliances are generally quick and easy to use. OTC occlusal appliances, such as boil-and-bite mouthguards, can be molded to the patient's teeth in just a few minutes and are ready to use immediately. OTC mandibular appliances, such as repositioning splints or night guards, may require a bit more time to adjust to the proper fit and positioning, but this can usually be done within a few days of use.



time involved treating Bruxism will vary depending upon the type of device (dental impression splint shown)
courtesy of mintdentalclinic.co.uk

In connection with repositioning type appliances, mandibular appliances tend to involve more time than occlusal appliances. Repositioning splints, such as the Farrar or Gelb appliances, require careful adjustment over time to gradually reposition the jaw and alleviate symptoms of TMJ disorders. This can involve several weeks or months of use, during which the patient may need to return to the dentist for adjustments or check-ups.


• Degree of Control


With regard to degree of control, occlusal and mandibular appliances can differ depending on the type of appliance and its intended purpose.


For over-the-counter (OTC) type appliances, both occlusal and mandibular appliances generally provide a moderate degree of control. OTC occlusal appliances, such as boil-and-bite mouthguards do not provide an adjustment or really require any due to the custom fit. However, boil-and-bite appliances may not be set right the first time, in which case the fitting process can be performed again if desired. While it may be possible to repeat the process for a nightguard that seemingly loses some of its custom feel over time, generally repeating the process tends to expand the material making it difficult to obtain the same fit you can obtain on the first attempt, if performed correctly. OTC mandibular appliances, such as repositioning splints or night guards, can also provide some control over the positioning and movement of the jaw, but may not be as precise or effective as custom-made appliances.


 
 

When it comes to repositioning type appliances, mandibular appliances tend to provide a higher degree of control than occlusal appliances. Repositioning splints, such as the Farrar or Gelb appliances, are specifically designed to reposition the lower jaw to alleviate symptoms of TMJ disorders. These appliances provide precise control over the movement and positioning of the jaw, and can be adjusted over time to achieve optimal results.


Overall, the degree of control provided by an occlusal or mandibular appliance depends on the specific appliance and the patient's individual needs. It is important to consult with a dentist or healthcare provider to determine the best type of appliance and treatment plan for each individual case.


• Repair


With reference to repair, the two compare in the following ways.


For over-the-counter (OTC) type appliances, repair options may be limited. OTC occlusal appliances, such as boil-and-bite mouthguards, may be more prone to wear and tear due to their lower quality materials, and may not be easily repairable. OTC mandibular appliances, such as repositioning splints or night guards, may be more durable but as the appliance wears, adjustments are limited if available at all.


While comparing repositioning type appliances, mandibular appliances may have more repair options than occlusal appliances. Repositioning splints, such as the Farrar or Gelb appliances, are typically custom-made and can be adjusted or repaired by a dentist or healthcare provider.


There is better repair in terms of clinical use as the dentist has more control over the situation in custom sets.


• Budget


Time and money matter when considering dental occlusal stabilization splints, nightguards, mouthguards and other kinds of splints.
courtesy of abaforlawstudents.com

For over-the-counter (OTC) type appliances, occlusal appliances are generally more budget-friendly than mandibular appliances. OTC occlusal appliances, such as boil-and-bite mouthguards, can be purchased for as little as $15-$140. OTC mandibular appliances, such as repositioning splints or night guards, may cost more due to their custom-made design and higher quality materials, with prices ranging from $20-$150.


Relating to repositioning type appliances, mandibular appliances are generally more expensive than occlusal appliances. Repositioning splints, such as the Farrar or Gelb appliances, are custom-made and require specialized training and equipment to create and adjust, making them more costly. Prices for mandibular repositioning appliances can range from $300-$1,500, depending on the type of appliance and the complexity of the case.


Overall, the cost of an occlusal or mandibular appliance depends on the specific appliance and the patient's individual needs. It is important to consult with a dentist or healthcare provider to determine the best type of appliance and treatment plan for each individual case, and to discuss any budgetary concerns or payment options that may be available.


Gingiva (Gum) and Nerve Damage Potential


Periodontitis and dental professionals alike are always monitoring patients for healthy gingivae (gums) and potential nerve damage. For dental splint impression appliances, both occlusal and mandibular appliances generally do not pose a significant risk for gum or nerve damage.


However, for both OTC occlusal and mandibular appliances, such as night guards or repositioning splints which can provide some control over the positioning and movement of the jaw, if not installed correctly may have the unintended consequence of placing excessive pressure on the gums and / or nerves. Probably the most common concern is for damage to the gums (gingivae) from OTC products because it’s left up to the individual user to be certain the material has no contact with the gums. Ideally, a dentist or periodontitis will be given the opportunity to check how well a nightguard is fitted and working as intended to be certain no contact occurs as contact can aggravate the gum tissue.


Regarding repositioning type appliances, mandibular appliances may have a higher risk for nerve damage than occlusal appliances. Repositioning splints, such as the Farrar or Gelb appliances, are specifically designed to reposition the lower jaw to alleviate symptoms of TMJ disorders. While these appliances can be effective for some patients, they may also place pressure on the nerves and muscles in the jaw if not properly fitted or adjusted.


It is important to consult with a dentist or healthcare provider to determine the best type of appliance and treatment plan for each individual case, and to monitor any potential risks or complications associated with the use of these appliances.


Conclusion

In conclusion, both occlusal splints/appliances and mandible appliances serve important functions in protecting the teeth, jaw, and associated structures from damage and pain. Occlusal splints/appliances primarily protect against damage to the teeth and mouth pain, while mandible appliances primarily protect the jaw and against joint (TMJ) damage and associated pain. Therefore, the choice of appliance may depend on the specific needs and symptoms of the individual patient. It is important to consult with a healthcare provider to determine the most appropriate type of appliance and treatment plan for each individual case.


 
 


References


[1] Hardy, R. S., & Bonsor, S. J. (2021). The efficacy of occlusal splints in the treatment of bruxism: A systematic review. Journal of Dentistry, 108, 103621.


[2] Abe, S., Huynh, N. T., Kato, T., Rompré, P. H., Landry-Schönbeck, A., Landry, M. L., ... & Lavigne, G. J. (2022). Oral appliances reduce masticatory muscle activity-sleep bruxism metrics independently of changes in heart rate variability. Clinical Oral Investigations, 26(9), 5653-5662.


[3] Dinan, J. E. (2023). CE Credit. Oral Appliance Therapy in the Management of Temporomandibular Disorders and Bruxism. Journal of the California Dental Association, 51(1), 2176975.


[4] Li, D., Lobbezoo, F., Kuang, B. et al. Effects of continuous positive airway pressure and mandibular advancement appliance therapy on sleep bruxism in adults with obstructive sleep apnea: a pilot study. Sleep Breath (2023).


[5] Melath, A., Arjun, M. R., Mahesh Raj, V., & Subair, K. (2022). Bruxism-A Periodontal Overview. Journal of Dental Science Research Reviews & Reports. SRC/JDSR-144. DOI: doi. org/10.47363/JDSR/2022 (4), 130, 2-5.

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Rated 5 out of 5 stars.

Very well written. Happy to see that there are options for those who are suffering from bruxism/grinding teeth, etc.

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