A night guard is an appliance that is worn while sleeping to protect the teeth from tooth on tooth wear as a result of grinding or clenching. We term excessive teeth grinding and clenching “bruxism.”
bruxism appliances were regarded as temporary measures that enabled clinicians to analyze and improve dental relationships in order to treat the disorder. Potential treatments included orthodontics, malocclusion treatments, and restorative dentistry. Now we understand that bruxism appliances are designed to protect the teeth and hopefully reduce muscle activity during sleep.
bruxism can cause a range of symptoms that include the following:
Bruxism appliances do not prevent bruxism; they are designed to distribute the force across the masticatory system. Using bruxism appliances can decrease the frequency of bruxism episodes but not necessarily their intensity.
Most bruxism appliances are made in the dental lab and fabricated from a hard or soft acrylic material that provides either a hard or a soft occluding surface. Some softer bruxism appliances are fabricated using thermal sensitive material that is heated in hot water before use. Other appliances have a hard shell and a smooth occlusal surface.
Hard acrylic bruxism appliances are fabricated with a flat occlusal surface, ensuring even contact with the opposing arch.
Soft bruxism appliances are also fabricated with a flat occlusal surface that can be lightly indexed according to the clinician’s preference. A night guard’s softness can be customized to increased the patient’s comfort. Soft bruxism appliances may be more suitable for children who still have dental bone growth or when the appliance is only required for a short period. Even if the appliance doesn’t result in any appreciable changes in nocturnal behavior, it will still protect the dentition.
When the patient is diagnosed with bruxism but doesn’t have signs of TMD, they will most likely benefit from a full coverage bruxism appliance with acrylic covers that completely protect the entire arch of teeth.
When the patient clenches isometrically, the most appropriate bruxism appliance is a maxillary night guard that keeps all the teeth in contact and provides full coverage. If a mandibular splint is used, then the force created during clenching won’t be distributed appropriately. When the patient has the power of movement in protrusive and lateral directions, a bruxism appliance for the mandibular arch may be more appropriate. With lateral para-functional movement, a mandibular splint that doesn’t touch all the anterior teeth is appropriate, provided it touches the cuspids for guidance. If mandibular movement during the night isn’t definite, a maxillary bruxism appliance is preferable.
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