If you grind your teeth, chances are that a night guard has been a part of your life. There’s good reason for that. A protective splint can greatly reduce the damage that grinding does to your teeth. Still, as new research in BMC Oral Health shows, even with a well-fitted night guard, your teeth may still be wearing down.
For the study, 16 people with sleep bruxism wore high-quality PMMA (polymethyl methacrylate) splints for 18 months. (“Bruxism” is the clinical term for habitually clenching and grinding your teeth.) Using advanced digital scanning, the research team measured microscopic changes in tooth volume over time.
What they found was both encouraging and concerning.
On the plus side, the splints were clearly doing their job. Both the upper and lower teeth showed similar amounts of wear. This suggests that the splint was effectively distributing forces and protecting the upper arch. Without the splint, you’d expect to see much more dramatic differences.
Still, even with nightly splint use, all teeth showed measurable wear over the 18-month study period. Every single tooth group – canines and molars, upper and lower – lost some tooth structure.
While PMMA splints may help reduce tooth wear during sleep-related bruxism, measurable tooth wear still occurred.
These changes were tiny, of course – fractions of a cubic millimeter – but thanks to modern digital scanning, we can now see differences that would have been all but invisible just a decade ago.
This isn’t to say that night guards are worthless. They are, in fact, valuable tools. But often, they treat only the symptom rather than the cause. It’s like giving a helmet to someone who is repeatedly hitting their head against a hard wall. Sure, the helmet helps. But wouldn’t you also want to figure out why they’re hitting their head against the wall in the first place?
Often, bruxism works as something we might call a destructive adaptive behavior. The body is always working to self-regulate, to find some kind of equilibrium – even when that attempt comes at a significant cost to your oral health.
Bruxism rarely happens in isolation. More often, it’s a sign that something else is going on – your nervous system’s misguided way of responding to a problem that needs to be fixed. There are a couple of underlying problems that we see more often than others: sleep-disordered breathing and bite imbalances.
As we’ve noted before, sleep apnea and bruxism often happen together. When your airway becomes blocked during sleep, your body may respond with jaw movement to help open the airway by repositioning the jaw and tongue. A large 2023 study in the Journal of Clinical Sleep Medicine found that almost half of sleep apnea patients also bruxed.
Bite problems can also trigger grinding. When your teeth don’t come together properly – whether due to an uneven bite, missing teeth, or poorly fitting dental work – your jaw muscles work overtime to find a comfortable resting position. Grinding is an attempt to adjust the bite, even though it ultimately makes things worse.
This is why our approach goes well beyond just fitting you with a night guard. We absolutely use them as needed to protect your teeth but seek to simultaneously address what’s driving you to brux in the first place.
Dr. Abdulla’s comprehensive evaluation looks at your entire airway, from your nose down to your throat. We assess your jaw alignment, bite relationship, and how your jaw joints (TMJ) function. We discuss your sleep quality, along with any breathing or other issues and symptoms that might seem unrelated but actually paint a much bigger picture.
For many of our patients, oral appliance therapy for sleep apnea not only improves their breathing and energy but greatly reduces their bruxism. Others benefit from bite adjustments or TMJ treatment that addresses the mechanical imbalances causing their grinding. In most cases, a combination of therapies is needed for long-term success. As the study authors themselves note,
PMMA-based occlusal splints are supported as a protective adjunct in the management of sleep bruxism when combined with long-term monitoring and patient-centered care.
For our patients, this might include oral appliance therapy for sleep apnea, manual therapy to address TMJ dysfunction, and ozone therapy to reduce inflammation, along with help with behavioral modifications, nutrition, stress management, and other lifestyle factors that impact both sleep quality and jaw function.
The key is getting to the root of why your body feels compelled to grind in the first place. When we can address those underlying causes, we often see the grinding resolve naturally, without your body having to work so hard to compensate.