Having an occlusal splint

An occlusal splint — often called a night guard — is a custom-made hard plastic appliance that fits over your upper teeth. It protects natural teeth, crowns and implants from the wear and cracking caused by clenching and grinding, and it takes pressure off the jaw muscles and joints.

Bruxism is clenching or grinding of the teeth beyond normal chewing, often during sleep and often without you knowing. Over time it wears the teeth down and can permanently damage both the teeth and the jaw joints.

• We take a digital scan or impressions of your teeth and record how your jaws meet.
• A dental technician makes the splint on models of your teeth so that, when you bite on it, the load is spread evenly across all the teeth instead of landing on a few.
• At the fitting appointment we check the fit and adjust the biting surface until it's even.

An even bite on the splint stops individual teeth wearing, and reduces the forces going through the jaw joint, its ligaments and cartilage. A splint manages the effects of grinding — it doesn't stop the habit itself.

Wear it as directed — usually just at night, though some people need it during the day as well while acute pain settles. Don't wear it while eating.

In the first few weeks you're likely to notice one or more of these. They're normal, and most people are used to the splint within about a month:

• It feels tight on your teeth, especially the front ones, when you first put it in.
• More saliva than usual.
• When you take it out, your teeth feel for a while as though they don't fit together normally.

Clean it with a soft brush and cool water after each use, keep it in its case when it's not in your mouth, and keep it away from heat and from pets.

Every splint needs adjusting, and the number of adjustments depends on how severe the clenching or grinding is and how the jaw joint and muscles respond. Adjustments aren't an extra — they're part of the treatment, and each one allows the joint and muscles to settle further.

There's a fee for the first adjustment only. Further adjustments in the 12 months after the splint is fitted are free of charge.

Once the initial adjustments are done, the splint still needs checking from time to time, which we usually do at your regular check-up. Bring the splint to every dental appointment — any new filling or crown can change how the splint fits, and it may need adjusting to suit.

• Tooth or jaw soreness in the first weeks, while you adjust to it and while the bite on the splint is being refined.
• A change in how your bite feels when the splint comes out, which settles within minutes to hours. Lasting bite changes are uncommon and are why regular checks matter.
• Cracking or wearing through under heavy grinding. The splint is taking the damage instead of your teeth, and it will need repair or replacement in time.
• Tooth movement if the splint is worn only now and then over a long period, or if it no longer fits well.
• Gagging or difficulty sleeping with it at first — usually passes; tell us if it doesn't.
• It only works when worn. On the nights it stays in its case, the teeth and joints are unprotected.

The enamel on the biting surfaces wears down and exposes the softer dentine underneath, which then wears much faster. Once the wear is deep enough, bacteria can reach the nerve and the tooth may need root canal treatment. Restoring badly worn teeth usually means crowns or veneers.

Crowns and implants are also at risk: without a splint, the same forces can chip porcelain or loosen an implant's crown or screw.

• A soft, over-the-counter guard. Cheaper, but it wears through quickly and some people clench harder on a soft surface.
• Jaw exercises and physiotherapy for muscle and joint symptoms — see our TMJ exercises page. Often used alongside a splint rather than instead of it.
• Managing what drives the habit — stress, caffeine late in the day, sleep problems — with your GP where appropriate.
• Doing nothing, and restoring the wear later, which is the most expensive path.

A splint is a long-term appliance. To get the benefit from it:

• Wear it as directed and follow the care instructions.
• Bring it to every dental appointment so it can be checked and adjusted.
• Come in for examinations and cleans every 6 months. There's a fee for these visits, which isn't included in the cost of the splint.
• Tell us straight away if it cracks, stops fitting, or if your symptoms change.

If you don't attend follow-ups or keep up the maintenance, problems with the teeth, the joint or the splint itself can become difficult, costly or impossible to treat, and you would be liable for the full cost of correcting them.