A night guard – also called an occlusal guard – is a great way to protect teeth from the ravages of bruxism. Bruxism is the involuntary clenching and grinding of teeth.
There are two types – sleep bruxism and awake bruxism. Click here to read my post about the nature of these disorders, how we diagnose them, and what causes them.
An occlusal guard is the most common treatment and often the most appropriate treatment for bruxism, but it’s not the only option.
Click here to read my post about different bruxism treatments and the pros and cons of each approach.
Topics in this post:
Save Money and Teeth With a Night Guard
I beg my heavy sleep-bruxing patients to wear a night guard. It can be as important as saving for retirement. Wearing this simple appliance will prevent the need to rebuild your smile and bite – at a cost comparable to the average annual salary in the United States! It will also protect your expensive dental work.
Significant attrition – tooth wear caused bruxism – doesn’t happen overnight. It seems abstract and in the future, so it’s hard to appreciate how devastating it can be. But, it’s real.
The most under-appreciated complication of seriously worn teeth is the difficulty of sustaining good dental work. Worn teeth offer little tooth structure to work with.
People with worn dentitions seeking to improve their smile, often just ask for crowns or veneers on their front teeth. That won’t work. To make teeth longer and more attractive, you may need to elongate your entire bite. That requires a very expensive full-mouth rehabilitation.
If you’ve already experienced significant attrition and you can’t afford to rebuild your bite, let’s preserve what you have! Having no teeth is worse than having worn teeth.
It is the mission of Informed Dental Consumer to protect your dental health and your wallet. Preserving your teeth by wearing a night guard when appropriate does both. If you are a bruxer, I’m glad you’re here! Let’s figure out the right choice for you.
Who is a Candidate for a Night Guard?
The best candidates for a night guard are adult bruxers who do not have symptoms of temporomandibular disorder (TMD).
Not for TMD Patients
TMD is characterized by jaw pain, limited opening, crepitus, and headaches. Bruxism is one cause of TMD.
A conventional night guard is usually not the remedy for those who are suffering from TMD. That said, a small percentage of people do find some relief from TMD symptoms with a conventional night guard. But for others, a conventional night guard makes TMD worse. TMD patients should see a provider with specialized training in the management of this disorder.
Not for Children
A night guard is usually not appropriate for children. A rigid appliance may restrict the full growth and development of their teeth and jaws. There is usually not enough time during their growing years to cause significant damage to their permanent teeth. And, most children grow out of bruxism. We usually just monitor the condition. If it persists to adulthood, we can make a night guard guard then.
Sleep Bruxers vs Awake Bruxers
Sleep bruxism causes significantly more damage to your teeth than awake bruxism. I am much more concerned when a sleep bruxer forgoes an occlusal guard than an awake bruxer. But, an occlusal guard can be beneficial to both.
What Type of Night Guard Should You Get?
Upper or Lower?
Most people wear an occlusal guard on either the upper or the lower arch. Not both. An upper night guard is more popular than a lower night guard. That is because the tongue is out of the way, and the upper jaw does not move. The lower jaw is doing the bruxing motions. If the night guard covers the lower teeth, it has more potential to pop out in the middle of the night.
However, some people are better served with a lower occlusal guard including:
- people with a strong gag reflex that can be triggered by an upper guard.
- people who find the lower guard more comfortable.
- people who have the majority of their dental work in the lower jaw. The teeth covered by the guard are a little more protected than the opposing teeth. However, all teeth and dental restorations are better off with an occlusal guard. Teeth-to-occlusal guard contact is much less destructive than teeth-to-teeth contact.
Some people do like to wear both an upper and a lower guard at the same time. In that case, they should be very thin.
What About Over-the-Counter Night Guards?
I do not recommend cheap off-the-shelf night guards as a long-term solution for sleep bruxism. They are either one-size-fits-all, or they use a boil-and-bite method. Either way, you won’t get a comfortable, well-fitting, or durable occlusal guard.
It’s better to invest a little more for a custom fit, higher quality guard.
Impressions Required
Fabricating a custom occlusal guard requires that impressions of your teeth are sent to a lab. Sometimes just one impression is needed. Other times you need to send both upper and lower impressions. The impressions needed depend on the style of the night guard you choose.
Soft vs Hard vs Hybrid
Occlusal guards can be soft, hard, or hybrid. Hybrid guards are soft on the inside around the teeth, but hard on the outside.
Soft is for comfort while hard is for durability. The hybrid night guard strives to offer the best of both worlds – comfort and durability.
There are also some materials described as in between soft and hard.
For most bruxers, I recommend either a hard or hybrid night guard. A hard outer surface allows for freedom of movement and discourages clenching. Hybrid is more popular than all hard. But, the heaviest bruxers are best served with an all hard night guard.
Soft Guard Risk
If the guard is soft on the outside, bruxers can depress it when they bite into it. Their teeth can get stuck in the guard which restricts the side-to-side movement of the lower jaw. Clenchers may be encouraged to chomp down into a depressible material.
We don’t want the occlusal guard to restrict the grinding motion or encourage clenching. If it does, bruxers will have increased muscle activity and greater potential for jaw pain.
That said, you can certainly try a soft guard. Jaw pain and sore muscles don’t happen to everyone who uses one. Some people do well with a soft guard and find it more comfortable.
How Thick?
Night guards are generally between 1 and 3 mm thick. Thinner is more comfortable. Thicker is more durable. The thickness appropriate for you depends on your bruxing severity and comfort tolerance.
They’re Tight – They Have to Be
Many newbies to night guards complain that they’re too tight. If they aren’t tight, they will fall out. You will adapt. It will be worth it. Many people find that once they get used to it, they can’t sleep without it!
Should You Buy From Your Dentist or a Direct-to-Consumer Company?
Your dentist can make your occlusal guard or you can purchase a kit online. The latter will usually cost less, but you will have to make your own impressions.
If your insurance plan offers coverage for a night guard, you must go through your dentist to use it. In many cases, your insurance co-pays still cost more out-of-pocket than the night guards you can purchase online. But there are advantages to going through your dentist.
- Dentists or their auxiliaries know how to take high-quality impressions.
- If you need an adjustment, or something isn’t fitting properly, it’s easier to work directly with your dentist than try to navigate the systems of an online company.
What Will My Dentist Charge?
To determine the approximate fee considered usual and customary in your area, check out the Fair Health Consumer website. They show both insured and uninsured rates. The code for an occlusal guard is D9944.
If you have decent insurance coverage, I recommend purchasing your occlusal guard through your dentist. Otherwise, the kits you can purchase online from companies should work just fine. And, they will save you money.
Direct-to-Consumer Options
The internet and CAD-CAM technology have made a direct-to-consumer business model feasible.
These companies sell impression kits along with a pre-paid envelope to ship your impressions to their lab.
Once they have your impression, they can simply scan it into their system and keep your impressions on a digital file. That way, you will not need to repeat your impressions unless your dentition changes.
Each company offers a video tutorial to help you take a good impression. The quality of the end product is largely dependent on the quality of the impression you send to them. Here are a few tips that videos don’t always offer:
- Choose the LARGEST tray that will fit. You want to be sure that teeth are captured completely within the tray. You do not want any teeth to touch the edges of the tray.
- Mix the putty thoroughly so that the color of the material is uniform – no marbling.
- The handle of the tray should line up with the midline of your two front teeth, and should be horizontal to the ground.
- When you seat the tray be sure there is space between the tray and your front teeth.
- Seat the tray deeply. You want to capture both teeth and gums in your impression.
Four Direct-to-Consumer Companies
Informed Dental Consumer may earn a small affiliate commission for some products we recommend. We strive to offer thorough information about every product.
1. Cheeky
Occlusal Guard Options
- Soft – choice of 1.5 mm, 2 mm, or 3 mm thick
- Hard – 0.78 mm thick (Their website mentions hard/soft which is incorrect. Currently, they are not offering a hybrid option.)
Subscription
YES – You can opt-in for the subscription service and receive a replacement every three months.
Price
The prices below do not reflect any discounts. They usually offer a promotion for a discount.
- one-time purchase – $139 for one arch, $153 for both upper and lower
- subscription – $219 per year for one replacement every three months, $295 per year for two replacements every three months
- shipping – free
Materials
Described as: FDA approved, BPA, Silicone and Latex free
Customer Service
No phone support. email: hello@getcheeky.com
Return Policy
30-night money-back guarantee
Cheeky Pros and Cons
Pros
- Affordable
- 3-month subscription is convenient – prevents the night guard from getting too dirty and worn
- Upgrading to two night guards at a time is just a few more dollars.
- They have the thinnest hard I have come across. Just 0.78 mm. That may be a plus for some.
Cons
- They have no hybrid options, and just one style of hard guard – the super thin 0.78 mm hard.
- Their hard night guard is too thin to withstand moderate to heavy bruxing.
- Subscription less eco-friendly.
- No phone support
Who Should Buy Cheeky?
- Light grinders who want to wear both upper and lower night guards at the same time – the 0.78 mm hard guard on the top and bottom may be the most comfortable way to go.
- Light grinders who want the thinnest occlusal guard to protect delicate dental work.
- Someone very sensitive to a thicker guard. Some people find that their airway is compromised by a thick night guard and want the thinnest option possible.
If you beat the thin guard up before the three-month replacement, you may need to choose a more durable, thicker night guard.
- Those who prefer a soft guard and like the frequent three month replacements at a low price.
2. Remi
Occlusal Guard Options
- Hybrid – choice of 1 mm, 1.3 mm, or 2 mm thick (but the default is 1 mm.)
Subscription
YES – You can opt-in for the subscription service and receive a replacement every six months or sooner if you request.
Price
The prices below do not reflect any discounts. They usually offer a promotion for a discount.
- one-time purchase – $169 for both upper and lower – while you probably won’t wear both at the same time, it’s nice to try both styles. There is no option to get one night guard. You will always get two.
- every six months subscription – called Remi Club. Your initial purchase is $129 for two night guards. Then you will get two replacements every six months for $49. However, you can request a shorter interval. Their default is to send you both an upper and a lower night guard, however, you can ask for two of the same arch if that is your preference.
- shipping – free for Remi Club members
Materials
Described as: Dental-grade, BPA-free, high-quality plastic and made in the USA.
Customer Service
Phone support offered – (800) 234-1874, email: support@shopremi.com
You are asked to send a photo of your impressions to the technicians before you send them in. That is a great service that prevents you from wasting time. They will also set up a zoom session to help you through the impression process if you need it.
Return Policy
30-day money-back guarantee
Remi Pros and Cons
Pros
- Affordable.
- Very flexible service options – you can shorten your subscription interval and you can ask for two of the same arch. Frequent subscription and two guards will prevent it from getting dirty and worn.
- Always get two night guards.
- Excellent Customer Service.
Cons
- They only offer hybrid night guards – no soft or hard options. The heaviest bruxers may be best served with an all hard night guard.
- The maximum thickness is 2 mm. Some need up to 3 mm thickness for durability. That said, with the Remi Club, you will get frequent replacements if you chew through it.
- Subscription less eco-friendly.
Who Should Buy Remi?
- Your average moderate bruxer. Hybrid night guards work nicely for most sleep bruxers.
- Given their good customer service, and various Hybrid options, Remi is Informed Dental Consumer’s choice for a subscription provider. We recommend that you request the same arch every six months rather than the upper and the lower. That essentially converts your six month subscription into a three month subscription for the same price.
3. Sparkling White Smiles – TeethNightGuard.com
Occlusal Guard Options
- Soft – choice of 2 mm, 3 mm, or 4 mm thick
- Medium firmness – 3 mm
- Hard – choice of 1 mm, 2 mm, or 3 mm thick
- Flexible hard – 2 mm
They also offer a “front cut” option. This style shortens the guard around the front teeth so that they feel more natural against the lip.
Subscription
NO – But you can purchase additional guards at a discount.
Price
The prices below do not reflect any discounts. They usually offer a promotion for a discount.
- Soft
- 2 mm $79.99, discounted additional guard(s) – add one for an extra $59.99, add two for an extra $119.99
- 3 mm $89.99, discounted additional guard(s) – add one for an extra $69.99, add two for an extra $139.98
- 4 mm $109.99, discounted additional guard(s) – add one for an extra $79.99, add two for an extra $159.99
- Medium Firmness
- 3 mm $99.99, discounted additional guard(s) – add one for an extra $79.99, add two for an extra $159.98
- Hybrid
- 3 mm 169.99, discounted additional guard $109.99
- Hard
- 1 mm $119.99, discounted additional guard(s) – add one for an extra $79.99, add two for an extra $159.99
- 2 mm $129.99, discounted additional guard(s) – add one for an extra $99.99, add two for an extra $199.98
- 3 mm $159.98, discounted additional guard(s) – add one for an extra $99.99, add two for an extra $199.98
- Option to order additional guards three months after initial purchase for a 40% discount.
- shipping – customer pays
Materials
Described as: BPA, Latex, and Phthalates free made in the USA
Customer Service
Phone support offered – (877) 588-6716 email: sales@teethnightguard.com
Return Policy
30-day money-back guarantee, no warranty
TeethNightGuard.com Pros and Cons
Pros
- They offer a much greater selection of night guards to choose from.
- They can customize with a front cut.
- Occlusal guards are designed for long-term use – no recurring subscription expense.
Cons
- No subscriptions. You will have to work harder to clean your night guard thoroughly.
- No warranty. Warranties are nice for night guards intended for long-term use.
Who Should Buy TeethNightGuard.com?
- Someone who is not interested in a subscription.
- Someone who would like a product unique to TeethNightGuard.com
4. Sentinel Mouthguards
Occlusal Guard Options
- Soft – “thin,” “thicker” and “thickest” – exact thickness not specified. Probably 1, 2, and 3 mm respectively
- Hybrid, “dual laminated” – “thin,” and “thicker” – exact thickness not specified. Probably 1.5 and, 2 to 2.5 mm respectively
- Hard – 1 mm, 1 mm + “extra layer”, 3 mm
- Flexible – No Show Day Guard – thickness not specified, probably 1 mm. Excludes front teeth for discretion.
Subscription – No
Price
The prices below do not reflect any discounts. They usually offer a promotion for a discount.
- Soft, thin, thicker, and thickest – $124.00
- Hybrid (dual laminated), thin and thicker – $149.00
- Hard –
- 3 mm – $189
- 1 mm or 1 mm + “extra layer” – $149
- shipping – free in USA
Materials
Described as: BPA-free, MMA-free, PVC-free, phthalate-free, silicon-free, latex-free, gluten-free, manufactured without bisphenol-S (BPS) or any other bisphenol compounds. Made in a dental grade lab in the USA.
Customer Service
Phone support offered – (888) 317-0724 email: info@sentinelmouthguards.com
Return Policy
90-day money-back guarantee
Warranty
Hard and Dual laminated Night Guards- 1-year warranty (if you grind or wear through your guard they will remake it free of charge).
Soft Night Guard- 6-month warranty (if you grind or wear through your guard they will remake it free of charge).
Sentinel Pros and Cons
Pros
- Variety of styles. No Show Day Guard is unique to Sentinel.
- Generous return policy and warranty.
- Occlusal guards are designed for long-term use – no recurring subscription expense.
Cons
- No discounts for buying additional night guards.
- No subscriptions – You will have to work harder to clean your night guard thoroughly.
- More expensive than teethnightguards.com, (though not substantially more since shipping is free).
Who Should Buy Sentinel?
- Someone who wants more assurance about materials used.
- Someone looking for a product unique to Sentinel.
- With a generous warranty and high-quality materials, Sentinel is Informed Dental Consumer’s Choice for those who do not want a subscription.
Where-ever you decide to purchase your night guard, you’re making a good decision! They are an excellent way to protect your teeth and your wallet!
This is the first time I’ve ever heard the term “bruxism”. I learned something new just from the first paragraph of your post lol. Thank you! My wife tells me all the time about how badly I grind my teeth at night.
I never knew how much damage that would cause though. It looks like I’m going to need to end up ordering some of your night guards.
If you don’t have any painful symptoms, and you are just a grinder, then, yes! Please get a night guard! Before you do, you can look at my other two posts on the topic. This one explains possible causes and shows you what we are looking for to diagnose it. https://informeddentalconsumer…
This one reviews other treatment options for bruxism: https://informeddentalconsumer… But, if you are just a grinder and have no other issues, a night guard will usually do the trick.
Super educational post!
I have a friend with this issue, and she’s been using one of these for years, but I never understood the problem in depth and what it causes until reading this.
I’ll be sending this article her way to see if it can be helpful to her.
Thank for you taking the time to share this!