Teeth grinding and night guards

Here is the awkward thing about grinding your teeth: the people doing the most damage are usually asleep for all of it. They come in for a routine check-up, we point out that the edges of their front teeth are flat and the back teeth have polished dents in them, and they are genuinely surprised. Nothing hurts. Nothing woke them up. The wear happened quietly, a bit at a time, over years.

The dental term is bruxism, which covers both grinding teeth side to side and clenching them together. Plenty of people do both, some during the day when they are concentrating or stuck in traffic, and many at night.

How to tell if you grind

Since you are asleep, you have to go by what your body reports in the morning:

• A jaw that feels tired, tight or achy when you wake up, sometimes clicking when you open wide
• A dull headache around the temples first thing, which eases as the morning goes on
• Teeth that feel sore, loose or newly sensitive to cold
• A partner who hears the grinding at night, which is often how people find out
• Front teeth that are getting shorter or flatter, or chips appearing along the edges
• A ridge along the inside of your cheek, or scalloped edges on the sides of your tongue

At a check-up we can usually confirm it quickly. Normal chewing wears teeth slowly and unevenly. Grinding leaves flat, shiny facets where upper and lower teeth have been rubbing against each other, and the pattern is unmistakable once you know what to look for.

Why it matters more than it sounds

The forces involved at night are far higher than the forces you use to chew dinner, and they go on for far longer. That has consequences. Enamel wears down and does not grow back. Worn enamel exposes the softer dentine underneath, which is exactly why grinding shows up as new sensitivity to cold. Fillings and crowns fail earlier. Teeth crack, and a cracked tooth can turn into a root canal or a lost tooth rather than a small repair. Jaw joints and the muscles around them get sore.

Grinding is also hard on your teeth in the same way habits like chewing ice are, and for the same reason: teeth handle steady pressure well, but they do not enjoy repeated hard impacts. We wrote about a related habit in quit that ice chewing habit.

What causes it

There is rarely one neat answer. Stress gets the headlines, and it is genuinely part of it for a lot of people, but it is not the whole story. Disrupted sleep matters, and grinding often travels with snoring and sleep apnea. Caffeine late in the day and alcohol in the evening both make it more likely. Some medications list it as a side effect. And sometimes the bite itself is a factor, when teeth do not meet evenly and the jaw keeps hunting for a comfortable position.

That is why we would rather look at the whole picture than simply hand you a guard. If your grinding is tied to disrupted sleep, that is worth knowing about, because it has consequences well beyond your teeth. If crowded or uneven teeth are part of it, orthodontic treatment may be part of the answer.

What a night guard does, and what it does not

Let us be straight about this, because night guards are often oversold. A night guard does not cure grinding. Your jaw muscles will do what they do. What the guard does is sit between your upper and lower teeth so that it takes the wear instead of your enamel. The guard grinds down over a few years and gets replaced. Your teeth do not, and cannot.

Many patients also report waking with a less tight jaw, because the guard changes how the muscles work against each other. That is a real benefit, but the main job is protection.

Custom guard or drugstore guard?

The boil-and-bite guards at the pharmacy are inexpensive, and they are better than nothing for a short stretch. But they are bulky, usually soft, and a lot of people spit them out in their sleep without noticing. A soft guard can also give the jaw something satisfying to chew on, which is not the goal.

A custom guard is made from a scan or mould of your own teeth, so it is thinner, it stays where it belongs, and it spreads the force across all your teeth rather than a few high spots. It costs more up front and lasts much longer. Given that we are comparing it against the cost of replacing worn-down teeth with crowns later, it is usually the cheaper path.

What else helps

• Cut caffeine after mid-afternoon and go easy on alcohol in the evening. Both make night-time grinding more likely.
• Notice daytime clenching. Many people clench at a desk or in the car without realising it. Lips together, teeth apart is the resting position you want.
• Give your jaw a warm compress before bed if it is sore, and try not to chew gum all day.
• If you snore or wake up unrefreshed, mention it. Sleep and grinding are connected more often than people expect.
• Keep up your check-ups so we can track the wear over time. Comparing today with two years ago tells us whether things are stable or moving.

We look after whole households through our family dentistry care on Hamilton Mountain, and grinding often runs in families, or at least gets noticed by them. If someone in your house has been told they grind at night, it is worth a conversation at the next visit.