Bruxism is a common parafunctional activity characterized by involuntary clenching or grinding of teeth, occurring during sleep or wakefulness. It is associated with tooth wear, temporomandibular disorders (TMD), muscle pain, and restorative complications.
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Night guards (occlusal splints) are widely used in dental practice as a conservative management approach. However, it is essential to emphasize that night guards do not cure bruxism; instead, they protect oral structures and reduce the clinical consequences of excessive occlusal forces.
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Bruxism is classified as:
▪️ Sleep bruxism, a sleep-related movement disorder.
▪️ Awake bruxism, often associated with stress and behavioral factors.
Clinical diagnosis relies on patient history, clinical signs (wear facets, fractures), muscle tenderness, and, in selected cases, instrumental assessments. Accurate diagnosis is essential to avoid overtreatment and to select appropriate management strategies.
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Night guards act as protective and biomechanical devices, reducing direct tooth-to-tooth contact and redistributing occlusal forces. Their main clinical roles include:
▪️ Prevention of enamel wear and fractures
▪️ Reduction of muscle hyperactivity
▪️ Protection of restorations and prostheses
▪️ Symptom relief in TMD-related discomfort
Importantly, night guards do not modify the central mechanisms responsible for bruxism, reinforcing the need for patient education and realistic expectations.
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Commonly used appliances include:
▪️ Hard acrylic stabilization splints, typically fabricated for the maxilla
▪️ Soft or dual-laminate splints, often used for short-term protection
▪️ Anterior bite appliances, indicated in selected cases under strict monitoring
Material selection and design should be based on occlusal stability, symptom severity, and patient compliance.
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Night guards are indicated for patients with:
▪️ Moderate to severe tooth wear
▪️ Recurrent restoration failure
▪️ Muscle-related pain associated with bruxism
▪️ Temporomandibular discomfort
Limitations include:
▪️ Lack of effect on bruxism frequency
▪️ Possible occlusal changes if poorly designed or improperly monitored
▪️ Dependence on patient adherence
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Optimal bruxism management requires a multimodal strategy, combining:
▪️ Occlusal protection (night guards)
▪️ Behavioral counseling and stress management
▪️ Sleep hygiene optimization
▪️ Referral to medical professionals when sleep disorders are suspected
💬 Discussion
Current literature supports night guards as an effective method for damage control rather than etiologic treatment. Their value lies in preventing irreversible dental damage and improving patient comfort. Dentists must clearly communicate their protective role and integrate them into a broader management plan tailored to individual risk factors.
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Night guards remain a cornerstone in the conservative management of bruxism, offering significant protection against dental and muscular complications. However, they should be prescribed with a clear understanding of their limitations and supportive role within a comprehensive, evidence-based treatment strategy.
🎯 Clinical Recommendations
▪️ Perform a thorough clinical assessment before prescribing a night guard
▪️ Educate patients that night guards control consequences, not causes
▪️ Ensure regular follow-up to monitor occlusion and appliance wear
▪️ Integrate behavioral and medical interventions when indicated
📊 Comparative Table: Treatment Options for Bruxism
| Treatment Approach | Clinical Benefits | Limitations |
|---|---|---|
| Night Guards (Occlusal Splints) | Protect teeth and restorations; reduce muscle load; improve comfort | Do not eliminate bruxism; require patient compliance |
| Behavioral Therapy | Addresses stress-related triggers; useful in awake bruxism | Limited effect on sleep bruxism; requires long-term commitment |
| Pharmacological Management | May reduce muscle activity in selected cases | Not recommended for routine use; potential side effects |
| Physiotherapy | Improves muscle function and reduces pain | Supportive role only; does not prevent tooth wear |
✔ Lobbezoo, F., Ahlberg, J., Glaros, A. G., et al. (2018). Bruxism defined and graded: An international consensus. Journal of Oral Rehabilitation, 45(11), 837–844.
✔ Manfredini, D., Winocur, E., Guarda-Nardini, L., Paesani, D., & Lobbezoo, F. (2013). Epidemiology of bruxism in adults. Journal of Orofacial Pain, 27(2), 99–110.
✔ Klasser, G. D., & Greene, C. S. (2009). The changing field of temporomandibular disorders. Journal of the Canadian Dental Association, 75(7), 507–512.
✔ Dao, T. T. T., & Lavigne, G. J. (1998). Oral splints: The crutches for temporomandibular disorders and bruxism? Critical Reviews in Oral Biology & Medicine, 9(3), 345–361.
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