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Mouth Guards

What are mouth guards?

Mouth guards are dental devices worn on the upper or lower teeth. They can be hard or soft, and may cover all or some of the teeth. They are generally listed under the umbrella term of “intra-oral mouth guards” and are worn for various reasons.  Based on the purpose of the guard, the name may change while still falling in the category of an intra-oral mouth guard [1]

Types of mouth guards

Guards are usually constructed by the dentist out of moulds made from impressions of your teeth. The majority of such guards are made of hard plastic, but soft vinyl guards may be prescribed for certain needs. 

There are also mouth guards that can be bought over the counter at a pharmacy or sports store.  These guards are generally soft “boil and bite” guards, with very simple instructions as to how to soften the guard in hot water and then to mould it in place by biting on it.  These are mostly for temporary use until you can see your dentist, but can be valuable in certain circumstances.

The type of guard, and whether you get it from your dentist or a pharmacy, depends on the purpose of the mouth guard.

Common reasons for the use of an intra-oral mouth guard

  • Fluoride application
  • Tooth whitening
  • Protection from bruxism (nighttime grinding and clenching)
  • Helping with stability of loose teeth due to periodontal gum and bone disease
  • Protection or treatment of temporomandibular joint disorders and related face, head, neck and muscle disorders
  • Treatment of the bite before dental reconstruction or as an orthodontic appliance for tooth movement.
  • Sports guards
  • Treatment of sleep disturbances such as snoring and sleep apnea

Mouth guards for Fluoride application

After you go to the dentist to have your regular cleaning, the hygienist will ask that you swish your mouth with a mouthwash that generally delivers sodium fluoride to your teeth. This is a way to strengthen your teeth and is especially useful for preventing cavities with children.  The dentist may then prescribe a fluoride tray (mouth guard) for use at home with a sodium fluoride rinse or gel, in addition to the dental visit application. These are usually necessary in patients who may be at high risk for cavities due to systemic problems such as radiation therapy for cancer or due to medications that can cause dry mouth, such as antihistamine allergy medications. The lack of saliva contributes to the build up of dental plaque along the teeth; bacteria in the plaque, along with the acid created cause dissolution of the tooth enamel. This leads to the formation of a cavity, which if left untreated can cause tooth loss. Presently newer types of materials can be used as a paste for re-mineralization of tooth structure. Ask your dentist which will be the best for you [2].

The application of daily fluoride is extremely helpful. Soft vinyl guards fitted for the upper and lower teeth act as trays into which the fluoride gel is filled. The guard is worn with the paste in it for the amount of time your dentist has prescribed.

Mouth guards for Tooth Whitening

Dental tooth whitening has become a major area of dentistry and is a sector that continues to grow. Most of the tooth whitening is done with the use of a gel or paste containing approximately 9% hydrogen peroxide that is placed into thin bite plates, which the patient places over their teeth.

Your dentist will use an in-office or an in-home combination with guards made from your own impressions. In these guards, there is a built in stop for the gums in order to isolate the paste from the gums, so as not to cause irritation. The level of active whitener is dependent on the type and make of the product.

There are over the counter whiteners made by companies that give you ready-made soft mouth guards for use with their whitening paste. These are also effective, but are not designed to keep the paste or gel away from the gums. In these cases, you may experience some burning or redness and tenderness of the gums from the paste.  Rinsing your mouth after using the whitening product should help, but if it continues you should stop using the product and check with your dentist [3]

Mouth Guards for Protection from Bruxism

(For more information on Bruxism, please see the Bruxism Knol

Tooth grinding is a nighttime event called bruxism. Bruxism is a common problem, with up to 75 percent of the adult population experiencing it at some point in their lives.  Not all grinding is severe enough to require treatment, but when the dentist notices signs of tooth grinding he or she may prescribe a night guard [4].

The most common night guard is an acrylic guard resembling hard plastic, which covers your upper teeth. It is based on impressions taken by your dentist of your teeth, and can be made on a vacuum-forming machine or sent by the dentist to a dental laboratory. 

Once it is inserted into your mouth, the dentist will adjust the guard.  Your dentist will usually use a colored wax or paper marker and have you grind down on it while wearing your new appliance. This will leave spots on the guard, letting the dentist know where your teeth are hitting and allowing him or her to adjust the appliance correctly.  Generally, the dentist will try to have your teeth strike equally all around, but sometimes it may be designed to strike only on the front teeth.  This can prevent grinding of the back teeth.  There are certain newer guards on the market, which are designed with this in mind, and focus on only allowing the front two teeth on the upper and lower jaws to come together [5]. Regardless of the strategy behind it, all of the guards are designed to protect the teeth from injury during nighttime grinding.

There are also over the counter guards, some of which have been approved for temporary use in nighttime grinding. These are usually available at local pharmacies or CVS type stores. The majority of these guards are “boil and bite” soft guards with simple instructions for use.  Some of them are adjustable for ease of wear. These can be effective, but you should read the instructions carefully to make sure you do not have dental conditions that could be aggravated by wearing them.  Some of the better over the counter guards are a combination of soft and hard materials, which allow for more support and protection of the teeth. Lately, new emerging technologies have shown promise for a digitally developed night guards that is based on the patients own teeth [6].

Mouth Guards for Stabilizing Loose Teeth

In patients with moderate bone loss due to gum disease, the teeth may be loose due to a reduction of bone support. These loose teeth can lead to pain and the inability to eat.

The most common treatment for this kind of periodontal disease is usually to treat it with medications and surgery, followed by re-constructive dentistry to help stabilize the teeth. During this step, temporary splinting of teeth may be recommended with the use of an acrylic hard dental mouth guard made to cover the loose teeth. The guard is designed to hold the teeth from moving and to help in the post-surgical healing phase. These guards must be made by the dentist and balanced to allow for the opposing teeth to rest comfortably on it.  Once the tissues have healed, the guard may continue to be worn unless the dentist tells you otherwise [7]

Mouth Guards for the treatment of TMJD and other Muscle Disorders

(For more information on TMJD, please see the TMJD Knol)   

If you have signs and symptoms of temporomandibular joint disorders (TMJD), the dentist may suggest a combination of muscle relaxants, stress and relaxation training, physical therapy, and mouth guard treatments [8].

The most frequently used mouth guards when dealing with TMJD are called “bite splints,” and are hard plastic guards worn over the teeth. Commonly, an upper guard is used during the nighttime, and a lower guard is recommended for during the day. This combination allows your dentist to control the position of your jaw while sleeping, but at the same time allows the dentist to support your jaw position while allowing for speech and aesthetics during the day. 

The height and balance of the guards is determined by your dentist. After putting in the guard, you may have an adjustment period of one or two days with more muscle tightness.  If this continues, you should call your dentist to check the height and balance of the guard.  For instance, if you start having a dull, aching pain in the back of your head, the guard may be too thick for you and the dentist can thin it down. If your jaw is not comfortable when you close or there is a big shift of your jaw upon closing, the guard will need to be rebalanced.

At times the way your bite comes together requires that the dentist cut away parts of the bite plate so that the bite can be stabilized. If your upper front teeth completely cover your lower front teeth when your teeth are together, a full coverage guard may open the bite too much. If you have such a bite, putting in a full appliance would be like sticking your finger in between the front two teeth- the back of the jaw would be too open. In such cases, cutting out the front plastic would allow the back of the jaws to be aligned without the front teeth interfering. 

Bite plates are also used for the management of headaches and neck pain [9]. These bite plates are designed to relax the muscles of the head, face and neck by changing the way the bite comes together. Increasing the vertical height of teeth temporarily by the insertion of a bite plate for the lower teeth tends to position the head straighter on the neck [10]. You can test this out for yourself.

Wash your hands and then sit down in a normal position, paying attention to your natural head position as you sit. Now with the first two fingers of either hand place them between the upper and lower teeth on either side and rest your teeth on your fingers. Close your lips lightly around the fingers and you will find that to be able to swallow you will have to lift the head up onto your neck. The bite plate has that same type of effect. As the head rests upright on the neck, the neck muscles do not have to work as hard and they tend to relax. A significant number of headaches are muscle related and can similarly be affected by bite plate therapy in conjunction with physical therapy.

In patients with TMJD, clicking and popping can occur upon the opening and closing of the jaw.  This is calleddisc displacement and is related to a forward shift of the cartilage that lies between the rounded condyle of the lower jaw and the temporal bone of the skull. Bite plate therapy can help reduce the noise, and in those instances where the disc is displaced, can allow the jaw to open fully by recapturing the disc. In such cases, a lower bite plate which is designed to bring the lower jaw forward and hold it there has been shown to be effective in reducing pain and improving function. Bite plates have also been found to be effective in reducing muscle pain and tension in TM Disorders.

Some over the counter “boil and bite” guards can be temporarily helpful if the pain you have is related to a muscle. Generally, the clenching muscles on the sides of your jaw or on your temples will become painful and can be helped by wearing these over the counter guards until you get in to see your dentist. These guards prevent damage to the teeth by simply not allowing the teeth to come together. 

Mouth Guards for Correcting and Maintaining the Bite

There are many cases where a bite needs correcting, or broken and missing teeth need to be replaced in order to correct the overall jaw position. The umbrella term for this type of dental work is prosthetic reconstruction of the teeth.  In such cases, a mouth appliance can be used to find a relaxed jaw position before building the new bite. Depending on the philosophy of the dentist, bite plates can be used to bring the jaw into a position that the teeth can be built in [11]

In cases where orthodontics are required, a technique using a series of removable orthodontic appliances – thin soft guards that can help position and move teeth – are now available for use in certain cases. Your orthodontist or dentist will decide if such a system is appropriate for you.  In children, another soft guard type appliance guides the teeth coming out into their proper place. Other orthodontic guards are made as retainers. Retainers are designed to prevent teeth from moving after orthodontics. They are usually made out of a combination of plastic and wire to hold the teeth in place. 

In children and in some adults, specific orthodontic appliances are designed to help expand the arch of the roof of the mouth [12]. These are called functional appliances and are made of hard plastic with a metal screw in the middle. The plastic comes in two separate pieces, with only the screw holding the two pieces together.   This design allows the left and right parts of the appliance to be moved apart, thus expanding the arch. Functional appliances are best if used during growth and development to help position the teeth properly. 

Mouth Guards for use in Sports

Sport guards come in many shapes and sizes, but they are all designed to either prevent injury to the teeth, prevent concussions, or to improve athletic function [13].

The most common forms of guards for school sports are “boil and bite” guards.  These are bought over the counter at a store and molded at home using hot water.  However, not all sports guards are the same.  You need to be cautious in deciding which of the many guards on the market are right for the sport you are considering.

What makes a good sports guard?  It needs to fit properly, so the best guard is one that the dentist can have made for you. Usually, this will be an upper guard made out of a hard outer shell and a softer inner cushion and protects the upper front teeth from a direct blow. 

Lately the focus of a good sports guard has changed to include protection of the TM joints and to prevent head concussions. Due to the wearing of helmets in some contact sports, such as football and lacrosse, and the fact that the helmets have face shields, it is more important to have a guard designed to prevent concussion than one designed to protect the upper front teeth. This requires that the lower jaw be held stable during contact to the head, as there is evidence that the stability of the head and neck is helped by specific jaw posture.

A lower guard made by the dentist to hold the jaw in a stable height and position with respect to the upper teeth has been shown to be helpful in reducing the incidence of concussions.

In the event that you wish to get a sports guard from the sports store or the pharmacy, you should look for:

  • The best over the counter guards are “boil and bite” that are made of two materials- an outer harder shell and an inner softer shell, much like the guard you might get from a dentist.
  • Most over the counter guards are designed for the upper teeth.  However, you should look for one that has an upper and a lower bite arch so that you can position the lower jaw to prevent it from shifting during a blow to the head, face or jaw.
  • In addition, the guard must have channels for breathing and you should be able to talk with it in the mouth.

Studies have shown the ability of some guards to help with strength in sports. Many professional and amateur athletes wear guards to give them as improvement in their ability. While the idea of a performance improving guard is still in its infancy in the United States, many teams in Europe have been experimenting with strength guards.  Not all dentists are knowledgeable in this field and it does not work in all cases. You should talk to your dentist or seek out a specialist who is involved in sports dentistry [14]. This is a new area of sports dentistry and is still being studied.

Mouth Guards for Snoring and Sleep Apnea

Snoring and sleep apnea are two of the best known sleep disturbances. Snoring is a sound caused by the movement of air passing through restrictions in the breathing tube in the throat. Snoring usually occurs more in men than in women, and is especially prevalent among those with a collar size of 17 inches or more. The sound is usually a vibration related to the movement of the uvula or the soft palate. While snoring may not be always harmful to the person, it can be detrimental to relationships due to the sound produced while the person is asleep [15].

A reduction of the airway space is the main cause for snoring and often related to a malpositioned jaw or missing teeth. During sleep, the lower jaw tends to fall back, especially when lying on your back. Bringing the lower jaw forward so that the lower front teeth are almost edge-to-edge with the upper teeth opens the airway in a method similar to that used in CPR.  This is the reason why dentists make mouth guards called sleep appliances to hold the lower jaw forward during sleep. This tends to also bring the tongue forward, which helps to open the airway space. Treatment is considered successful if the sound of snoring is reduced or eliminated. 

Snoring, accompanied by restless sleep, may result in daytime sleepiness and is a sign of a more underlying serious sleep disorder: sleep apnea. The term sleep apnea refers to periodic pauses in breathing during sleep. If you have apnea, you may not be aware of it until someone who has heard you in your sleep tells you of jerky body movements, along with sudden gasps of breath. This is a result of a sudden drop of blood oxygen levels during sleep, and the body fighting to take in a large gulp of air to counteract it [16].

Since snoring and sleep apnea have similar causes, the treatment of sleep apnea also follows the same path – with one major exception. Snoring can be loud and uncomfortable to your partner, but sleep apnea can be the cause of serious conditions, including heart attacks. So if you have been told that you gasp at night in your sleep or you feel chronically tired even after a full night’s sleep, you may need to have a polysomnogram conducted.  A polysomnogram is a sleep study done in the hospital or in a sleep laboratory, and is the current gold standard to evaluate sleep problems. There are some new in-home sleep apnea testing devices that can be used to help make the decision as to the need of the polysomnogram, but conducting a guided test with a professional is the best way to find out if you have apnea [17].

If you have sleep apnea, your sleep physician may prescribe a CPAPmachine (Continuous Positive Airway Pressure). A CPAP machine is a mask with compressed air blowing through it that the individual wears at night to help open up the airway space.  The compressed air lifts up the back of the throat and allows more oxygen to flow during sleep. This should always be the first treatment for sleep apnea. If you have tried it and found you could not wear it, you may then be referred to your dentist for a sleep guard. 

Presently, there are many dentist-made sleep appliances that attempt to treat mild to moderate sleep apnea. Some of these may be ready made and the dentist can modify it for you, or the dentist may take measurements of jaw position and send out to a dental sleep laboratory for a personalized guard. These types of guards can be on either the upper or lower jaws, and allow the mandible to be incrementally moved to your optimum position. Once this is done, the dentist will work with the sleep physician to schedule a second sleep study to evaluate the effectiveness of the guard. You can tell if the guard is effective rather quickly as it will allow a deeper, more restful sleep and will provide you with an increase in daytime energy. 


Mouth guards come in a wide range of designs, befitting their wide range of functions.  They can be used in preventing injury, treating pain, allowing for better sleep, and positively affecting the general quality of your life.  While there are many great brands of over the counter guards, it is always best to consult with your dentist before deciding on a plan of treatment involving a mouth guard.