Why Every Dentist We Spoke to Said to Avoid Over-the-Counter Night Guards (2024)

A night of solid sleep is supposed to mean you leap out of bed, twirl around your bedroom and breeze out the door to conquer the universe.

But if the main thing you notice as you stagger to the coffee maker is that your jaw or teeth ache, or that you have a headache, you might be clenching your jaw or grinding your teeth in your sleep, a condition known as bruxism. Not everyone has these symptoms of bruxism, but your dentist may call it out: Tooth damage, unusual wear on your enamel, white scars on the inside of your mouth or half-moon shaped "scallops" around the edge of your tongue are all tipoffs, says Nojan Bakhtiari, D.D.S., FAAOP, a dentist in New York City who specializes in temporomandibular joint (TMJ) and orofacial pain.

It can be tempting to pick up an over-the-counter night guard at the pharmacy, but hold up! The ones you’ll find hanging there near the floss picks may cause more harm than good if you wear them for any length of time, according to every dentist Good Housekeeping spoke to for this article. So, let's get to the bottom of this.

Also called an occlusal splint, a night guard is “a removable appliance that can be used in either the upper or lower jaw and covers the surface of the teeth,” explains Sercan Akyalcin, D.D.S., M.S., Ph.D., head of orthodontics at Harvard School of Dental Medicine. They’re usually made of plastic or harder acrylic, and are used to treat sleep bruxism, certain jaw disorders and obstructive sleep apnea (OSA) which is a sleep disorder where your throat muscles relax and block your airway, causing you to wake up gasping for breath. Because you stop breathing multiple times in the night, sleep apnea is related to host of chronic illnesses, including high blood pressure, diabetes and it ups your risk of heart attack and stroke.

A well-fitting night guard made of the right materials can be helpful in managing several conditions. It can protect your teeth if you’re prone to grinding and clenching in your sleep, and some doctors use them as part of treatment for jaw-joint related disorders to help manage pain and headaches, says Dr. Akyalcin.

There is also a particular kind of sleep guard that temporarily repositions your jaw to help keep your airway clear while you sleep, used to treat mild to moderate obstructive sleep apnea. Your dentist won’t diagnose OSA, but may give you a referral. “Sleep apnea is a medical condition and should be diagnosed with a sleep doctor,” says Kami Hoss, D.D.S., M.S., an orthodontist in Chula Vista, CA and author of If Your Mouth Could Talk. The sleep specialist may then send you to a dentist who specializes in fitting a device particular to your anatomy, he says. A night guard like this may be a one-two punch: Research shows that many people who grind their teeth also have OSA, though they haven’t nailed down exactly why; these devices can manage both.

But while dentists and specialists recommend night guards, “the literature lacks robust evidence to support or deny their usefulness,” says Dr. Akyalcin. Whenever possible, says Dr. Hoss, the ideal solution to the symptoms caused by teeth grinding, jaw problems and sleep apnea is to address the root causes of these conditions.

As to whether a night guard is inherently good for your teeth, the answer is no — there is no added benefit to sleeping with a night guard if you don’t have a condition that requires treatment, and because any night guard can trap bacteria against your teeth if not properly cleaned, if you don't have a medical need for one, it's better not to wear one.

Night guards are made differently depending on what they’re meant to treat, but broadly, there are three types:

So what type is best? Hands down, a custom mouth guard overseen by your dentist or specialist is the best option.

“I never, ever recommend an over-the-counter night guard,” says Dr. Hoss. “I would absolutely want to get a custom-fitted one, since you’re going to wear this in your mouth for hours at a time.”

The dentists we spoke to want you to hear one thing loud and clear: The mouth is a sensitive place, and even small shifts in your bite or muscle imbalances can lead to bigger problems with your teeth and jaw. “Any time you introduce something in your mouth overnight, you can potentially cause harm,” says Dr. Bakhtiari. “It can benefit you, but it can also affect the homeostasis of your jaw and mouth and have a negative impact.”

That's why when it comes to night guards, a precise fit and the right materials are crucial. “Issues with over-the-counter guards relate to the nature of their fit, material quality, durability and the environment they can create in place,” says Dr. Akyalcin.

But before you think, Of course dentists don't like OTC night guards, since they make bank if I pay for a custom guard, check out their reasoning, below.

Here are a few potential risks:

To be clear, many people will have no problem at all with an over-the-internet or OTC night guard. “The question is, how do you know if you’ll be one of those?” asks Dr. Hoss. “If it were my son or daughter or me, I would not take the risk.”

Does insurance cover night guards?

It depends on your policy, and what medical issue the night guard is meant to treat. If the night guard is considered medically necessary (as for sleep apnea or bruxism) your insurance may cover a percentage of the night guard. Your dentist or doctor should let you know how much, if any, of your night guard will be covered.

Can a night guard be worn with braces?

For people with metal braces, an over-the-counter guard or internet night guard, aside from all the risks listed above, might not be comfortable and could damage the hardware. “If you use the boil-and-bite guards over brackets, that could cause harm,” says Dr. Bakhtiari. If you have wired braces, the best thing to do is speak to your orthodontist, who may be able to construct a solution. “But that is a challenging scenario,” he says.

Kelly Suralik, D.M.D., M.S., a prosthodontist at the Mayo Clinic in Rochester, MN, agrees. “Wearing bite guards with braces proves difficult as teeth are moving in orthodontic therapy and not stable to keep the guard in place.”

One option might be to switch to clear aligners, says Dr. Akyalcin, but because they're so thin, grinding could wear them out quickly. When the braces come off, however, it’s possible to get a retainer that both keeps your teeth straight and protect against grinding. “I always recommend that my patients have custom occlusal sprints fabricated using hard materials that can simultaneously serve as night guards and retainers,” he says.