Comparing Mouth Guard Types & TMJ Splints

Different types of mouthguards

Different Types of Mouth Guards & Which Protect your Jaw

By Ann McCulloch

Understanding the difference between similar oral appliances for Jaw and Sprain and Strain and other conditions. Learn how to obtain the one that is right for you.

There are important considerations as you decide whether to self-diagnose and research all options, or you decide to seek expert opinion.

The purpose of this article is to describe the difference between common types of mouth guards, nightguards, and special orthotic oral appliances (OA) for medical conditions such as temporomandibular disorders (TMD, or TMJ disorders), or obstructive sleep apnea. It will help you to sort through the confusion in terminology and type of oral appliances.

Gain a basic understanding of the purpose of six oral appliance types. Once you know the objectives of different mouth guard types, and fully consider your dentist’s recommendation, you can best evaluate your specific condition, budget, and needs.

What is a Mouth Guard?

Comparing 6 types of mouth guards
Comparing 6 Types of Mouth Guards

A mouth guard is a device, appliance, orthotic, or a splint that you wear in your mouth for a period. A mouth guard may be worn for a short period during the day, may be worn during the day (except when eating, or even when eating), it may be worn only during sleep. A mouth guard may be worn for a few days or weeks, for a year, or on an ongoing basis.

There is a simple way to sort through the confusion in terminology and type of oral appliances. Develop a basic understanding of the purpose of six different types of oral appliances. Once you understand the objectives of each type of mouth guard, you should fully consider the recommendation of your dentist. Now you can truthfully evaluate your specific condition, budget and how important it is/is not that the mouth guard be perfectly comfortable versus “good enough” for your needs.

Dentists describe mouth guards in many ways. This is because there are different types of mouth guards, and many options regarding the physical design of how teeth and upper and lower jaws come together. This is referred to as occlusal and craniomandibular relationships. There are also decisions as to the material, fit, and the fabrication method. Each factor has bearing on how best to satisfy the objective of each type of mouth guard.

What Words do Dentists use When Referring to Mouth Guards?

  • Bite splint.
  • Directive splint.
  • Permissive splint.
  • Stabilization splint.
  • Occlusal appliance.
  • Deprogrammer.
  • Oral orthotic.
  • Mandibular repositioning splint.
  • Posterior bilateral platform appliance.
  • Neuromuscular full-coverage appliance.
  • TMJ splint.

Six types of mouth guards:

Type Purpose Prescribed by Dentist, Over-the Counter or Either?
Temporary Designed to be used for a short period of time. The purpose might be to treat acute jaw pain, to diagnose TMJ symptoms as a step in treatment planning, to protect dental work for an interim period, or to diagnose the severity of bruxism as a step in treatment planning. Some are made by a dentist; some are consumer purchases.
Nightguard for Bruxism Specifically designed to protect dental enamel (tooth structure) from damage due to clenching or grinding the upper and lower teeth together during sleep. These mouthguards are worn at night, and they can be custom made by a dentist or dental lab or they can be purchased “over the counter”. Keep in mind that if you clench or grind, your condition may be mild, moderate or severe.
Orthotic Appliance for a TMJ Disorder Specifically designed to address an orthopedic condition of a patient’s joint anatomy, a musculoskeletal condition, or other specifically diagnosed TMJ Disorder. These oral appliances are worn as part of an overall treatment plan with specific objectives based on the diagnosis of an expert that can differentiate between the 30 types of TMJ disorders. These oral appliances are typically custom fabricated by a dental lab, and they are often reimbursable by medical insurance. The dental expert monitors and adjusts the oral appliance over several follow up office visits or on an ongoing basis based on changes in the patient’s joint anatomy and musculature.
Orthotic Appliance to for Obstructive Sleep Apnea A dental sleep medicine expert specifies the design to address a medical condition. Patients who have mild to moderate sleep apnea can choose treatment using a custom oral appliance that is designed to prevent the tongue from blocking the airway during sleep. Prescribed by a dentist trained in diagnosis and treatment of sleep disordered breathing. Appliances covered by medical insurance are custom fabricated by a dental lab. Some over-the-counter devices are sold as “snoring” nightguards.
Retainers after Orthodontics These mouth guards are custom fabricated to protect the alignment of the teeth that was accomplished by orthodontic treatment. For purposes of this article, we have not considered orthodontic mouth guards that are removable clear aligners as mouth guards because these are designed to move teeth. Retainers are provided by an orthodontist or dentist at the end of orthodontic care.
Sports Mouth Guards These mouth guards protect the teeth from damage during a high-impact sports event. Examples include a Sisu Guard, football mouth guards, gumshield, mouth protector, and battle mouth guards. Some are made by a dentist; some are consumer purchases.

These oral appliances are worn as part of an overall treatment plan with specific objectives based on the diagnosis of an expert that can differentiate between the 30 or more types of TMJ disorders. New jaw pain may surface after a dental procedure. Sprain/strain to the jaw joint and muscles may occur during a lengthy dental visit.

What are Examples of Temporary Mouth Guards?

A few examples of temporary mouth guards:

  • Anterior Bite Plane (ABP).
  • Boil and bite mouth guards.
  • A trial or temporary oral appliance, until a TMJ splint is ready from the dental lab.

Look for part two where we write more in depth about temporary mouth guards.

What is the Cost of Mouth Guards?

The cost range of mouth guards varies considerably.

Inexpensive over-the-counter boil and bite mouth guards can range from $20 to $100. When a dentist charges for a custom-fitted mouth guard, he or she is taking an impression of your teeth and having a dental lab fabricate the appliance, or taking a scan and making a 3D printed device. The charge depends on the total level of office visits to monitor your condition.

A simple mouth guard for bruxism is typically $100 to $400, if made by a dentist; it comes with a commitment to adjust the appliance to ensure that it fits properly.

An oral appliance for a TMJ disorder is more expensive because the dentist or orofacial pain specialist is providing a higher level of office visit examination throughout a therapy period that may be one to three years. Because of the differences in treatment plans for TMJ splints, there is no standard pricing, but the range might be between $750 for a splint for a common TMJ disorder to $3,000 for a more complex condition.

What is a Nightguard?

The most common mouthguard that is worn during sleep that both patients and dentists call a nightguard is a full-coverage oral appliance to protect the teeth from damage from bruxism. The nightguard may be made of thick or thin acrylic that is soft and chewy, or hard, or thin like clear aligners for orthodontics.

What are examples of nightguards for bruxism?

It’s common for a general dentist to recommend that you wear a nightguard to protect your teeth from damage due to general clenching or grinding. These are referred to as nightguards for bruxism for purposes of this article. Studies show that 80% of people who clench or grind during sleep are not aware of this condition.

Night guards purchased through your dentist or from an online retailer provide a custom-fit, professionally-made product that is designed to match your teeth. Dentists will recommend a specific design and material based on the severity of a patient’s condition. For a patient who clenches with force or grinds heavily, a hard acrylic material is usually chosen. Night guards are typically just worn on upper or bottom teeth.

Most people prefer the upper night guard as it is usually more comfortable, but some patients opt for the lower night guard if they have had dental work on the top teeth.

Three of common types of night guards are:

  • Soft night guard
  • Hybrid night guard
  • Hard night guard

How long does a Nightguard last?

“Night Guards will have varying durability depending on a number of factors. A night guard will have an average lifespan of 5 years, but depending upon the wear, it can need replacement in just 1 year”, according to the University of California Irvine. [1]

What about oral appliances that dentists recommend?

Its quite common for a dentist to recommend a protective nightguard for bruxism because the incidence of bruxism is so high [2]. Unfortunately, it’s common that patients don’t like to be told that they clench and grind.

When this happens, dentists are cast in an unfavorable light as trying to sell something to the patient. If however you do purchase a protective nightguard for bruxism, the dentist will adjust it and take responsibility for making sure that it is appropriate to your condition.

Avoid confusion about the term ‘mouthguards’

These are important considerations as you decide whether to self-diagnose and research all the options, or you decide to seek expert opinion.

There is a simple way to sort through the confusion in terminology and type of oral appliances. Have a basic understanding of the purpose of five different types of oral appliances. Once you understand the objectives of a type of mouth guard, you should fully consider the recommendation of your dentist and truthfully evaluate your specific condition, budget and needs.

What are Occlusal Appliances, Orthotic Appliances, and TMJ Splints?

These terms are interchangeable: occlusal appliance, orthotic appliance, and TMJ splint.

They are terms used to describe an oral appliance that is designed for an anatomical objective regarding the relationship of how a person’s upper and lower jaw come together when chewing, sleeping, or holding the jaw in a relaxed position.

These orthotic appliances are designed to address specific conditions of joint anatomy and supporting muscles, ligaments, teeth and other structures. This is just like how orthopedic specialists commonly specify an orthotic designed to address your ankle, knee, wrist or elbow joints and supporting muscles and ligaments in a particular way.

In choosing a design of a custom orthotic appliance, a dentist has performed a complete evaluation of a patients joints and muscles and uses a series of diagnostic tools. In selecting oral appliance therapy, the dentist fabricates an orthotic appliance to position the jaw in an optimal way to promote positive adaptation of the jaw. For patients with degeneration in the joint, arthritis or asymmetry in the joints, a dentist with expert training or orofacial pain specialist should evaluate whether treatment with an orthotic appliance would be beneficial.

Patients who wear an orthotic appliance for a TMJ disorder should be compliant with the scheduled appointments with their dentist. This is because the orthotic appliance is expected to help reduce inflammation in the jaw joints and/or relax masticatory muscles and the dentist will want to monitor the results. At each visit the dentist may modify the orthotic appliance to accommodate changes, for example, in how the masticatory muscles relax and result in greater range of motion in the jaw joint.

Two considerations when oral appliance therapy is recommended to treat TMD

  1. Is the dentist recommending an orthotic appliance that is irreversible? An oral appliance that is a repositioning device is not reversible, which means that the device is moving the lower jaw (the mandible) into a different relationship with the upper jaw (maxilla) in such a way that is a permanent anatomical change. These oral appliances may adjust the relationship of the upper and lower jaw vertically, forward, in a combination. This may be appropriate to your condition; the point made in this article is that you should understand beforehand whether you are electing to pursue irreversible treatment.
  2. The second consideration is that your dentist should indicate how long you will be in treatment and what your options are if oral appliance therapy for a TMJ disorder does not reduce your symptoms. When the dentist recommends a treatment plan with an orthotic appliance, you should know how long you should continue to wear the appliance, how frequently you should be evaluated and what services are included in the price you are paying for the appliance.

Will a Mouth Guard Help with Jaw Pain?

The right type of mouth guard can help with jaw pain. Wearing a mouth guard to reduce jaw clenching and teeth grinding can help relax and heal jaw muscles. A semi-custom, temporary QuickSplint can provide relief from temporomandibular joint pain.

How do TMJ splints help jaw pain?

There are numerous explanations as to how orthotic appliances help reduce jaw pain, but there is no consensus explanation. A primary reason for differing opinions is the fact that there are so many physical designs for orthotic appliances that comparisons of efficacy can’t be made. It is difficult to compare clinical trials of TMJ splints and develop a conclusion. Again, this is partly due to splint design and in part due to different probable causes of the TMJ disorders under study.

Behavioral changes may explain both muscular and joint responses to wearing an OA

Associated behavioral changes may explain both muscular and joint responses to OA therapy. There are well-designed studies reporting behavioral modification with OAs. These findings fit well within the biopsychosocial model of care for TMDs, according to Adrian U. Yap in Sleep bruxism: Current knowledge and contemporary management.

Additional Findings in the September 2016 article signal that OAs may reduce bruxism on a short-term basis. “OAs change proprioception, which increases brain modulation of muscle activity for 2–6 weeks as a protective mechanism to something foreign.” Simutaneiously, especially when augmented with additional interventions such as cognitive behavior therapy, counseling, anti-inflammatory medications, and physiotherapy, a variety of positive responses as TMD signs and symptoms improve is expected. Then the OA may become a “crutch” to stabilize the system. After the initial reduction in bruxism the CNS accommodates to the appliance and engrams return to normal parafunction for those patients.

AME Groups offer possible explanations in Intraoral appliances for temporomandibular disorders: what we know and what we need to know. Published March 2021, it talks about the need to reduce joint loading.

Oral appliances decrease mechanical stress and joint inflammation by changing the load applied to the TMJ’s.

some clinicians believe that OAs should be regarded as devices that are intended as a preliminary or diagnostic step prior to definitive dental therapy. Within that conceptual framework, an OA is used to modify joint position and anatomy, evaluate vertical dimension of occlusion, “deprogram” the patient so that irreversible occlusal modification can be performed in “phase II” treatment, or other mechanistic protocols.” – The Value of OA’s section

Which Mouth Guard is Best for TMJ Pain?

A professional selects the appropriate mouth guard for TMJ pain based on a diagnosis.

An orofacial pain specialist may ask: is the new or recurring jaw pain? They will seek to answer: is the joint itself causing your pain? Or are the muscles that your jaw depends on? There are multiple temporomandibular (TMJ) disorders. Meaning, which mouth guard is best for your TMJ pain is determined by your diagnosis. Knowing your underlying condition determines the best TMJ mouth guard. This is why there is no consensus on what is the best.

When it comes to a custom mouth guard to treat a TMJ disorder, these oral appliances are also commonly called “splints” or “orthotics”. If a dentist prescribes a TMJ splint, there are over 15 different designs that your dentist might recommend.

Here are the most common mouthpiece designs:

  • Stabilization Splint: Stabilization splints prevent complete closure of the upper and lower jaw. They typically flex more, meaning that their flat surface facilitates free movement of the jaw when wearing the splint. These are typically used to protect the teeth from jaw clenching and teeth grinding.
  • Repositioning Splint: This mouth guard type is intended to change how the upper and lower jaw function together – properly alignment is vital. They fit the need for a more rigid hold on the jaw joint and teeth when a specific alignment is best. They are used more often in TMJ disc disorders.
  • Anterior Bite Plane: Anterior bite plane splints are similar to stabilization splints. The difference is that they do not cover the back molars. This design completely inhibits activation of the posterior teeth (meaning that the teeth can’t clench together). They are “permissive”, allowing the jaw to find its most comfortable position. Their use should be temporary (typically up to 6 weeks) and monitored for any change in the position of your. Otherwise, your back teeth may sift position over time that would create what is called an “anterior open bite”.

Does an oral splint help cheekbone pain?

When the temporomandibular joint is excessively inflamed, it is known to trigger pain elsewhere in the face. This may impact a person’s cheeks, under the eyes, even the temples in the forehead region.

Levels of significant facial swelling are an uncommon symptom of TMJ disorders but do occur. Individual with a severe, untreated TMJ disorder or significant jaw misalignment report associated cheekbone pain more often. After ruling out the possibility that you have cheekbone pain from a sinus condition, consider evaluation by a dentist or orofacial pain specialist who is trained to evaluate facial pain.

Comparison of Mouthguard Types & TMJ Splints Conclusion

For acute cases of jaw pain with no prior history of pain or dysfunction, try a temporary mouth guard or a mouth guard designed to prevent grinding and clenching. Monitor your results carefully and determine whether you are qualified to make a decision about your symptom improvement. It may be time speak to a TMJ healthcare provider.

If you have signs and symptoms of severe bruxism or TMJ dysfunction or pain, do not try to guess which over-the-counter mouth guard type would address your issue.

We designed QuickSplint as a short-term trial device to help you and your dentist determine the next step in care a TMJ Disorder.

Author bio

Author Dr. Brad EliAnn McCulloch, MBA is co-founder and president of Orofacial Therapeutics, this site, and oversees the company’s expanding portfolio of resources and tools for jaw and headache pain diagnosis and treatment. Her chronic jaw pain issues continue to inspire her to investigate the needs and challenges of patients suffering from orofacial pain.

 

References

[1] https://shc.uci.edu/sites/default/files/docs/How%20to%20Care%20for%20your%20Nightguard.pdf

[2] https://www.ncbi.nlm.nih.gov/books/NBK482466/