Grinding or clenching of the teeth is a very common problem. It is a nasty problem for its bearer as it causes pain in the muscles and in the jaw joint, headache, toothache and even disturbed sleep at night. If nothing is done to the problem the teeth will eventually suffer from the grinding especially if the occlusion is imbalanced. There will be a recession in the gum, worn enamel, chipped enamel and periodontal problems to start with.
So if you do know that you grind or clench your teeth at night – or even more so if you clench your teeth during the day which is a definite sign that you do it also at night – go to see your dentist. But here’s an important advice:
Do not go to see just any dentist. Find a specialist in prosthodontics and stomatognathic physiology (even better if one has a PhD).
Why? I will tell you the reasons from my own experience.
My First Mouth Guard Or Should I Say Bite Block
I am a dental professional and in my early career I was quite naive and thought that all the dentist can do all the stuff they are taught at school. I was so wrong.
In my first year after graduation I had a bite guard made by a regular dentist in my practice. I soon realised it wasn’t perfect and sought help from a specialist in prosthodontics who was working in our practice.
The first thing the specialist did was that he filed away about 0,7 cm (0,28 inches) of the hight of the bite guard without fitting it in the middle of the filing. Once he was done with the filing he started to adjust it to my occlusion. He was covered with acrylic dust and he did lots of eye rolling and head shaking.
He told me that the bite guard is not ideal and it would be better to have it redone. I never really used it after that and I carried on suffering from the grinding and clenching of the teeth.
My Second Mouth Guard – When Desperate You Accept Anything
Couple of years later I lived in another country and once again sought help from a dentist for the grinding. She recommended me an anterior night guard (also known as NTI or MCI) which she did routinely for every patient suffering from grinding.
Now I tried to find you a web site that had a photo and impartial info about anterior night guard but wasn’t able to find one. So I took a photo of mine. I must apologise that the device is not in a mint condition anymore. There is my current mouth guard (that I will tell you more about later in this post) in the photo for comparison.
I felt this anterior night guard – I will call it MCI from now on – relieved the symptoms I had. I was very happy about the dentist and the MCI. Until I spoke to a former colleague of mine, a very good dentist.
He warned me that I was in risk of developing an anterior open bite due to a use of MCI. I did not second guess him once he explained the reasons.
With MCI the back teeth do not make contact. And when the teeth don’t make a contact with the opposite side they will erupt while the front teeth are kept in place by MCI. The overerupted back teeth cause the open bite in the front. Simple as that.
We’ve all seen what happens to a tooth that lacks an opposing partner in occlusion. It overerupts!
So I got an advice to use the MCI for 2 weeks and then keep 2 weeks break to avoid the overerupting back teeth. So I did. But it did not keep the symptoms of grinding at bay.
My Third Mouth Guard Was Almost What It Should Be
Five years later I was back in my home country where I was advised to have a mouth guard done by a dentist in my practice. I did and she removed my upper wisdom teeth so that it was easier to have the mouth guard done. Once I received the mouth guard I didn’t feel it was helping me at all.
At this point I had had enough of the dentists in this matter and decided to see a specialist in prosthodontics. One that was known to be a good one.
The specialist did a careful examination on my teeth and the mouth guard. He said the mouth guard was ok’ish and that he just needed to adjust it. I also showed him my MCI which he advised to use only as emergency basis and only 4-5 days in a row.
I told to the specialist that I have a feeling that only my last molars were in contact. He checked it and said there was no imbalance – meaning that my bite was as it should be. I also asked if I should do the exercise for the jaw muscles. The specialist said there is no benefit of it.
I had to return to see the specialist every 6 months and every time he adjusted the mouth guard and charged quite a lot even compared to the specialist’s fares.
After 3 years of using the mouth guard there was a hole in it. I had apparently “bitten” through it. It was time to have a new mouthguard done.
My Fourth And Current Mouth Guard
For one reason or another I did not completely trust the specialist I had been seeing so I asked for recommendations of specialists from my colleagues. Based on the recommendations I went to see a specialist in prosthodontics and stomatognathic physiology – she had PhD too!
I was kinda shy when mentioning that I have a feeling that only my last molars were in contact – well hell yeah, one specialist had told me I was imagining things.
Only this time I was told I was right. She also told me that I have a partial anterior open bite. I was flabbergasted. I knew that not all the dentist master the matters of occlusion but even the specialists get it wrong!
And once she had done her magic about my occlusion by balancing it I felt the difference immediately.
By the way – my intact upper wisdom teeth were unnecessarily removed by the dentist who made my third mouth guard. A mouth guard can be done with the wisdom teeth in place as long as they are nicely positioned as mine were.
So after I had my occlusion sorted out I got my new bestest of the best mouth guard. It is amazing I must say. It brought me an immediate relief. But I was only half way through the treatment.
I was booked to see a dental hygienist who did massage for the muscles of the jaw in 3 separate visits and gave instructions (based on the specialist’s recommendations) on how to exercise the muscles by stretching and strengthening them. I realised that having a mouth guard is not enough. It won’t take away the root cause of the grinding which in my case was the weak muscles that did not support the jaw.
The MCI I was not allowed to use again. I did not argue with that.
I, a dental professional had three mouth guards (including the MCI) done until I got a proper one. None of the dentists I saw for the mouth guard had a clue about occlusion or what is the best treatment for it. The second specialist was only concentrating on the mouth guard and did not find the imbalance in my bite. Naughty naughty. I guess he was concentrating in money making – I sense these things as I am HSP – and that was probably one reason I didn’t go back to see him.
I worry over the patients who do not have an understanding of what is right treatment for grinding and clenching of the teeth. There are lots of people using MCI every night and they have been using it for years and years. Do they realise that the open bite they have developed is caused by the use of MCI? No they don’t as the dentist won’t necessarily tell them – especially if the patient is seeing the same dentist who recommended the MCI (see my previous post about this phenomenon). And it is not guaranteed that another dentist will tell either.
Also very commonly the treatment dentists offer for the grinding is the mouth guard. And only the mouth guard. But that is never enough! The best thing any dentist can do for the patient who is suffering from the grinding is to REFER to a specialist.
Important information for the patients: You can make a self referral to a specialist by simply booking an appointment. They will not say no to the new patients. Be prepared to pay more for the mouth guard but it is money well spent.
The occlusion is a delicate thing. I always advice patients not to let just anyone adjust the bite. It can go from bad to worse. You are in better hands when seeing a specialist in prosthodontics and stomatognathic physiology. The higher educated one the better – in any health matter.
I learned my lesson the hard way. I suffered from the grinding for many years. I lost two intact wisdom teeth unnecessarily. And I can’t help but think that the malocclusion on my back teeth and the partial anterior open bite were caused by the MCI. There was a dreadful moment when the specialist was thinking that I might need crowns for my intact canine teeth to fix the open bite and to get enough support for the side movements of the jaw. So I can count myself as lucky that the malocclusion could be fixed by simply filing the teeth.