Custom vs over-the-counter night guards: which should you get?

What a night guard does, and what it doesn’t

A night guard is a plastic tray that fits over your upper or lower teeth while you sleep. It keeps your top and bottom teeth from grinding against each other, so the guard wears down instead of your enamel.

It protects your teeth. It doesn’t stop the grinding itself, and there isn’t much evidence that guards ease jaw joint pain on their own. If you’re not sure you grind, start with jaw and tooth pain from grinding.

The four kinds of night guard

Custom, from your dentist

Your dentist takes impressions or a scan of your teeth and sends them to a dental lab, which builds a guard to fit them. It takes up to two weeks.

• Fit: the closest and usually the most comfortable. Your dentist checks how it sits and can adjust it in the office.
• Protection: the best of the four, according to both the ADA and Cleveland Clinic.
• Lifespan: several years with good care.
• Cost: the most expensive option. Some dental insurance plans pay for part of it.

Custom, from impressions you take at home

Companies such as Pro Teeth Guard and Remi mail you a kit. You press putty trays onto your teeth, mail the impressions back, and a lab makes the guard.

• Fit: made from your own teeth, so it should fit far better than a store-bought guard. How well depends partly on how good your impressions are.
• Materials: Pro Teeth Guard says its lab uses the same materials it uses for guards it makes for dentists.
• Cost: you pay for the guard only, with no exam or fitting visit included.
• The catch: no one examines your mouth. Nobody looks for a cracked tooth, a failing filling or a jaw problem, and nobody checks the fit in person.

Boil-and-bite, from the drugstore

You soften it in hot water, then bite into it so it takes a rough shape of your teeth.

• Fit: better than a stock guard, but bulky and less exact than a custom one.
• Protection: less than a custom guard. The ADA notes that store-bought guards may not protect the way one made for you does.
• Lifespan: short. Cleveland Clinic says store-bought guards may need replacing a few times a year.
• Cost: the cheapest way to try a guard.

Stock, ready to wear

These come pre-formed and go straight in your mouth. Most are sold for sports. They’re inexpensive, but they often don’t fit well.

Why a dentist exam first matters

Grinding is often a sign of something else, and a guard can cover up a problem without fixing it.

• Cracked or worn teeth. Grinding can chip, crack or loosen teeth. A guard won’t repair a crack, and a cracked tooth can get worse. See cracked tooth.
• Jaw joint problems (TMJ disorders). Grinding can lead to jaw pain, clicking or a jaw that locks. These can need more than a guard.
• Sleep apnea. Many people who grind also have sleep apnea, where breathing stops and starts during sleep. A guard doesn’t treat it. If you snore loudly, wake up tired, or someone has seen you stop breathing, talk to a doctor or dentist before you buy a guard.

A dentist also makes sure the guard doesn’t change how your teeth meet. Avoid any guard designed to permanently change your bite. If a guard causes pain, stop wearing it and see your dentist.

Which one should you get?

• You have jaw pain, a sore or damaged tooth, or you snore: see a dentist first, and get a guard through the office.
• A dentist has already checked you, or you’ve worn a guard before without trouble: a lab-made guard from home impressions is a reasonable option.
• You’re not sure you grind and want to try one for a few weeks: a boil-and-bite is a cheap test. Don’t count on it for long-term protection.
• Stock guards: skip them for nightly wear.

What it costs

We haven’t found a trustworthy national price range for night guards, so we’re not quoting one. What drives the price:

• Who makes it: a custom guard costs more than a drugstore one because it’s made for your mouth.
• Material: hard, soft or a hard-outside, soft-inside hybrid.
• The visit: a dentist’s price includes the impressions and fitting, and the exam is often billed with it.
• Coverage: some dental insurance pays part of a dentist-made guard.

Ask your dentist for a written estimate. If you don’t have dental insurance, a dental savings plan (a discount membership, not insurance) can lower the price at participating dentists.

How to make it last

• Wear it every night. It only protects your teeth on the nights it’s in.
• Rinse it in cool water after each use, and clean it with a soft brush and soapy water.
• Let it air dry, then store it in a sturdy, vented case.
• Keep it away from hot water, dishwashers and a hot car. Heat can warp it.
• Bring it to your checkups so your dentist can check the fit and wear.
• Replace it if it cracks, gets thin or stops fitting snugly.