A night guard is a specialized dental appliance worn over the teeth, typically during sleep, to protect them from bruxism (teeth grinding or clenching). These devices also alleviate strain on the temporomandibular joints (TMJ) and associated muscles. Professional adjustment by a dentist is a standard part of ensuring the appliance is comfortable and effective. This modification achieves proper contact points between the upper and lower teeth, ensuring balanced jaw function and long-term protection.
The Need for Adjustment
Despite being custom-made, a new night guard often requires modification shortly after the initial fitting because the material may have slight imperfections or the jaw muscles need time to adapt. A common issue is the presence of “hot spots,” which are areas causing localized discomfort, soreness, or irritation to the soft tissues of the mouth. These spots indicate an uneven edge or a point of excessive pressure.
Adjustment becomes necessary over time due to changes in the mouth itself. Dental work, such as a new filling, crown, or extraction, can alter the alignment of the teeth and affect the guard’s fit. If the underlying teeth shift slightly, a night guard that once fit perfectly may begin to feel loose or tight. Material warping, often a result of improper cleaning or exposure to heat, also necessitates a professional visit to restore the fit.
If a night guard is too loose and falls out during sleep, or too tight, causing pain when inserted, it requires attention. An ill-fitting appliance can cause jaw stiffness or a feeling that the bite is uneven upon waking, a condition known as occlusal interference. These symptoms compromise the guard’s ability to protect the teeth and jaw.
The Adjustment Procedure
The adjustment procedure focuses on achieving a perfectly balanced bite, known as harmonious occlusion, when the jaw closes on the appliance. The dentist begins by checking the guard’s fit and retention to ensure it is secure on the dental arch.
A specialized colored film called articulating paper is then placed between the night guard and the opposing teeth. The patient is instructed to gently bite down and grind lightly, which transfers marks from the paper onto the surface of the night guard. These markings identify the areas of heavy or premature contact, which are the high spots that must be reduced. The dentist uses specialized rotary dental tools, such as tungsten carbide burs, to carefully grind away small amounts of the appliance material at the marked areas.
This process is repeated multiple times—mark, grind, and check—until the articulating paper shows an even distribution of light contact marks across the occlusal surface. The goal is to ensure the patient’s opposing teeth make contact with the appliance simultaneously and evenly. Finally, any rough edges created by the adjustment are smoothed and polished to prevent irritation.
Custom vs. Over-the-Counter Guards
The ability of a dentist to adjust a night guard depends significantly on the type of appliance the patient is using. Custom-made, laboratory-fabricated night guards are designed to be adjusted. They are typically constructed from high-quality, durable materials like acrylic, which allow for controlled and precise removal of material without compromising structural integrity.
In contrast, over-the-counter (OTC) guards, such as boil-and-bite types, are generally not suitable for professional dental adjustment. These generic appliances are made from softer, thinner, and less dense thermoplastic materials.
While they can be slightly molded by the user at home, a dentist using high-speed burs risks weakening the guard’s structure or creating an even worse fit. If an OTC guard fails to fit properly or becomes uncomfortable, it is recommended that the patient replace it rather than attempt professional adjustment.