A night guard is a protective appliance worn over the teeth, typically at night, to cushion the impact of bruxism, which is involuntary teeth clenching or grinding. This device serves as a barrier, protecting the enamel and jaw joint from intense forces. Braces are fixed orthodontic appliances composed of brackets, bands, and wires, bonded to the teeth to gradually move them into position. The presence of these fixed appliances challenges the use of a standard night guard. Orthodontic treatment involves dynamic tooth movement, which conflicts directly with the static fit and protective function of a traditional guard.
The Mechanical Conflict With Traditional Night Guards
Traditional, over-the-counter night guards, such as stock or “boil-and-bite” varieties, are fundamentally incompatible with fixed orthodontic hardware. These generic appliances are designed for static tooth alignment and cannot safely accommodate the brackets and wires of active braces. A major concern with boil-and-bite guards is the thermoplastic material; when softened for molding, it can flow around the brackets and wires, creating a seal that risks damaging or dislodging the orthodontic hardware upon removal.
A night guard’s primary function is to distribute force evenly, but a non-custom guard applies uneven pressure over the irregular surface of braces. This asymmetrical pressure works against the controlled forces applied by the orthodontist, potentially hindering movement or causing undesired tooth shifting. An ill-fitting guard also increases stress on the delicate brackets and archwires, leading to breakages that prolong treatment time and necessitate repairs. The goal of orthodontic therapy is to guide teeth predictably, and an appliance that impedes this process poses a significant risk.
Safe Alternatives for Orthodontic Patients
While traditional guards are unsuitable, patients who grind their teeth while undergoing orthodontic treatment do have safe, specialized alternatives. The most reliable option is a custom-fitted night guard provided directly by the orthodontist. This appliance is fabricated from a precise impression of the teeth and braces, ensuring it accommodates every bracket, band, and wire without placing undue pressure on them.
These specialized guards are often made from soft or semi-rigid thermoplastic materials, which offer flexibility to fit over the fixed appliances and provide a protective cushion against grinding forces. The softer material is advantageous because it is less likely to exert rigid forces that interfere with tooth movement, unlike hard acrylic guards. The orthodontist designs the guard to protect the teeth and jaw joint while allowing the braces to continue their work unimpeded.
For patients with mild bruxism, a specialized orthodontic mouthguard, similar to those used for sports, may also be recommended. These guards are designed with a channel to fit over the brackets and are often constructed from materials that can be remolded or adjusted easily. Crucially, any night guard solution must be explicitly approved, designed, or provided by the patient’s orthodontist to ensure compatibility with the ongoing course of treatment.
Ongoing Management and Treatment Considerations
The dynamic nature of orthodontic treatment means that even a custom-fitted guard will require periodic management. As the braces gradually shift the teeth, the initial precise fit of the night guard will change. A guard that was comfortable and well-fitting one month may feel tight or restrictive the next, indicating that it is no longer safely accommodating the new tooth positions.
Patients must maintain regular communication with their orthodontist, especially if the guard begins to feel uncomfortable or difficult to seat. Ignoring a tight fit can lead the appliance to exert unwanted orthodontic forces, which can slow down treatment or cause adverse tooth movement. The guard may need to be adjusted during scheduled appointments or, in some cases, completely replaced to reflect the new alignment of the teeth.
Hygiene and Maintenance
Proper hygiene is a significant component of ongoing management, as braces already create surfaces where plaque can accumulate. The night guard must be cleaned daily using a soft brush and non-abrasive cleanser. Avoid toothpaste, which can scratch the material and create more areas for bacteria to adhere. Allowing the guard to air-dry completely before storing it is important to minimize bacterial growth and maintain oral health.