Teeth grinding at night, or sleep bruxism, can wear your enamel and leave your jaw sore by morning, and most people only find out from a partner or their dentist. A custom night guard protects the teeth while you sleep. This blog will walk you through the signs, the causes, whether you need a night guard and the cost.
What teeth grinding at night is
Teeth grinding at night is sleep bruxism: the chewing muscles clench the teeth together or slide them across each other while you sleep. An international panel of bruxism researchers, writing in the Journal of Oral Rehabilitation in 2018, describes it as muscle activity during sleep rather than a disorder in itself. In otherwise healthy people it is a behaviour that only becomes a problem when it damages the teeth or causes pain.
Awake bruxism is the daytime version, usually clenching or bracing the jaw while concentrating, driving or under stress. Many people do both.
It is common. A 2013 systematic review in the Journal of Orofacial Pain found that about 12.8% of adults report frequent grinding in their sleep. It is equally common in men and women and becomes less common in older age.
Common signs you are grinding your teeth at night
Grinding happens while you are asleep, so the clues usually show up in the morning or at a dental checkup.
Morning jaw pain
A jaw that feels sore, stiff or tired when you wake up is the most common sign. The muscles have been working for much of the night. In the Chest study of 13,057 adults, half of those who ground their teeth weekly had a real consequence such as muscle discomfort on waking or dental work.
Headaches at the temples
The temporalis, one of the main chewing muscles, sits at the side of the head. When it works overnight, it can leave a dull ache at the temples when you wake.
Worn, flattened or chipped teeth
Grinding wears the biting edges flat and can chip the front teeth. Teeth may look shorter or more even in length than they used to. Your dentist may spot wear facets, flat shiny patches where teeth rub together, before you notice anything.
Tooth sensitivity
As enamel wears thin, the dentin underneath is exposed and teeth start to twinge with cold drinks or ice cream. Our guide to sensitive teeth explains how worn enamel causes it and what helps.
Clicking or a sore jaw joint
Clenching loads the jaw joints as well as the muscles, which can bring clicking, stiffness or aching in front of the ears. Painless clicking is common and normal; our guide to TMJ and jaw clicking explains when a click needs an exam.
A partner hears you grinding
Often the first person to know is the one sleeping next to you. Grinding can be loud enough to wake a partner. In a 2013 study of jaw pain patients by Paesani and colleagues, a partner's report of night-time grinding matched the dentist's diagnosis more closely than any other question asked.
Why teeth grinding at night happens
Teeth grinding at night is mainly driven by the brain and the sleep cycle, not by the shape of the teeth. Lobbezoo and Naeije's review in the Journal of Oral Rehabilitation concluded that bite and jaw anatomy play "only a small role, if any", and that grinding appears to be linked to brief arousals during sleep.
The largest study of risk factors, published in Chest in 2001, surveyed 13,057 people in the UK, Germany and Italy. The Chest study on sleep bruxism risk factors found the odds of reporting sleep bruxism were higher in people with:
- obstructive sleep apnoea and in heavy alcohol drinkers, both about 1.8 times
- loud snoring and caffeine use, both about 1.4 times
- smoking, a highly stressful life and anxiety, each about 1.3 times
Some medicines trigger it too. A systematic review of case reports in Neurology Clinical Practice found fluoxetine, sertraline and venlafaxine were the antidepressants most often linked to grinding. Symptoms started within 3 to 4 weeks of starting the medicine and often settled within 3 to 4 weeks of a change. Never stop a prescribed medicine on your own; ask your doctor whether it could be involved.
What grinding does to your teeth and jaw
Over months and years, grinding forces wear away tooth structure that does not grow back:
- Enamel wears, and the teeth get shorter and flatter.
- Teeth chip or crack, and teeth weakened by large fillings are most at risk. A cracked tooth often needs a dental crown to hold it together.
- Fillings, crowns and veneers chip or come loose. In a 20-year study of porcelain veneers, people who ground their teeth had a 7.7 times higher risk of the veneers failing.
- The chewing muscles and jaw joints ache, and grinding can feed into jaw pain and headaches. Our comparison of grinding and TMJ explains how the two overlap.
A tooth that cracks with sharp pain when you bite needs an exam soon, and a broken tooth with severe pain is a job for our emergency team.
Do I need a night guard
You probably need a night guard if grinding is already doing damage: worn or chipped teeth, broken fillings or crowns, or a jaw that aches most mornings. You may not need one if a partner has heard you grind but your teeth show no wear and nothing hurts.
People most likely to benefit include those who:
- wake with jaw pain or temple headaches several times a week
- have visible wear, chips or cracks
- have crowns, veneers, implants or large fillings to protect
- have sensitive teeth from worn enamel
- clench under stress or have jaw joint symptoms
- have been told by a partner or dentist that they grind
A dental exam answers the question in one visit. The dentist looks for wear facets, cracks and muscle tenderness and asks about your sleep, stress, medicines and snoring.
How a custom night guard protects your teeth
A night guard, also called an occlusal guard, is a thin plastic appliance that fits over the upper or lower teeth while you sleep. It takes the wear instead of your enamel and spreads the force of clenching across all the teeth.
What a guard does not do is stop the grinding. A Cochrane review of occlusal splints for sleep bruxism found there was not enough evidence that a splint treats sleep bruxism itself, but that it may help with tooth wear. NIDCR adds that a guard should not be designed to change your bite permanently, and that you should stop wearing it and see your dentist if it causes pain. Our dentists make a custom night guard as part of jaw and TMJ care.
Custom guards vs store-bought guards
A custom guard is made from a scan of your teeth, so it stays in place without you biting to hold it. Store-bought boil-and-bite guards are softer and bulkier. That difference matters: in Okeson's study in the Journal of the American Dental Association, a hard guard significantly reduced night-time muscle activity in 8 of 10 people, while a soft guard reduced it in only 1 and increased it in 5. The study was small, but it is why dentists usually make guards for grinding from hard acrylic.
How much a custom night guard costs
A custom night guard from a dentist typically costs $300 to $1,000, according to GoodRx's June 2022 night guard cost guide. The same guide puts over-the-counter guards at $20 to $30 and custom guards from online retailers at $50 to $200. CareCredit's national cost list puts the average for a dentist-made mouthguard at $611.
The dentist's fee covers the exam, the scan, the lab work and the fitting, and an adjustment if the guard rubs or the bite feels wrong. An online guard made from a home impression has no exam behind it, so nobody checks for cracked teeth or jaw joint problems first.
Insurance varies more than most people expect:
- On the Covered California dental HMO, the 2026 copay schedule lists an adult hard night guard (CDT D9944) at $115.
- The Delta Dental PPO family plan sold through Covered California lists night guards among its adult exclusions.
Ask us to check your plan before the guard is made. Our front desk confirms coverage and payment options before your visit.
Getting a night guard at our office
A custom night guard at Smiles By Design takes two short visits:
- Exam. The dentist checks jaw movement, the bite, enamel wear and the jaw joints.
- Digital scan. A 3D scan records your teeth without impression putty.
- Lab work. The guard is made to the scan.
- Fitting. You receive the guard within days, with cleaning and care instructions, and the fit is adjusted if needed.
Bring the guard to your checkups so the dentist can check it for wear and cracks.
Other ways to manage teeth grinding
A guard protects the teeth, so the other half of care is reducing what drives the grinding:
- Cut back on alcohol and caffeine in the hours before bed, and stop smoking if you smoke.
- Tell your doctor if you snore loudly or feel sleepy during the day, because sleep apnoea is linked to grinding and needs a sleep assessment.
- Ask your doctor about your medicines if grinding started soon after a new antidepressant.
- Notice daytime clenching and rest your jaw with the lips together and the teeth slightly apart.
- Use relaxation or breathing exercises before bed, and gentle jaw stretches or a warm compress if the muscles are tight.
Be wary of treatments that grind down or move the teeth to "fix the bite". Research does not support the bite as the main cause, and NIDCR warns that bite-changing treatments for jaw pain can make it worse.
Night guards at our Carmel Mountain Ranch office
Night guards at Smiles By Design are planned by Dr. Dan Javaheri, a graduate of the NYU College of Dentistry with more than 17 years in general, cosmetic and implant dentistry, or by Dr. Cody Cohen. Every guard starts with an exam and a 3D scan, and we check your insurance before it is made. If grinding has already damaged a tooth, we can repair it at the same office.
Frequently Asked Questions
How do I know if I grind my teeth while sleeping?
The usual signs are a sore or tired jaw when you wake, headaches at the temples, flattened or chipped teeth, new sensitivity to cold and a partner who hears grinding at night. A dentist can confirm it by looking for wear facets and checking the chewing muscles at a routine exam.
Does everyone who grinds their teeth need a night guard?
Not everyone who grinds their teeth needs a night guard. A guard is worth having when grinding is wearing or chipping teeth, damaging fillings, crowns or veneers, or causing jaw pain. If a partner hears occasional grinding but your teeth show no wear and nothing hurts, your dentist may simply monitor it.
Will a night guard stop me grinding my teeth?
A night guard will not stop you grinding your teeth. A Cochrane review found no clear evidence that a guard treats sleep bruxism itself, but it protects the teeth from wear. Reducing alcohol, caffeine and smoking, managing stress and treating sleep apnoea address what drives the grinding.
Are custom night guards better than over-the-counter guards?
Custom night guards fit your teeth exactly and are usually made from hard acrylic, so they stay in place and last. Store-bought guards are soft and bulky. In a JADA study, a hard guard reduced night-time muscle activity in 8 of 10 people, while a soft guard increased it in 5 of 10.
How much does a night guard cost?
A night guard from a dentist typically costs $300 to $1,000, according to GoodRx, and CareCredit's national average for a dentist-made mouthguard is $611. Over-the-counter guards cost $20 to $30. On the Covered California dental HMO, an adult night guard is a $115 copay.
Can teeth grinding crack teeth?
Teeth grinding can crack teeth, and teeth weakened by large fillings are most at risk. The damage builds slowly, so small cracks can be present before anything hurts. A tooth that hurts sharply when you bite down needs an exam, and a cracked tooth often needs a crown.
Can teeth grinding cause TMJ problems?
Teeth grinding and clenching put extra strain on the jaw joints and chewing muscles, and they often appear together with TMJ pain. NIDCR lists reducing clenching among the first steps for jaw pain. Painless jaw clicking on its own is common and usually needs no treatment.
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