Night guards.
Where a patient grinds or clenches, a night guard takes the wear that the teeth and restorations would otherwise take. The Rx form offers hard or thermal, and the choice matters.
What a night guard is protecting
Natural teeth from attrition, ceramic restorations from fracture, and implant components from the loads that loosen and break screws. In a patient who has just received substantial restorative work, it protects the investment.
It does not stop the parafunction. Bruxism has multiple contributors — sleep disordered breathing, medication, stress, and central factors — and an appliance manages the consequences rather than the cause.
That is worth saying to the patient, because a guard that shows wear after a year is working exactly as intended rather than failing.
Hard or thermal
A hard acrylic guard is durable, precisely adjustable, and holds the occlusal scheme it was made to. It is the appropriate choice for a heavy grinder and for any patient where the guard is protecting extensive restorative work.
A thermal or dual-laminate guard has a softer inner surface with a harder outer layer, which is more comfortable to wear and more retentive, particularly on teeth with limited undercut. It is a reasonable compromise for a patient who will not tolerate hard acrylic.
Fully soft guards are comfortable and are worth using with caution. In some patients a resilient surface appears to increase muscle activity rather than reduce it, and they wear through quickly under heavy function.
Coverage and arch
Full-arch coverage, for the same reason splints require it: a partial-coverage appliance allows uncovered teeth to over-erupt over months, producing an occlusal change nobody intended.
Upper is the more common prescription and is usually easier to make retentive. Lower is frequently better tolerated for speech and gagging, and is often preferred by patients who have struggled with an upper guard.
Where the patient has a partial denture or extensive restorations in one arch, that may decide it. Say which arch you want rather than leaving it to be inferred.
Occlusion on the guard
Even simultaneous contacts across the arch, with excursive guidance that discludes the posterior teeth. A guard with heavy contacts on a few teeth concentrates load exactly where you were trying to protect.
Verify at delivery with articulating paper and adjust as needed. A guard adjusted properly at fit is worn; one that feels uneven is not.
Polish anywhere you have adjusted. A rough acrylic surface is uncomfortable and accumulates plaque.
Records
An accurate impression or scan of both arches and a bite record. The impression needs to capture the full clinical crowns and the undercuts that provide retention — a guard made from a record that stops short of the gingival margin will not retain.
For a patient with an unstable or unclear intercuspal position, or where the guard is being made at an altered vertical dimension, say so.
Guards over restorations and implants
A patient who has just received extensive ceramic work or implant restorations is among the strongest indications for a guard, and the guard should be made after the restorative work is complete rather than before.
A guard made to the pre-restorative occlusion will not seat correctly against the new anatomy, and adjusting it into fit compromises both the appliance and the protection it offers.
Build it into the treatment plan and the fee from the outset. A patient told at the end that they now need a guard tends to hear it as an additional charge rather than as protection for a substantial investment.
What to put on the prescription
Tick Night Guard under Procedure and select Hard or Thermal. State the arch and mark it on the design chart.
Note what is being protected — natural dentition, ceramic restorations, implants — and any evidence of how heavy the parafunction is. A guard for a patient who has fractured two crowns is built differently from one for mild clenching.
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