Jaw pain, clenching and the appliance that goes with it

A night guard and a splint look alike. They are aimed at two different problems, and knowing which one you need is most of the answer.

What people notice

Four things people notice before they call

TMJ is short for the temporomandibular joint, the hinge in front of each ear that lets your jaw open, close and slide sideways. When that joint and the muscles working around it are held under load for hours, tissue kept working for hours aches the way any overworked tissue does. Clenching and grinding are the usual reason, and the load does not stop when you fall asleep.

A couple in their sixties standing together outdoors, smiling.

One of the signs below on its own is common. Several at once is worth having someone look at, because the pattern says more than any single sign does.

Tight on waking
The jaw feels stiff or tired first thing, which points at muscle work done overnight rather than at anything you did that morning.
Headaches at the temples
The muscle that closes your jaw runs up over the temple, so hard clenching is often felt there rather than in the jaw.
Aching around the ear
The joint sits directly in front of the ear canal, so joint and muscle pain often reads as earache with nothing wrong in the ear.
A joint that clicks
A click is often the cushioning disc inside the joint slipping out of position and back as you open and close.

Guard or splint

One protects your teeth. The other is aimed at the joint.

Set side by side, the two appliances look much alike. Both are worn over the teeth and both are usually worn at night. What separates them is the surface each one is built against, and what that surface does to the force your jaw generates.

One thing worth knowing before you buy anything from a pharmacy shelf. Something soft to bite on invites more clenching, so a chewable tray can make matters worse for some people. It also has one shape, and that shape was not chosen for your bite by anyone.

A night guard compared with a custom splintAn illustration. A night guard follows the shape of the teeth at an even thickness, so biting force stays concentrated on the teeth that already meet first. A splint carries a designed flat surface, so contact is even across the arch and the force is spread rather than concentrated.Night guardShaped to the teethForce stays where the teeth already meet.Custom splintShaped to your biteContact is even, so the force spreads.Illustration, not a photograph.
An illustration rather than a photograph. It shows the one thing that separates the two appliances: the surface each is built against.
A night guard compared with a custom splint, attribute by attribute.
What it is shaped againstNight guardYour teeth. It is made to fit over them.Custom splintYour bite. Both arches are scanned along with the way they come together, and the biting surface is designed against that record.
What it is designed to doNight guardTake the wear that grinding would otherwise put through your enamel.Custom splintControl where your teeth land and how the load is shared when you close on it.
What it does to load on the jointNight guardLittle. The force still lands where it landed before, on plastic instead of on enamel.Custom splintChanging where contact falls changes how the load travels, and that is what takes pressure off the joint.
What happens to the musclesNight guardThey carry on contracting. A guard does not tell the jaw to stop.Custom splintSpreading the load typically gives the muscles a reason to stop bracing overnight.
What it does not doNight guardSettle a sore jaw reliably. If you have worn one faithfully and still wake up aching, the guard is doing exactly what it was made for while the clenching continues underneath.Custom splintStop the grinding itself. It changes what the grinding lands on, not whether it happens.

What a splint can and cannot do

Jaw pain has more than one cause

Muscle, joint, bite, stress and sleep all feed into this, usually in some combination. An appliance addresses part of it rather than all of it.

Muscle
The muscles that close the jaw can hold a low-level contraction for hours, and a muscle kept under load aches.
The joint
The hinge itself takes the force, and where the disc inside it sits badly, opening and closing can catch or click.
Your bite
Where a few teeth meet before the rest, those teeth take more force than their share and the muscles work around it.
Daytime stress
Clenching through a tense day is usually unconscious, and the muscles carry that work into the evening.
Sleep
Grinding happens in bursts through the night, tied to brief shifts from deeper into lighter sleep.

Many people find a well-made splint makes a real difference within a few weeks. Some find it makes a modest one. Nobody can tell you honestly which you will be before you try, and anyone who does is overselling.

Grinding is sometimes downstream of how you breathe at night

Grinding overnight is sometimes tied to disturbed breathing during sleep. Where that is the case, treating the grinding on its own leaves the more important problem in place, so sleep is worth asking about at the same time. A physician diagnoses that; we screen for the signs and tell you what we see. Our dentists write about how the airway and the jaw are connected in more detail.

Who we are, and when to tell us it is more than clenching

The dentists here are general dentists providing appliance therapy. We do not hold a jaw-pain specialty credential and we do not perform surgery on the joint. That matters most when the picture points at the joint itself, so say so when you call if any of this applies to you:

  • The jaw locks, catches, or will not open fully.
  • The pain sits in the joint itself, just in front of the ear, rather than in the muscle along the side of your face.
  • Your teeth have started meeting differently.
  • You snore, wake unrefreshed, or have been told you stop breathing at night.

Those point somewhere different and need a closer look. Where the answer is someone other than us, we will tell you and help you get there.

Four members of the Advanced Dental Care of Stafford team standing together against a charcoal wall in black scrubs embroidered with the practice name.
Members of the team at the Stafford practice. We do not publish photographs of patients.

How it is made and fitted

An appliance is easy to order and harder to get right

What the appliance should do, and where its surface needs to carry the load, depends on what the examination finds. Getting that right also protects the rest of your dentistry, because the same forces that wear enamel shorten the working life of fillings and crowns.

  1. Treatment room five at the practice seen through its glass wall, with the chair reclined, the overhead light parked and a wall-mounted x-ray arm folded against the wall.
    1

    Examination

    We check the joint, the muscles and the way your teeth meet, and look for the wear patterns clenching leaves behind. Those are visible and we can show you.

  2. A masked member of the team at the digital scanner cart in the corridor, with a three-dimensional scan of an upper and a lower arch closed together on the screen.
    2

    Scan & Design

    A digital scan records both arches and how they come together. The appliance is designed against that record rather than to the shape of the teeth alone.

  3. An empty treatment room with the chair reclined beside a window, the overhead light swung clear and instrument hoses hanging from the delivery unit.
    3

    Fitting & Bite Adjustment

    At delivery the surface is adjusted so contact is even across it. Small reshaping of enamel is sometimes part of this, where a few teeth are carrying more than their share.

  4. The corridor between treatment rooms at the practice, with numbered glass doors on the right and a prepared room at the far end.
    4

    Review Over Time

    We see you again once you have slept in it. Muscles typically settle over the first weeks and the appliance often needs adjusting once or twice while they do.

Clenching and grinding wear teeth down quietly, and the flattened edges are usually visible long before anything hurts. If it has been a while since anyone looked, here is what a first visit here involves.

Start with an exam and a conversation

Tell us what you notice and when you notice it. We will examine the joint, the muscles and the way your teeth meet, and explain what we find before anything is made.

Call (540) 288-2800Send the contact form
A treatment room at the Stafford practice with the chair empty beside a large window and the overhead light parked to one side.

Common Questions About TMJ & Splint Therapy