Night Guards Compared: Custom vs Boil-and-Bite vs OTC | Smyleee | Smyleee Blog

If you grind or clench at night, a night guard is the first-line treatment to prevent tooth wear, cracks, and worsening jaw pain. But "night guard" covers a wide range of products — from a $20 boil-and-bite at the pharmacy to a $700 custom dental lab model. They are not equivalent. This guide compares the four main categories on protection, durability, comfort, and value.

For the broader picture, see the pillar: Teeth Grinding and Bruxism.

Key Facts (at a glance)

Custom hard acrylic guards are the gold standard — best fit, best protection, last 5+ years.
Soft guards are comfortable but can worsen grinding in heavy bruxers by giving them something to chew on.
Boil-and-bite guards offer a middle ground — moderate protection, replace every 6–12 months.
OTC stock guards offer the least protection and shortest lifespan; reasonable only as a 1-month bridge while waiting for a custom guard.
Lab-made dual-arch guards (NTI, MCI) target specific bruxism patterns and require dentist evaluation.

Why protection matters

Bruxism forces can exceed 200 PSI — many times normal chewing force. Over years, this causes: - Enamel wear (flattening) - Tooth cracks - Failed restorations (crowns, fillings) - Cervical notches (V-shaped notches at the gumline from flexural stress) - Tooth mobility - Pulp damage - TMJ overload

A properly designed guard: - Distributes forces across many teeth instead of concentrating them - Allows controlled sliding so the joint isn't loaded statically - Provides a sacrificial wear surface that wears instead of teeth

The 4 main categories

1. Custom hard acrylic guard (dental lab)

How made: dentist takes an impression or digital scan, lab fabricates a guard from rigid acrylic (PMMA), fitted at a follow-up visit, occlusion adjusted to provide even contact.

Cost: $300–$700 typically; insurance often covers a portion

Lifespan: 5–10 years with normal use

Protection: highest — won't deform under bruxism forces

Comfort: initially feels bulky but adapts in 1–2 weeks; thin (1.5–2mm) at the chewing surface

Best for: anyone with documented bruxism, especially moderate-to-heavy grinders

2. Custom soft guard (dental lab)

How made: same impression/scan process, but fabricated from soft EVA (ethylene vinyl acetate)

Cost: $150–$400

Lifespan: 1–3 years; wear depends on bite force

Protection: moderate — protects against tooth wear but may worsen jaw muscle activity as the brain interprets the soft material as something to chew

Comfort: softest and most accepted by new wearers; ideal for sensitive teeth

Best for: mild grinders, clenchers with sensitive teeth, patients who can't tolerate hard guards initially

Caution: evidence increasingly shows soft guards aren't ideal for heavy bruxers — the squishy material reads as "food" to muscle reflexes and can elicit more clenching

3. Boil-and-bite guards (drugstore, $20–$60)

How made: thermoplastic material softened in boiling water, then bitten into to take a rough impression of your teeth

Cost: $20–$60

Lifespan: 3–12 months depending on grinding force and material

Protection: moderate-to-poor — fit is approximate, edges often irritate gums, material wears quickly

Comfort: variable — better after careful molding

Best for: short-term bridge while waiting for a custom guard; mild occasional grinders; clear evaluation of whether a custom guard is worth the investment

Brands worth considering: - Dr. Brux - Plackers Grind No More (single-use) - SmartGuard (with dental design intent) - The DenTek line (varies by model)

4. OTC stock guards ($5–$15)

How made: one-size pre-formed shape; no molding

Protection: minimal

Comfort: poor (no custom fit)

Recommendation: skip these — they don't fit well enough to protect reliably and often fall out at night.

Special designs (lab-made, dentist-prescribed)

NTI (Nociceptive Trigeminal Inhibition)

Small, hard, fits only the upper front teeth
Prevents the back teeth from making contact, reducing the temporalis muscle response
Effective for some bruxers and migraine sufferers
Risk: if worn long-term, posterior teeth can over-erupt — requires dental monitoring
Cost: $400–$800

MCI / Anterior Bite Plane

Similar concept; thinner profile in some designs
Same posterior-eruption monitoring needed

Dual-arch full-coverage guards

Cover all upper and lower teeth simultaneously
Used in select TMJ-related cases

These designs require dentist evaluation; they're not interchangeable with standard guards.

Hard vs soft — what evidence shows

For mild bruxism, soft guards can reduce tooth wear acceptably and are better tolerated. For moderate-to-heavy bruxism, multiple studies have shown that hard occlusal splints reduce muscle activity (measured by EMG) more reliably than soft guards. Some patients on soft guards develop increased clenching activity over the first few weeks — likely because the soft material is interpreted as a chewable target.

Bottom line: - Mild: soft is acceptable - Moderate-to-heavy: hard custom is the recommended standard

How to know which intensity you have

Signs of mild bruxism	Signs of moderate-heavy bruxism
Occasional morning jaw soreness	Daily morning jaw soreness
Faint flattening of cusps	Visible flattening across multiple teeth
No restorations failing	Cracked teeth or recurrent crown failures
Partner doesn't hear grinding	Partner hears grinding regularly
No headaches	Tension headaches multiple times per week

A dentist's exam — looking at wear patterns, muscle palpation, and asking partner-reported grinding — typically clarifies the category.

Maintenance

For all guard types: - Rinse and brush with a soft brush after each use; air dry in the case - Avoid hot water (warps thermoplastic and EVA materials) - Avoid harsh chemicals (bleach, mouthwash with alcohol) - Weekly deep clean with denture cleaning tablets or vinegar soak - Bring to dental visits for inspection and professional cleaning - Store dry in a vented case to discourage bacterial growth - Replace when worn through, cracked, or fitting poorly

When OTC is acceptable

A boil-and-bite guard makes sense: - As a 4-6 week bridge while waiting for a custom guard - For occasional travel grinding (one or two nights when stressed) - To test tolerance — if you can't sleep with even a fitted boil-and-bite, the custom may not work for you - For mild occasional clenchers as a budget option

It's not a substitute for a custom guard if you're a moderate-to-heavy bruxer.

Insurance and HSA/FSA

Many dental insurance plans cover occlusal guards under the major category, often 50% after deductible
Pre-authorization is sometimes required — your dentist's office handles this
HSA/FSA funds can be used for both custom and OTC guards
Some medical insurance covers guards when prescribed for migraine prevention or TMJ disorder

Check your specific plan; coverage varies widely.

Frequently Asked Questions

Will a guard stop my grinding? Mostly no — it protects your teeth from the grinding rather than stopping the grinding itself. Reducing the underlying drivers (stress, sleep quality, sleep apnea if present) is what reduces grinding episodes. A guard is the protective layer, not the cure.

Can I wear my night guard during the day if I clench? Yes — many awake clenchers benefit from a thin daytime guard or awareness-cuing device. Discuss with your dentist; the design may differ from your night guard.

My night guard makes my jaw hurt — should I stop wearing it? First two weeks of adaptation often include mild discomfort. If pain persists or worsens beyond that, the guard likely needs adjustment by your dentist — usually a minor in-office tweak, often free as a follow-up. Don't tolerate ongoing pain.

How often should I replace a hard custom guard? Most last 5–10 years. Replace when you see significant wear-through, distortion, cracks, or when fit becomes loose. Dentist will check at routine visits.

Will my bite shift if I wear an NTI long-term? It can — NTI guards prevent posterior contact and can allow over-eruption of back teeth if worn nightly for years without monitoring. Dental visits every 6 months to check are essential with NTI-type designs.

Sources

Macedo CR et al. Occlusal splints for treating sleep bruxism (tooth grinding). Cochrane Database of Systematic Reviews.
American Academy of Sleep Medicine. Treatment of Bruxism. Position statement.
Klasser GD, Greene CS. Oral appliances in the management of temporomandibular disorders. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology.

Pillar topic: Teeth Grinding and Bruxism. Reviewed by the Smyleee Medical Advisory Board.

Night Guards Compared: Custom, Boil-and-Bite, and OTC — What's Worth It?