What's the difference between a night guard and a TMJ splint?

A night guard is designed to protect teeth from grinding forces — its job is durability and even bite distribution. A TMJ splint is designed to therapeutically modify jaw function — its job is to produce a specific occlusal contact pattern that reduces muscle activity or repositions the joint. The materials can look identical; the design intent, occlusal adjustment, and follow-up commitment are what differ.

Can I use a night guard for TMJ pain?

Sometimes, partially. A well-fitted night guard reduces overnight grinding load and may improve TMJ symptoms driven primarily by nocturnal bruxism. For diagnosed TMJ disorder with significant pain, restricted opening, or internal derangement, a therapeutically designed splint with planned occlusal adjustment by a TMJ-experienced clinician is more appropriate than a standard protective night guard.

Are over-the-counter night guards safe?

Well-fitted boil-and-bite guards from reputable brands are reasonable for mild bruxism with no existing damage and no jaw symptoms. Stock one-size trays sold at gas stations and sporting goods stores are not — they fit poorly, fall out, and in some cases produce tooth movement or aggravate jaw symptoms. The OTC category is wide; quality varies dramatically. See our night guards comparison for the detailed breakdown.

How much does a custom TMJ splint cost?

In the US, $700–$1,800 typically, depending on the design and the clinician. The higher cost compared to a standard night guard reflects the occlusal design complexity, the follow-up visits (usually 2–4 adjustment appointments), and the specialised expertise. Dental insurance sometimes covers TMJ splints under medical benefits with appropriate documentation; coverage is highly variable and worth checking before treatment.

How long does a TMJ splint take to work?

Most patients notice some symptom improvement within 4–6 weeks of consistent overnight wear with appropriate adjustments. Substantial improvement typically takes 8–12 weeks. The appliance works best as part of a broader conservative plan that includes physical therapy, behavioural modification, and addressing contributing factors like stress and bruxism. Splint therapy alone, without supporting interventions, usually produces less change than the combined approach.

Can I just buy a TMJ splint online?

Direct-to-consumer custom appliances — where you take impressions at home and the company fabricates from those — sit between boil-and-bite and dentist-fitted. They are reasonable for protective use in mild bruxers without TMJ symptoms. They are not appropriate as therapeutic TMJ splints because there is no clinical fitting step, no occlusal adjustment, and no follow-up. Diagnosed TMJ disorder warrants an in-person fitting and adjustment process.

TMJ Splints vs Night Guards: What's the Difference?

The short version, if you only read one thing

A night guard is designed primarily to absorb the destructive forces of nocturnal bruxism so that they wear down the device rather than the teeth. The fit prioritises stability and durability; the bite surface is usually flat or near-flat; the goal is protection. A TMJ splint (more formally, an occlusal stabilisation splint, orthotic, or therapeutic appliance) is designed primarily to therapeutically reposition the jaw, provide a stable occlusal platform, and reduce input from contributing structural and muscular factors in TMJ disorder. The bite surface is carefully designed to produce specific contact patterns that decompress the joint or reduce muscle activity. Both are typically made from similar materials by similar labs; the substantial difference is in the design, the fitting process, and the clinical follow-up. For a patient with simple bruxism and no jaw symptoms, a well-fitted night guard is usually sufficient. For a patient with a clear TMJ diagnosis — pain, clicking with symptoms, restricted opening, masseter and temporalis tenderness — a TMJ splint designed and adjusted by a clinician with orofacial pain expertise is the more appropriate device. The two categories overlap meaningfully but are not the same thing, and being told one when you actually need the other is a common reason for treatment that does not deliver what the patient hoped for.

What a night guard is designed to do

The conceptual goal of a night guard is mechanical protection. The device is a sacrificial layer between the upper and lower teeth that absorbs the forces of clenching and grinding so the teeth do not absorb them. Its job is durability and consistent fit; its design priorities are stability in the mouth, even distribution of bite forces across the appliance surface, and resistance to wear over years of use.

The bite surface of a night guard is typically flat or very gently contoured. The objective is to allow the opposing teeth to make light, even contact across the device when the patient closes; the load is distributed; the appliance wears progressively over time and is replaced when it has worn enough to no longer provide reliable protection. A well-made hard acrylic night guard lasts five to ten years in average bruxers; dual-laminate guards (hard outside, soft inside) provide comfort without the durability cost. Soft EVA guards are generally not recommended for moderate-to-severe bruxers because the soft material can paradoxically increase grinding muscle activity in some patients.

The fitting process for a night guard is straightforward. The dentist takes impressions of both arches, sends them to a lab, the lab fabricates the appliance from the impressions, the dentist fits it at delivery, makes any minor adjustments to ensure comfortable bite contact, and the patient takes it home. Follow-up is usually limited to occasional checks at routine cleanings. The whole process is designed to be efficient and repeatable.

What a TMJ splint is designed to do

The conceptual goal of a TMJ splint is therapeutic — to actively change how the jaw, the joint, and the masticatory muscles function rather than simply protect existing structures from mechanical damage. The bite surface of a TMJ splint is carefully designed to produce specific contact patterns that achieve specific clinical objectives: decompressing the joint by repositioning the condyle, reducing the activity of overactive masseter and temporalis muscles, providing a stable reproducible occlusal platform that allows the joint and muscles to find a more comfortable position over time.

The most common type of TMJ splint is the stabilisation splint, sometimes called the Michigan splint or the flat-plane splint, which provides flat contact for all the teeth in the opposite arch and produces immediate disclusion of the back teeth on any lateral or protrusive movement. The contact pattern is precise — usually adjusted with articulating paper at multiple appointments — and the patient is reviewed at follow-up visits where the splint is checked, adjusted as the muscles relax and the bite settles, and progress is documented. The clinical engagement is more involved than for a simple night guard.

Other types of TMJ splint exist for specific indications. Anterior repositioning splints are designed to hold the jaw forward to recapture a displaced disc — a specific indication that is now less commonly used than in the past because of concerns about producing permanent bite changes. Anterior bite stops (NTI-style appliances) cover only the front teeth and aim to reduce posterior clenching activity; they have specific indications, real risks if used incorrectly, and a published profile that warrants careful patient selection. Each splint type has a specific design rationale and is not interchangeable with the others.

The overlap and the practical confusion

The reason these two categories blur in everyday clinical practice is that the materials and the basic shape are often similar. A hard acrylic stabilisation splint and a hard acrylic night guard can look indistinguishable to the patient. The lab might use similar fabrication techniques. The cost may be comparable in some practices, dramatically different in others. And many general dental offices use the terms interchangeably, often dispensing what is essentially a night guard but calling it a TMJ splint, or fitting a guard with minimal occlusal adjustment and presenting it as a therapeutic appliance.

The genuine clinical distinction lies in three places. Design intent: what specific occlusal contact pattern is the appliance trying to produce, and why? Fitting and follow-up: is the appliance being delivered with a thorough occlusal adjustment and a planned series of review visits, or is it a fit-and-go device? Clinical context: is the clinician treating documented TMJ pathology with a coordinated plan that includes the appliance as one part, or is the appliance the entire plan?

A "TMJ splint" delivered by a general office with no specific contact-pattern adjustment and no follow-up schedule is functionally a night guard with a different name. A "night guard" delivered by an orofacial pain specialist with careful occlusal balancing and scheduled reviews may be functionally a TMJ splint. The names matter less than what is actually being done.

60–70%

Approximate proportion of patients with TMJ disorder who improve substantially with a well-designed and properly fitted occlusal stabilisation splint, in combination with appropriate behavioural management and where indicated physical therapy. The remaining patients require more intensive intervention. The number is high enough to make the splint a reasonable first-line therapeutic intervention for TMJ disorder; it is also low enough that splint therapy alone is not a guarantee, and a treatment plan should include the conservative ladder beyond it.

When a night guard is the right answer

For the patient whose problem is bruxism without significant TMJ symptoms — visible wear on the back teeth, sometimes morning muscle soreness, no chronic pain, no joint clicking, no restricted opening — a well-fitted night guard is the appropriate appliance. The clinical objective is protection of the dentition from continued mechanical wear. The patient does not need a therapeutic occlusal design; they need a durable, well-fitted barrier between the teeth. This is the scenario that supports the standard night guard prescription, and it is the appropriate scope for a general dental office to handle.

Within the night guard category, the published evidence supports custom-fitted devices for moderate to severe bruxers and for any patient with existing damage to protect. Well-fitted boil-and-bite appliances can be defensible for mild bruxers with no damage and no symptoms (see the night guard comparison piece for the full conversation). The specific appliance design — hard acrylic, dual-laminate, soft — depends on grinding intensity and patient tolerance.

When a TMJ splint is the right answer

For the patient with diagnosed TMJ disorder — symptomatic clicking, persistent pain in the joint or surrounding muscles, restricted or painful opening, headache with masseter and temporalis tenderness, documented internal derangement on imaging — a therapeutic occlusal splint designed and managed by a clinician with TMJ expertise is the more appropriate device. The clinical objective is not just mechanical protection but reduction of muscle activity, decompression of the joint, and provision of a stable platform that allows the disrupted joint mechanics to settle.

The right splint for a given TMJ patient depends on the specific diagnosis. A patient with myofascial pain dominated by masseter and temporalis tenderness benefits from a stabilisation splint that produces immediate posterior disclusion on excursive movements. A patient with internal derangement may benefit from a stabilisation splint for symptom management or, in selected cases, from a specifically designed anterior repositioning splint. A patient with bruxism-driven muscle hypertrophy and headache may benefit from a hard acrylic splint with careful occlusal balancing. The splint is the tool; the diagnosis selects the design.

For these patients, the clinician matters as much as the device. An orofacial pain specialist, a dentist with significant TMJ experience, or in some regions a prosthodontist or oral surgeon with TMJ focus, is the right clinical home for fabricating and managing this kind of appliance. A general dental office without specific TMJ training can fabricate a hard splint that resembles a TMJ splint but may not deliver the occlusal precision or the follow-up that distinguishes effective therapeutic splint use from ineffective protective appliance use.

What to be sceptical of

The first thing worth being cautious about is the "TMJ splint" delivered by a general office with no specific occlusal adjustment beyond a basic bite check, no scheduled follow-up, and no integrated treatment plan that addresses the other contributors to TMJ disorder (physical therapy, behavioural management, where indicated medication). This is, in functional terms, a hard night guard with a more expensive name. If the device is going to be priced as a TMJ splint, the clinical care delivered with it should match that pricing.

The second is the partial-coverage anterior appliance — most commonly the NTI-style device that covers only the front teeth. These have specific indications and can be useful in carefully selected patients, but they carry a real risk of producing posterior tooth super-eruption and unintended bite changes if used incorrectly or for too long. A patient being offered one of these should understand the rationale, the planned duration of use, and the follow-up plan to detect any unintended occlusal effects early. They are not appropriate as long-term unsupervised devices.

What about all the marketing-driven categories?

The dental marketplace contains a proliferation of named appliances — "TMJ orthotic", "MORA splint", "phase I/phase II therapy", "neuromuscular dentistry appliance", "ALF appliance", various proprietary devices marketed by specific companies or training programmes — each with a specific design philosophy and a specific price tier. Some of these have legitimate clinical roles in specific situations. Some are essentially branded variants of standard appliance types. Some are associated with treatment philosophies that have generated significant controversy within the dental profession.

A thoughtful patient considering any non-standard appliance should ask three questions: what published evidence supports this specific appliance for my specific condition; what is the planned duration of treatment and what happens at the end; what is the cost over the full course of treatment, not just the initial appliance. A clinician who can answer these specifically and grounds the answers in published evidence is one to take seriously. A clinician who deflects to broader claims about treatment philosophy without specific evidence is offering something less rigorous than the standard splint category supports.

Cost expectations

The pricing landscape varies widely by geography and provider, but the typical ranges in the United States are:

Custom night guard from a general dental office: $300 to $700, including impressions, fabrication, and the fitting appointment. Includes a basic bite check at delivery; minimal follow-up planned.

Stabilisation splint from an orofacial pain specialist or TMJ-experienced dentist: $700 to $1,800. The higher cost reflects the more involved occlusal design, the planned follow-up visits (typically two to four adjustment appointments over the first three to six months), and the clinician's specialised expertise.

Anterior repositioning splint or other specialty appliance: $1,000 to $2,500. Higher complexity, more demanding follow-up, sometimes requires additional imaging.

Direct-to-consumer at-home custom (night guard category only): $100 to $300. Sufficient for mild bruxism without symptoms; not appropriate for therapeutic TMJ use because there is no clinical fitting or adjustment step.

Dental insurance coverage varies. Night guards are often covered partially or fully under restorative or preventive benefits, depending on the plan. TMJ splints are sometimes covered under medical insurance when the diagnosis is appropriately documented as a temporomandibular disorder, but coverage is highly variable and worth checking specifically before treatment begins.

The decision conversation

The right questions to ask before agreeing to either appliance:

What specific problem is this appliance treating? "Bruxism" and "TMJ" are different answers, and the design of the appliance should match. If the answer blurs the two, ask the clinician to be more specific about which.
What occlusal design has been chosen and why? A clinician fitting a therapeutic splint should be able to describe the planned contact pattern in specific terms (flat plane, anterior guidance, specific cuspid disclusion) and explain why this design fits your condition.
What is the follow-up plan? A therapeutic splint typically requires several adjustment visits over the first months of use. A protective night guard typically does not. The follow-up commitment should match what the appliance is meant to do.
What does success look like, in concrete terms? Reduced morning headache frequency, improved opening range, reduced muscle tenderness, fewer joint clicks with symptoms — specific measurable outcomes are more useful than "feeling better."
What is the plan if this appliance does not produce the expected improvement? A clinician with a thoughtful Plan B is one who has thought about the case beyond the immediate prescription.

The functional difference between an appliance designed to protect teeth from bruxism forces and one designed to therapeutically modify jaw function lies in the design intent, the occlusal precision, and the planned follow-up — not primarily in the material. The same piece of hard acrylic delivered with different clinical care produces different outcomes.

Paraphrased editorial summary of Klasser & Greene on oral appliances in TMD² and Türp et al. on stabilisation splint efficacy³

The bottom line

Night guards and TMJ splints are related but distinct categories of dental appliance. Night guards exist to protect teeth from the destructive forces of bruxism. TMJ splints exist to therapeutically modify jaw, joint, and muscle function in patients with diagnosed TMJ disorder. The materials and the gross appearance overlap; the design intent, the fitting process, the follow-up commitment, and the clinical context differ in important ways.

For the patient choosing between them, the question is not really which device but which problem is actually being treated. Bruxism without TMJ symptoms — night guard, general dental office, straightforward fit. Diagnosed TMJ disorder — therapeutic splint, orofacial pain specialist or TMJ-experienced clinician, several follow-up visits. Both conditions in the same patient — likely a single therapeutic splint that addresses both functions, designed with both in mind. And in any case, the price being charged should match the clinical care being delivered. A night guard priced as a TMJ splint, with no specific therapeutic design and no follow-up plan, is not the same product even if it looks similar in the mouth.

If you are weighing this decision, the most useful first step is usually a consult with a clinician who can clearly articulate which problem they are treating and which appliance design they are recommending for it. A practice that uses "night guard" and "TMJ splint" interchangeably, with the same fitting protocol and the same price, is not the practice for a patient with actual TMJ disorder. Find a clinic near you on Smyleee or browse dentists by specialty to start that conversation with someone whose work you can actually evaluate.

Frequently asked questions

What's the difference between a night guard and a TMJ splint?: A night guard is designed to protect teeth from grinding forces — its job is durability and even bite distribution. A TMJ splint is designed to therapeutically modify jaw function — its job is to produce a specific occlusal contact pattern that reduces muscle activity or repositions the joint. The materials can look identical; the design intent, occlusal adjustment, and follow-up commitment are what differ.
Can I use a night guard for TMJ pain?: Sometimes, partially. A well-fitted night guard reduces overnight grinding load and may improve TMJ symptoms driven primarily by nocturnal bruxism. For diagnosed TMJ disorder with significant pain, restricted opening, or internal derangement, a therapeutically designed splint with planned occlusal adjustment by a TMJ-experienced clinician is more appropriate than a standard protective night guard.
Are over-the-counter night guards safe?: Well-fitted boil-and-bite guards from reputable brands are reasonable for mild bruxism with no existing damage and no jaw symptoms. Stock one-size trays sold at gas stations and sporting goods stores are not — they fit poorly, fall out, and in some cases produce tooth movement or aggravate jaw symptoms. The OTC category is wide; quality varies dramatically. See our night guards comparison for the detailed breakdown.
How much does a custom TMJ splint cost?: In the US, $700–$1,800 typically, depending on the design and the clinician. The higher cost compared to a standard night guard reflects the occlusal design complexity, the follow-up visits (usually 2–4 adjustment appointments), and the specialised expertise. Dental insurance sometimes covers TMJ splints under medical benefits with appropriate documentation; coverage is highly variable and worth checking before treatment.
How long does a TMJ splint take to work?: Most patients notice some symptom improvement within 4–6 weeks of consistent overnight wear with appropriate adjustments. Substantial improvement typically takes 8–12 weeks. The appliance works best as part of a broader conservative plan that includes physical therapy, behavioural modification, and addressing contributing factors like stress and bruxism. Splint therapy alone, without supporting interventions, usually produces less change than the combined approach.
Can I just buy a TMJ splint online?: Direct-to-consumer custom appliances — where you take impressions at home and the company fabricates from those — sit between boil-and-bite and dentist-fitted. They are reasonable for protective use in mild bruxers without TMJ symptoms. They are not appropriate as therapeutic TMJ splints because there is no clinical fitting step, no occlusal adjustment, and no follow-up. Diagnosed TMJ disorder warrants an in-person fitting and adjustment process.

Sources & further reading

Macedo CR, Macedo EC, Torloni MR, Silva AB, Prado GF. "Occlusal splints for treating sleep bruxism (tooth grinding)." Cochrane Database of Systematic Reviews. 2014.
Klasser GD, Greene CS. "Oral appliances in the management of temporomandibular disorders." Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2009;107(2):212–223.
Türp JC, Komine F, Hugger A. "Efficacy of stabilization splints for the management of patients with masticatory muscle pain: a qualitative systematic review." Clinical Oral Investigations. 2004;8(4):179–195.
Greene CS. "The etiology of temporomandibular disorders: implications for treatment." Journal of Orofacial Pain. 2001;15(2):93–105.
Stapelmann H, Türp JC. "The NTI-tss device for the therapy of bruxism, temporomandibular disorders, and headache — where do we stand? A qualitative systematic review of the literature." BMC Oral Health. 2008;8:22.
Lobbezoo F, Ahlberg J, Raphael KG, et al. "International consensus on the assessment of bruxism: Report of a work in progress." Journal of Oral Rehabilitation. 2018;45(11):837–844.

How we wrote this

This piece draws on the peer-reviewed sources and authoritative guidelines listed below, and where appropriate also on patient-facing materials from the relevant professional bodies and the National Institutes of Health. Each substantive claim links to its source via the inline footnote next to it — click any number to jump to the citation. Where the evidence is genuinely uncertain or contested, the text says so rather than presenting one position as settled. We do not accept clinic, device, or pharmaceutical sponsorship for the content of editorial articles.

This article was last medically reviewed in June 2026 by the Smyleee Medical Advisory Board. We update when significant new evidence emerges or when published guidelines change. If you have feedback on a specific claim or believe an updated source warrants inclusion, please contact our editorial team.

Editorial note. This article is provided for general informational purposes and is not a substitute for individualised medical or dental advice. It reflects the evidence and clinical reasoning current at time of publication; specific decisions about which appliance is appropriate for your condition, including diagnostic workup, design rationale, and follow-up planning, should be made in consultation with a licensed dentist or orofacial pain specialist who has examined you. Reviewed by the Smyleee Medical Advisory Board.