Mouth guards, what to know

I do often see patients complaining about their jaws. They mostly have pain in their jaws or muscles or headache. In many cases a mouthguard, also called bite, is a good solution. Other cases where it might be needed is if you are clenching or grinding down your teeth in order to protect them. Moreover there are specific mouthguards for snoring, sport and sleep apnea.

Today we will talk about the one used for bruxism. When you grind or clench your teeth, we talk about bruxism and it is usually an activity caused by some kind of stressor. Bruxism often cause muscle soreness or headache (especially in the morning) and often some jaw pain close to the ears. The reason is the overtrained masticatory muscles, like the one you feel the day after going to the gym.

Since stress is one of the main factors, try reducing it as much as you can as a first step. Then your dentist will check for any malocclusion ( if your teeth are not straight) or a filling/crown that is too high and finally if you are biting unevenly. In all these cases your body will try to rebalance your bite by grinding down the culprit filling/crown/tooth which is not in balance with the other teeth, but because it might take months or years to grind it down, you might develop pain in the mean while by this new extenuant activity.

A mouthguard is a device made of an hard material which fit perfectly your upper or lower teeth and then have a slightly flat surface on the opposite side which will be in contact with the opposite arch. It works because it rebalance your bite, it kind of reset how you bite and since one of the two jaws will be able to bite on a new surface which will force your muscle to be stretched in a more comfortable position,you will feel better. Most of the patients usually have immediate relief after only few days, but of course the mouthguard need to be correctly adjusted in order to achieve this result. Over the counter mouthguards are usually not enough or even harmful and your problem might get worse, since they are often too soft, acting as a chewing-gum which will make you overtrain your teeth or not balanced, which will aggravate the problems.

Which means that in order to make the right mouthguard for you, the dentist have to spend time to check what the problem is in the first place and only later an impression of your teeth and your occlusion (how you bite) is recorded.

On the next appointment the bite will be checked again with the new mouthguard on and a new control after few days is performed where new adjustments might be needed. If everything goes fine, only small adjustments might still be necessary once in a while (usually once per year) since the bite will be consumed as well.

But in order for the bite to work all these steps are necessary.

If you still have pain, you might either have a different problem which is not completely jaw related (e.g. a neck injury) or the problem is at an advanced stage where surgery and/or orthodontic treatment is needed.

Is then your mouthguard for life? In most cases not really, once the problem is identified, you can try to move your teeth or grind down/reconstruct specific areas of your teeth in order to mimic the occlusion obtained with the mouthguard, otherwise the intermitted use of a mouthguard (only few nights per week or months) might be enough.

Chlorhexidine

Chlorhexidine is a very useful drug. It is often used in dentistry as a mouthwash in any case where we want to reduce the bacterial load in the mouth. It is therefore very useful in case of gum diseases (Gingivitis,parodontitis, pericoronitis), so anything that goes from a bleeding gum to a wisdomtooth who is not completely erupted where the gum partially covering the wisdom tooth starts to hurt.

HOW TO USE IT?

Normally twice a day for at lest 30-60 seconds, 30 minutes or more after brushing your teeth in a concentration of 0,2% or 0,12% (which is less than 0,2%) from few days to up to about 2-4 weeks. Longer use will have the unpleasant effect to stain your teeth with a brown/black colour in the area where you didn’t brush properly your teeth, so usually close to the gums and between your teeth. The reason why you need to wait at least 30 minutes after brushing your teeth to use it, is because there are some ingredients (e.g. sodium lauryl sulfate and sodium monofluorophosphate) in many toothpastes which will inactivate the chlorexidin.

IS IT SAFE?

Except for the stains which can be removed with a professional cleaning, you could be allergic to it. Moreover, it can temporary (few hours) affect your ability to taste foods, but i mean if you just brushed your teeth, it doesn’t really make sense to eat again.

ARE ALL MOUTHWASHES WITH CLORHEXIDIN THE SAME?

No, if possible prefer the water-based one to the alcohol-based one, it is healthier and it will not increase the dryness in your mouth. 0,3 and 0,2 % are used for short time in the acute phase and 0,12 or 0,05% for longer use in order to avoid relapses or for mantainance protocols

WHAT IF I AM PREGNANT?

First of all congratulations, secondly, it is considered relatively safe (Animal reproduction studies have failed to demonstrate a risk to the fetus), but as always with pregnancies, caution is recommended. So, if it is not strictly necessary, it is better to avoid it. And remember that it is excreted in human milk while breastfeeding.

I just bleached my teeth, now what?

Recently I performed a bleaching to a patient, and I gave the classical/normal instructions, but I realised that what is clear to me, might not be that clear to a patient, so let’s say you just chair-bleached your teeth or are/were home bleaching your teeth, what should you do now?

First, sensitivity is normal, especially with cold or warm for the first few days, tipically the first 2-3 days, but can lasts to up to 7-14 days; if it still continues or it become a pulsating pain, contact your dentist. The reason for this sensitivity is that the oxidation process which allowed to bleach your teeth, will continue for few days and that mean that your teeth will become even whiter!

In order to reduce sensitivity, avoid too cold or too hot foods or acidic food, like vinegar, sour cream, yoghurt (especially if not white), sour food/fruit, such as berries,oranges,lemons or citrus fruits in general or tomatoes. The same goes to mint and chilly.

Toothpaste against sensitivity like “colgate pro-relief” or “sensodyne rapid” are a good options until the sensitivity disappears or even better, use it before it appears. And as always use an extrasoft/ultrasoft toothbrush from a recognised brand, such as “Curaprox 5460 Ultrasoft” and don’t forget to floss/using interdental brushes.

Transatlantic fligths/jet fligths or scubadiving can also temporary increase the sensitivity/pain, so even if it is not completely contraindicated, it is better to avoid them if possible for at least the first few days.

Discomfort of the gums, lips, throat or tongue is also a possibility, if it persist for longer of 2-3 days, contact tour dentist. In times of covid-19 extra rules apply, so in case of sore throat, contact your dentist and book a covid-19 test.

Avoid food that stains, tipically examples are coffe and tea who must be avoided for at least 7-14 days and it is better to avoid even later to guarantee a long lasting effect. There is no reason to bleach your teeth if you are covering them with a layer of stains, especially if you are used to have stained teeth. Maybe it’s the moment to stop over indulge in tea and coffe, in the same way if you smoke, maybe it’s the right time to stop smoking or reducing the amount of cigarettes/pipes/marijuana/e-cigarettes you use and actually bleaching can be a good motivation to try to stop smoking.

Avoid colourants, as a rule, anything that would be difficult to remove from a white t-shirt, such as tomato juice (both acidic and a colourant), red wine and cocktails in general with fancy colours, evcerything that is transparent is better, but might be acidic, the same goes for beer. All juices/centrifugates should also be avoided. Liquorice is also better to avoid, especially the salmiak type (so typical in Scandinavia). What about chocolate, better not, even if not completely contraindicated, it is not that good for your teeth. Other less typical colourants are curry/curcuma/beetroot/carrots/ black ink from squid

In conclusion: just drink water for at least 14 days and avoid smoking and avoid eating anything that is sour/too cold/too hot or with colours for at least the first few days. Foods that are normally allowed are e.g. pasta (not the one with fancy colours), potatoes (not the blue variety), meat, white fish, hard cheese and bread.

If you home bleached your teeth and you still have some whitening gel left, you can store it in the fridge in a dark container (so the light will not reach it), but ask to your dentist when it is the best time to re-bleach your teeth.

The effect of bleaching will last for few months in general form 3-9 months, depending on your smoking/drinking/eating and dental hygiene habits and it is generally safe to bleach your teeth once per year.

For any question, contact your dentist and remember to book an appointment for the next check-up with your dentist and enjoy your new beautiful smile!

Do I need antibiotics?

Short answer: probably no, unless you have an immunodeficiency or are susceptible of endocarditis (e. g. if you got a heart transplant).

Exceptions are:

Implant surgery, where a single dose 1 hour prior the operation can be considered and some periodontal surgeries or extractions where the surgeon had to manipulate the bone

And in case of an invasive dental treatment is followed by fever and/or malaise.

In details a lot of articles suggest that antibiotics are not normally necessary, unless you have cardiac disease or susceptible of having one (e. g. if you have received a transplant or in case of immunodeficiency). For more info

Ada or Kce

Do I need a stronger painkiller?

Short answer: probably no. After a dental treatment, only over-the-counter painkillers are recommended in case of pain. The most commons are Ibuprofen and acetaminophen and if necessary a combination of the two can be considered.

After an extraction or a root canal therapy, pain lasts normally a couple of days but can continue for longer time (usually up to 14 days after the treatment)

Most guidelines recommend against using antibiotics for most pulpal and periapical conditions and instead recommend only the use of dental treatment and, if needed, over-the-counter pain relievers such as acetaminophen and ibuprofen.