Appliance questions.
The questions practices and their patients ask most often about removable and occlusal appliances.
How long should a night guard last?
It depends almost entirely on how heavily the patient grinds. A light clencher may get many years from a hard acrylic guard; a heavy bruxer may wear through one in a year or less.
Wear is not failure — the guard is doing exactly what it was made to do, and the alternative was that wear occurring on teeth and restorations.
Tell patients this at delivery. A patient who expects a guard to last indefinitely experiences replacement as a fault; one who understands it is consumable does not.
Upper or lower?
Both work. Upper guards are more commonly prescribed and are usually easier to make retentive. Lower guards are frequently better tolerated for speech and by patients who gag.
Where one arch carries extensive restorative work or a partial denture, that may decide it. Otherwise it is largely patient preference, and a patient who has failed with one arch is worth trying in the other.
Can a night guard change the bite?
A full-coverage guard worn as prescribed should not. A partial-coverage appliance can and does — uncovered teeth over-erupt over weeks to months, producing occlusal change that is difficult to reverse.
This is the main reason full-arch coverage is standard. Where an anterior-only device is used, it should be short term and supervised.
Why does the splint feel tight in the morning?
Usually because the teeth have moved slightly during the day and the appliance is reseating them, which is normal and settles within minutes.
If it remains tight, or the patient's bite feels different after removal for a prolonged period, review it. Persistent occlusal change with a full-coverage appliance warrants assessment.
Can dentures be whitened?
No. Denture teeth are acrylic or composite and do not respond to bleaching agents. Staining can often be reduced by professional cleaning, and heavy staining may indicate the surface has become abraded and porous.
Where the patient wants a lighter appearance, that means new teeth — a rebase will not achieve it and a remake would be needed.
Why does a new denture feel worse than the old one?
Adaptation. A patient who has worn a prosthesis for years has adapted to its particular faults, and a technically better denture can feel worse initially because it is different.
This is more pronounced where the vertical dimension or tooth position has changed from the old prosthesis. Copying elements of a well-tolerated old denture into the new one reduces it substantially.
Where a patient has been happy with an existing denture, send it or photograph it. What to reproduce is as useful as what to improve.
Does a patient need a new guard after restorative work?
If the restorations changed the occlusal surfaces the guard seats against, yes — the guard was made to the previous anatomy and will no longer contact evenly.
Where a single small restoration has been placed, the guard can often be adjusted. Where several units have been restored or the occlusal scheme has changed, remake it.
Protecting new restorative work is one of the strongest indications for a guard, so this is worth planning into the treatment rather than raising afterwards.
Can an appliance be repaired rather than remade?
Frequently yes, for acrylic appliances with a clean fracture and all fragments present. Send everything, including small pieces, and do not attempt a temporary repair with adhesive — it contaminates the surfaces.
Flexible partials require the same thermoplastic and specific technique, and do not accept conventional acrylic repair.
A appliance that has fractured repeatedly is reporting a fit or occlusion problem, and repeating the repair without addressing it produces the same result again.
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