Bruxism splints: they protect the teeth but do not stop the grinding

The occlusal splint is the most prescribed device for bruxism, and its purpose is often communicated to patients in a way that creates the wrong expectations.

The splint does not eliminate bruxism. It is a protective device: it interposes a sacrificial surface between the arches so that wear falls on it rather than on enamel.

Saying so explicitly prevents the patient from reading it as a cure and being surprised when, months later, they still clench.

The distinction between hard and soft splints has the greatest bearing on the outcome, and the choice runs counter to what many patients expect.

A soft splint feels more comfortable but in a proportion of subjects increases muscle activity, because the yielding consistency invites biting as though on food.

The hard acrylic splint has the better documentation, and it allows a precise adjustment of contacts that soft material does not permit.

The occlusal surface should be flat and smooth, with even contacts on all opposing teeth. Cuspal indentations, which look like careful adaptation, lock the mandible in one position and prevent sliding.

A canine guidance built into the splint disengages the posterior segments during lateral movements, reducing elevator muscle activity.

Thickness is kept to the minimum the material's strength requires. An overly thick splint alters vertical dimension more than necessary and is less tolerated during sleep.

Periodic review serves to read the wear, which is valuable clinical information. Wear facets show where and how much the patient grinds, and their progression indicates whether activity is increasing.

A splint wearing rapidly at a single point indicates a premature contact to be corrected, not necessarily more intense bruxism.

The upper splint is more stable and gives better coverage; the lower is better tolerated by patients with a marked gag reflex. The choice is practical rather than doctrinal.

In summary: the splint protects and does not cure, hard splints have better evidence than soft, the surface stays flat rather than moulded to the cusps, thickness stays minimal, and wear read at review is diagnostic information.