Guarding Against TMJ and Bruxism
According to the American Dental Association (ADA), over 10 million Americans suffer from temporomandibular joint (TMJ) and muscle pain caused in part from bruxism and clenching. TMJ symptoms can happen chronically in the form of headaches, including severe migraines, clicking noises, and tenderness in the jaw. The discomfort is felt in the jaw as well as the muscles of the head, neck, and face. The pain can range from mild to excruciating. It results in an inability to eat properly, with a diet limited to soft foods. It also causes sleep issues, with insomnia plaguing many TMJ sufferers.
The International Journal of Oral Science estimates that 80-90% of the population will grind their teeth at some point. This action is known as bruxism and is a significant contributor to temporomandibular joint disorders, as well as chronic and other myofascial pain. There is an array of bruxism symptoms, including teeth grinding, clenching, flattened teeth, fractured or chipped teeth, and tooth pain or sensitivity. The forces exerted by bruxers are approximately six times that of the force exerted during normal chewing.
Because the TMJ is a complex joint with many nerves, clinical experts strongly recommend a conservative approach to TMJ treatment. The best approach is to avoid surgery and stay away from entering the tissues of the jaw or joint. Nocturnal splint therapy has been shown to relieve the symptoms of sleep bruxism and provide relief to patients.
The philosophies, technologies, diagnosis, and treatment modalities for TMJ syndrome and bruxism differ from one clinician to the next. In keeping with the commitment of Burbank Dental Lab to providing individualized services to customers, we stay on top of the industry's newest technologies, systems, materials, and the different treatment philosophies provided. Burbank Dental Lab can fabricate virtually any type of occlusal guard and bite splint needed to support the preferred treatment plan, no matter the theory. These occlusal guards are made to meet your specific prescription. This customization will follow your prescribed vertical dimension of occlusion (VDO) and bite requirements. Following are a few of the most widely prescribed splints offered:
The BiteSoft® appliance is one of the most popular TMJ splints and receives the most positive feedback from the dentists who prescribe it. Compliance is imperative in the success of any appliance for TMJ pain relief. The patients are more likely to wear their BiteSoft® appliance due in part to the size and comfort level of this modality.
Benefits of BiteSoft®
- By incorporating posterior disclusion in the design, the bruxing forces concentrate on the anterior. It allows for less muscle stress and also allows the facial muscles to relax.
- The appliance keeps the mandible positioned down and forward. Repositioning the mandible anterior not only relieves joint and muscle pain but also keeps the airway open.
- This design covers all six anterior teeth (6-11) and prevents anterior splaying.
- Protects all dental restorations from breakage
- Prevents natural tooth damage
- Provides TMJ relief, resulting in reduced jaw and neck pain
- Provides a 70% reduction in the intensity of bruxism
- Eliminates posterior clenching
- Stabilizes dental occlusal for TMD patients
- More comfortable than full arch appliances
- Extremely high patient compliance
Another option for TMJ and bruxism treatment is the Talon splint which supports those cases that require the combined features of a hard splint and a soft splint. This occlusal splint is fabricated from a thermoplastic polymer. This polymer allows for the splint to be warmed in water to ensure a custom fit. This warming can be done every time the patient wears it.
It is incredibly comfortable and offers exceptional retention. This thermoplastic layer is then bonded to a harder acrylic to make up the occlusal table and allows for occlusal adjustments.
Benefits of the Talon Splint
- Maximum comfort
- Excellent retention
- Proprioceptive response with opposing dentition is maintained
- Does not require clasps for retention
- Will not interfere with a patient's ability to speak
The Talon splint offers a superior fit, thanks to the soft retentive area of the appliance. This feature eliminates any pressure points, allowing the patient to adapt quickly. The retentiveness also reduces chair time, as it would not be necessary to spend as much time making adjustments.
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Achieving The Highest Comfort in Occlusal Guards
There are some important steps to ensure an occlusal guard will have a predictable fit and offer the patient the most comfort. It is all too common for an occlusal guard to fit the model but not fit the patient's mouth. If the occlusal guard doesn't fit comfortably, this may be due to distorted impressions, no bite or poor bite registration, and a poor mounting.
A few steps can significantly improve the fabrication process of occlusal guards and ensure a great fit. One of the most critical steps is in the impression taking and model work. The accuracy in this area is essential.
Following are a few guidelines to help ensure accuracy in the model work:
- Ensure the impression tray is the right size and fits properly. In most cases, a custom tray is the best option.
- Use a polyvinyl or polyether material as it will allow for multiple pours.
- Use an adhesive to ensure the impression does not separate from the tray. Even the slightest separation can result in an ill-fitting appliance.
- Use an adequate amount of impression material.
- Dry the dentition before placing the impression tray in the mouth. Drying it will allow for better adaptation.
- Take a construction bite like a wax bite, Lucia jig, or George gauge.
- Take a face bow like the Kois Facial analyzer to capture an accurate horizontal and occlusal plane.
With this information, the case mounts onto a semi-adjustable articulator like the Panadent. This will be a very accurate representation of the patient's occlusal needs and will allow for the most accurate results in the fabrication of the chosen appliance. With accuracy in these initial steps, Burbank Dental Lab can guarantee accuracy in the appliance fit.
Understanding the needs of our customers is what has made Burbank Dental Laboratory the lab of choice for over 65 years. Through this understanding, we can obtain the knowledge necessary to provide services that help support you and your patients. Our occlusal guards are just another way for us to do this. Contact Burbank Dental Lab for your next bruxism case.