TMJ Splint Therapy

Splint and Other Names.

Discussions about splints can often be confusing as there are many other words used for splints:  bite plate, bite applicance, mouth guard, night guard, night splint, occlusal appliance, orthotic, brux guard, mouthpiece.

Have You Tried Conservative Treatment Options?

It is true that most TMJ disorders will be helped with natural, home and professionally non-invasive treatments.  There is no harm in trying these options in conjuction with Stress Management and possibly Psychotherapy. The decision to wear a mouth splint for TMJ syndrome should only come after you have tried more conservative treatments and are certain that none of them can help your TMJ
disorder.  In addition, you have found a reputable TMJ specialist with experience in orthodontics that you feel comfortable with and trust.
Preferably, given your condition, the TMJ specialist will have encouraged you to exhaust all home remedies and non-invasive medical procedures prior to a discussion about Splint Therapy.  Even though the wearing of a splint is not an invasive option the follow up to a splint will very likely be invasive.

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Splints Types

Stabilization splints prevent night-time Bruxism, the clenching and grinding of teeth.  This type of  splint covers all the teeth and can be manufactured using a hard or a soft material.
Repositioning splints are worn 24 hours a day and are adjusted regularly by an orthodontist to get the joint (TMJ) to slowly end up in the correct position in the socket. 
Wearing a correctly made splint is said to allow the muscles to relax and therefore help rid you of jaw and face pain.  A splint will also protect teeth from wear and tear, stress fractures and chipping.

Why You Need a Splint

Your TMJ or joint and teeth are correctly positioned when all your teeth make simultaneous contact at the exact moment the condyles are seated in the most stable position in the sockets.  In this ideal position , there are no forces to damage the disc, joints or teeth and the muscles are relaxed or in a neutral position.
For TMJ disorders, your teeth may come tgether but the joint is pulled out of the socket.  This position leads to Buxism , the grinding and clenching of teeth at night.  Another TMJ disorder has the joint positioned correctly but the teeth do not come together correctly or only partially.
Treating a damaged joint with splint therapy is not a cure.  The splint will help manage the problem by placing the joint in a less traumatizing position so pain and future damage are minimized.  You may experience difficulties with wearing a splint such as a problem speaking, sleeping and it may be uncomfortable at fiirst. You will have to modify your diet somewhat, choosing softer foods.
A correctly made splint will put the joint in the right position and provide a bite where teeth, muscles and joint do not work against each other. If your symptoms improve from splint use then it can determined that the problem is definitely TMJ dysfunction. 
Some people who are having success with their splint in relieving their TMJ symptoms opt to continue the therapy instead of proceeding to the next phase.

Phase One - Getting the Splint

Apart from giving your medical history the doctor should also know about any dental history and if you have had any accidents or injuries. Give a detailed account of your TMJ symptoms such as headaches, pain and any sleep disorders. The doctor will examine you thoroughly and take X-rays of the jaw and a panoramex film.  An MRI or CT scan, though expensive, are well worth the money to get a good diagnosis from the doctor.
 
Once the doctor has his diagnosis he will discuss a treatment plan and what it may include.  Obviously a splint and perhaps medication to help reduce pain and muscles spasms and inflammation.  He may also recommend physical therapy to strengthen and increase range of movement which will help to prevent further joint injury.  The doctor may suggest injections to relieve trigger points in muscles or
alleviate inflammation.  In some cases, severe myofascial pain and headaches can also be treated with Botox injections.

Dental moulds of your teeth will be taken and precise measurements made.  Lastly your splint will be checked for fit and the doctor will inform you about care of your splint device.

Next Phase After Splint

You have been getting good results now for several months from wearing a splint 24/7 and it is time to take it out.  However, once a splint has been worn for a period of months or in some cases years, you will likely find that it has changed your bite and jaw position. 
At this point you will enter the next phase of therapy which can include the following treatments:

 Reshaping and/or grinding the teeth
 Braces
 Crowns, bridges or veneers
 Surgery

These treatments are permanent, cannot be reversed and there is a possibility that they may not work.

Splints and Research

It is important to note that there has been no significant or extensive research done on splints as a treatment for TMJ.  Be very caution
before beginning any treatment option that can cause irreversible harm.  Seek several independent, professional opinions prior to
commencing any treatment.


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Dental Procedures for TMJ

TMJ and the Dentist Chair

Make the Pain Stop

The American Dental Association estimates there are as many as ten million Americans with TMJ disorders.

To the poor TMJer's who brave the Dentist office looking for relief you have my greatest admiration and my deepest sympathies.

When I was very young many moons ago, I lived and went to school in a small town in New Zealand.
On the grounds of most city schools was a small brick-built one or two-chair dental clinic. Young Dental Nurses employed by the Government fresh out of a rigid two-year course attended to the dental health of rosy-cheeked school children up to the age of thirteen.

I have such fond memories of those antiseptic smelling clinics, the nervous nurses and the cheery sound of the drill. Yep I am lying! The bloom went out of cheeks pretty fast I can tell you when I had to visit the Dental Nurse. As much as I didn't like the smell, sound or FEEL of that drill ( I am told it was powered by electricity but in a power outage it could be foot-operated!) I didn't know what I was in for until at the age of thirteen I had to go to the family dentist.

This guy was a close family friend. I figured my parents must have owed him a ton of money or run over his dog and having me in his chair was his chance at retribution. I think he used saline in the needles. His drill had these mammoth drill bits and he liked to run the drill really slowly.

I thought the juttering vibrations would cause me and the chair to crash through to the first floor. Hey, maybe that is where my headaches and TMJ started; from this heavy handed Dr of Misery. I feared this man and his evil equipment and on my visits to him I would deal with the pain by citing a poem over and over again in my head.

Well that was then and this is now. I love modern dentistry, sort of. Well it has improved tremendously with all the great new anesthetics and supersonic what-nots and I think the College of Dental Surgeons screen now for maniacal masochists. Yes, Dentistry has definitely come a long way.

So my TMJers what can it do for you?

Mouth Splint

Don't talk with your mouth full.

Dentists like splints because they are the most popular non-surgical means to treat TMJ pain in the jaw. The Occlusal splint is a removable dental appliance made from either hard acrylic resin or a soft resilient plastic. It is possible to buy a generic mouth slpint for your TMJ over the counter at some stores but it is alway wise to seek advise from a TMJ specialist first.

There are several distinct types of Occlusal splints.

Stabilization or flat plane splint. Designed to reduce teeth grinding and relax jaw muscles it fits over all the upper teeth.


Modified Hawley splint. This splint fits on the upper jaw and makes contact with only the six lower front teeth. Only worn at night it keeps the teeth from grinding and clenching.

NTI-tss (Nociceptive Trigeminal Tension Inhibition Suppression System. (Try saying that while you are wearing one.) It doesn't sound like it but it is small and fits on the front upper teeth and is designed to prevent tooth clenching and grinding. However, because it fits on only a few teeth, it places a great deal of stress on them and that can be harmful to those teeth. There is also a danger of this small device being swallowed if it comes off at night.

Repositioning splint. A more invasive form of splint treatment this device is used to move the lower jaw either forward or backward into a new position permanently.



Questions you should ask your Dentist about splints.

• Why are you recommending this type of splint to me?
• Are you recommending this splint to decrease my pain, reposition my bite or both?
• What are my other options?
• What happens if my pain gets worse while wearing the splint?
• What happens if I develop an open bite (teeth no longer touch)?
• What proof do you have that this splint will help?
• Do I wear the splint during the day, night, or both?
• How long do I have to wear the splint before I feel significant improvement?
• If the splint doesn't help, what's next ?
• Will follow-up treatments be required, how many and how much each visit cost?
• Will insurance cover the cost of the splint and the follow-up treatments?
• Must I sign a financial contract with you to begin treatment?

Dentists who treat TMJ disorders will administer X-rays and prescribe a splint. They may also have you get other treatments such as massage to help you get relief from TMJ and ease the wearing of a splint.

After the Splint what are the Options?

Since many splints can change the bite and the teeth-jaw relationship, it is advised that patients exercise caution when beginning treatment, and seek a second (or third) independent opinion before consenting to irreversible treatments like these.

Splints may only work for a short term period and may even change your bite. If a splint fails to work, your dentist may recommend options for re-alignment of your teeth.

If simple techniques fail, more invasive treatment can be considered.

This could be Orthodontics or veneers, crowns and bridges. Perhaps even reshaping (grinding) of the teeth.

• Please note that these treatments are IRREVERSIBLE (so they are permanent even if they do not work).

Surgery is considered a last resort by most TMJ experts.

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