SPLINT THERAPY

from the library of Robert L. Talley, DDS.

Orthotic appliance therapy includes a removable orthotic (appliance) that covers the occlusal surfaces of the teeth. The appliance does not reposition or move any of the teeth. Treatment with an orthotic is directed toward the realignment of the mandible tot he skull, stabilization of the right and left temporomandibular joints, reduction of stress to the right and left temporomandibular joints, restoration to normal physiological function and reduction of muscle hyperactivity.

Your splint will be custom fitted from impressions of your teeth, to make it as comfortable as possible; and it will not cover the front of your teeth, to make it invisible. You may need to wear a splint for three to twelve months or longer. During that time, we'll adjust the fit as your jaw posture changes.

Management goals are to decrease pain, decrease adverse joint loading, restore normal physiological function, reduce muscle hyperactivity and restore normal daily activities.

Neuromuscular Relaxation Orthotic

An orthotic provides for the proper alignment of the mandible to the skull and maintains the muscles of mastication in proper physiologic resting length, from origin to insertion. By repositioning the mandible to achieve this neuromuscular position, we will attempt to eliminate the problems of sustained muscle contraction and related spasm, joint inflammation and dysfunction. The orthotics are 80%-90% effective in reducing symptoms.

The orthotics (appliances) are made of acrylic or flexite material with a lingual reinforcement and clasps. It should not be confused with an "orthodontic" appliance, which functions to reposition the teeth. During this treatment time, the appliances must be adjusted as the mandible is repositioned into proper relationship with the cranium and the muscles become relaxed. This appliance can be likened to a "cast" which limits range of motion and positions of the bones.

Craniomandibular Orthopedic Repositioning Orthotic

The primary purpose of this orthotic is to orthopedically reposition the condyles of the mandible into proper physiologic position within the glenoid fossa of the cranium, thus reducing a dislocation of the articular disc. This then places the fossa, disc and condyle into a juxtaposition with one another. This position allows for healing within the joint structure to occur. This includes tightening of the ligaments of the discal attachment apparatus and aids in reducing edema and/or inflammation of the capsule and retrodiscal tissue when present.

When the reposturing orthotic is used, there are often daytime and sleeping devices. It is necessary to use a maxillary device to maintain mandibular posture during the sleeping hours when the mandible is in its most vulnerable and relaxed position. The daytime device must accommodate the ability to chew, as well as to provide freedom for speech. The designs of the two appliances are vastly different.

When devices are worn 24 hours daily, it is ill-advised to have the same orthotic in place on the same group of teeth for fear of developing dental disease problems. This would include both an increased potential for caries and periodontal disease.

General Orthotic Information

When an orthotic is not being worn, it must be kept wet to keep it from changing shape.

At all times, even when wearing an orthotic, you should condition yourself to keep your teeth slightly apart. Your teeth should touch only when you swallow and eat. Separating the teeth will help your muscles relax and reduce the stress on the jaw joints.

An orthotic can be a diagnostic aid. If there is permanent damage or a patient is a habitual clencher and grinder of teeth, some of all of the symptoms may remain. In cases where damage is reversible, the signs and symptoms will disappear.

You should initially restrict yourself to a soft diet, i.e., eggs, hamburger, chicken, fish, soft cheeses, yogurt, soups, various breakfast cereals, pasta, cannelloni, lasagna, salads, soufflés and desserts. Avoid steak, raw vegetables, hard crusted bread, apples, and other foods difficult to chew because the excessive function these foods cause results in retarded healing of the joint and its tissues.

Appliances have a limited lifetime. The normal life expectancy of an appliance is approximately 12 months, though many will last longer. This allows adequate time for healing and stabilization in most jaw joint problems. Several cases may require greater time for healing and, consequently, may require more than one appliance. An appliance used only at night should last much longer.

While you are under treatment, do not move your jaw side to side to see if it clicks or grates or hurts. Do not chew gum, do not grit or clench your teeth. Repeat to yourself over and over again during the day, "lips together - teeth apart."

An appliance must be kept in adjustment. When an orthotic is out of adjustment, stresses are applied to the teeth, the temporomandibular joints and to areas of the appliance. When this happens, healing stops, damage begins again and your appliance may break. Whenever you feel that your teeth do not fit the appliance properly, an adjustment is probably needed to protect the splint, the teeth and the temporomandibular joints.

Keep appliances away from dogs. Dogs love the chew on orthotics.

When brushing your teeth, brush your appliance.