Ortho Tips March 6, 2011
A couple of weeks ago, a teen-age (19 yrs.) TMJ patient came in for his annual check-up appointment.
I checked his jaw joints and there was no clicking or popping. That was good! I asked about headaches and he said that he didn’t have any recently. That was good! I checked the tension in his masseter muscles and they were as hard as a wooden table. That was bad!
He must have been grinding his teeth a lot. I asked him how he felt it was going and he said everything was fine but his splints had some holes in them.
“OK, let’s have a look at your splints” I said. He had a two-splint system and the upper splint was broken down in the occlusal areas. Thankfully the wear and tear had happened on the splints and not his teeth or jaw joints.
“We will need to replace the upper splint,” I explained, “and unfortunately there will be a replacement fee.” I took the impression and poured it, but we didn’t’ make the replacement splint until his parents gave us the OK.
I got a call from his dad and he was upset. He pointed out that I told him that normally the splints last from 3 to 5 years and this splint only lasted 2 years. He had a point, but I could see that this patient was more than “2 standard deviations” beyond normal bruxing intensity and he was going to wear the splints out really quickly.
I pointed out that I was giving him a break and was not charging a full fee. Then, I pointed out that I could not be responsible that his son had a grinding habit that was far above a normal wear and tear situation. Finally, I pointed out that his son had been protected by the two-splint system very effectively and that it needed to be continued. Reluctantly, he agreed to the replacement.
This was not an easy situation and has remained in my mind ever since. That’s why I’m sharing it with you. We know that if your eyes change you need new glasses; and, if you are hard on your car’s tires, they will need replacing before the normal time. Why is dentistry the “domain of disappointment?”
I’m sure you have all come up against similar situations in your practices. If you have any comments or suggestions, I’d welcome them.
Anyhow, the new splints are back in use and the patient is happily grinding away on them. I wonder if I could have made them out of “Kryptonite”.
Have a great week.