Orthodontic Tips March 25, 2014
I went to lunch with a dental colleague last week. He asked me “Can you tell me when a two splint system is necessary instead of a one splint? Can you tell me when I should be doing the TMJ care and when should I refer it?”
Here are the answers.
A two splint system is necessary when there are bite marks or grinding marks on the single splint. The reason for this is as follows. If there are marks on the splint then the patient will play with the marks and the muscles will go into spasm again. Also, if there are marks and you repeatedly grind them out, the splint will get progressively thinner until it breaks.
A TMJ patient should be referred if the care you are providing is not making a significant change.
The patient will know within one week if a splint creates beneficial changes. If the patient is not feeling better in a week then the design of the appliance should be changed and possibly additional therapy such as Chiropractic, massage or low level laser care should be used. If you are not comfortable managing the changes and/or additional therapy, then consider referring the patient.
How do you know if a splint is working? Evaluate objectively using numbers and/or descriptive words. Test for Masseter muscle tension, jaw clicks or noises and jaw opening. Document what you see so that you can compare the results from appointment to appointment. Also write down the patient’s subjective feedback to track it.