Orthodontic Tips November 4 2014
How do I know which TMJ splint to use?
This morning I saw a patient with a chief complain of sore jaw muscles and a history of morning headaches.
The patient’s age was 32 years old. When I placed my hands on the Masseter muscles they were as hard as a table top. When I placed my fingers over the jaw joints and asked her to open a close there was no click at all and she was able to open her jaw satisfactorily.
We took a Pan to confirm that there was no pathology with the joints. I feel a Pan can give a good indication of condylar bone changes and pathology without a full tomographic series even though the Pan is not the “gold standard”.
I’m going to start treatment for this case with a full maxillary TMJ splint made of hard acrylic. I’ll adjust it gnathologically with point contacts in centric relation, gentle cuspid rise and gentle anterior tooth guidance in protrusion. I don’t use soft splints because often the patient will “chew them like chewing gum” and that will make the TMJ dysfunction worse.
If I don’t get resolution of the TMJ dysfunction I can add a mandibular secondary splint in the future. Once I’m into double splints I have a lot more choices.
In addition to the gnathological system, I can use an “open bite” system for mouth breathers who have anterior open bites; I can use an NTI system for patients who are predominately clenchers and not bruxers; I can use a unique “bump” system for patients who have subclinical sleep apnea. I don’t always know which one to start with; however, I can switch from one system to the other chair-side if I don’t get the results I expect.
The variability of etiology of TMJ dysfunction necessitates a variety of systems to get success.