Dentaltown November 2013 - (Page 39)

tmd message board Dr. Nosti is correct. Most disc displacements can be heard with a stethoscope. I personally don't see the benefit of more sophisticated instrumentation. Many sounds can be felt with just the fingertips. I want to emphasize just one more thing about "end feel." I described a "hard end feel above," which indicates DDWOR, however a "soft end feel" (when the patient initially opens to 25mm but then opens to different larger measurements) indicates a myospasm and easily distinguishes a joint problem from a muscle problem. n Harold Menchel JUL 3 2013 Just interested in the types of responses, like why you want posterior disclusion in excursive movements (if they go there), but not during centric clenching? Physiologic joint position is another weird issue; if it changes all the time, then why worry about it? If you use anterior midpoint stop appliances, the changes don't manifest in any type of "interference" on the appliance. I like not having to worry about it. As for muscle firing, it definitely happens with postural reflex, but increases dramatically with tooth contact, especially molar contact. I did the same appliances as you for many years, and had good success, but nothing like when I switched to AMPSAs. Plus the time savings in appliance adjustments is phenomenal, as is patient compliance. If you really learn to tweak the design, you can avoid the development of AOBs, plus save yourself a lot of aggravation with adjustments. I just don't see the downside, and wouldn't want to go back to the full-arch splints ever. Sure, we don't know that elevated EMGs are responsible for muscle pain, but they probably compress joint tissue more than low EMG levels. So, while the mechanism of action isn't known for any type of splint, I think I'll stick with the easier ones with the best patient compliance. After all, there's no science behind full-arch splints either. n Drive4show Member Since: 05/17/07 Post: 32 of 166 JUL 3 2013 Protrusive parafunction is the Jim Boyd DDS number-one oversight causing Member Since: 11/07/00 therapeutic failure when using an Post: 33 of 166 NTI (or any splint therapy). Practitioners just don't think it happens, apparently because somebody else said so. Does anyone ever think to minimize the vertical dimension when clenching in protrusive on a full-coverage splint? Why not? Because nobody thinks it happens, and when it does, it's just bilateral posterior contact allowing a monstrous clench with the condyles hung out to dry. Protrusive clenching is just bilateral LP contraction prior to clenching, as opposed to unilateral excursive clenching. Treating parafunction with a nocturnal device requires minimizing elevator contraction intensity (via incisor contact) and minimizing joint strain/load (by striving for minimal condylar rotation during the event). If you can't do that with a full coverage splint, it doesn't mean it can't be done. n JUL 3 2013 search Bruxism Worse t Find it online at: www.dentaltown.com FREE FACTS, circle 30 on card dentaltown.com « NOVEMBER 2013 39 http://www.dentaltown.com/MessageBoard/thread.aspx?a=11&s=2&f=154&t=208393&pg=1 http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown November 2013

Dentaltown.com Highlights
Howard Speaks: Not Getting it Done? Hire a Consultant
Professional Courtesy: Painful Advertising
Continuing Education Update
Second Opinion: The Role of Teamwork in the Third Era of Medicine
Deprogrammed Open Bite Can Help with Veneers
Bruxism Worse with Splint
Corporate Profile: Burbank Dental Laboratory
Product Profile: Eaglesoft 17
Debunking the Social Stigma of Stress
The Personal Side of Stress
In Your Face: Facing the Realities of Stress in Dentistry
When Tragedy Strikes: How to Prepare for and Recover from a Natural Disaster
The Latex Problem: It’s More Complicated Than You Think
Why Dentists Require Specific Exercise
How Much Money Can You Make When You’re Dead?
Denture Stabilizations with Small-diameter Implants
You Should Know: CrownMen
Product Profile: Synergy
Product Profile: NuSmiles ZR
Continuing Education: The New Evolution of Chariside CAD/CAM Technology
Ad Index
In This Issue: Dry Brush Inside Bottom Teeth First
Perio Reports
Dentally Incorrect
101 Ways to Reduce Stress
Achieving Goal Congruency

Dentaltown November 2013