Dentaltown November 2013 - (Page 32)

tmd message board Bruxism Worse with Splint » Dentaltown.com Message Boards > TMD & Occlusion, Sleep Apnea / Snoring and Appliance Therapy. > TMD and Occlusion > Bruxism Worse with Splint jeremydull1 Member Since: 05/13/10 Post: 1 of 166 t This Townie is stumped - what would you do? I have a 33-year-old woman who came to me with a history of clenching both while asleep and at work. She has a medical history of seasonal allergies treated with antihistamines and uses birth control medication. I see significant anterior and posterior wear, and she is symptomatic with headaches and sore facial muscles. I made a hard acrylic maxillary University of Michigan splint, which she wears consistently. On recall, she told me she feels, as she puts the splint in at night, that she clenches on it almost immediately, and with a lot of intensity. She states she does not sleep as soundly with it as without, and feels that her muscles are sorer than if she forgets to wear it. She is a physical therapist, so does massage and stretches of her muscles which helps relieve the morning tension. The splint has wear in the acrylic. I am not sure what to do at this point. I asked her if the vertical opening felt excessive and she did not think it was a factor. Does anyone have any thoughts or experiences with this type of issue? I appreciate any and all comments. n Jeremy Dull JUL 2 2013 jaysmasher Member Since: 02/28/10 Post: 3 of 166 If she's clenching during the day, I was taught that splints during the day can make it worse as the patient becomes more "occlusally aware" (just read that a few days ago on here and I love this term). I have told my patients if you clench all the time, stop doing it. Set an alarm every 15 minutes to half hour on your phone to check if you are clenching. If you are, stop. The idea being that clenching is aberrant behavior and should be stopped. If they can regulate themselves, they don't fatigue their muscles. One of the senior TMD doctors at my school likened it to holding your arm up all day. If she sleeps better without it, stop wearing it. I remember reading that it was something like one-third of people do well with guards, one-third have no change and one-third get worse. While you shouldn't quote me on that, there is a significant portion of people who get worse with splints. n JUL 2 2013 Jon Reth Member Since: 03/16/06 Post: 5 of 166 What is your rationale for trying to control "clenching" with a full-coverage splint? What design-aspect of a Michigan lowers clenching intensity? Without seeing the patient or the appliance, I would suspect that her posterior teeth are occluding more with the splint in than without. More posterior contact, more elevator intensity. I imagine that your Michigan could be refined to be more affective, but this would scream NTI therapeutic protocol to me with minimal VDO and no excursive posterior contacts. n JUL 2 2013 tthfairy4u Member Since: 09/04/12 Post: 6 of 166 I agree with Dr. Boyd; anterior bite splint or NTI appliance will keep the posterior teeth out of occlusion, therefore, eliminating the triggers. n JUL 2 2013 cloud9 Member Since: 07/14/04 Post: 9 of 166 Sometimes when patients say they clench more when wearing an appliance, I think that simply translates to them noticing their bruxism more when the appliance is in. It calls attencontinued on page 34 32 NOVEMBER 2013 » dentaltown.com http://www.Dentaltown.com 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