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TMJ, Bite and Splint Treatments

Diagnosis and treatment of “Bite disorders” and “TMJ” conditions is usually a long and difficult process.  There are many medical conditions that can mimic Bite and TMJ disorders that may become apparent during dental treatments or when Bite disorders have been ruled out.  Your dentist will refer you to the appropriate medical or dental specialist if resolution is not achieved.

It is difficult to explain a Bite disorder and how it happens.  It’s been found that a clenching or grinding habit of the teeth is common to most symptoms and it’s best to start here.  Unfortunately most people will be unaware that they have a clenching and grinding habit until they are shown evidence on their teeth.

Firstly you should consider clenching and grinding as the same even though they are not.  Clenching is a static heavy force, grinding is the same force while the teeth are moving.  As this is a developed automatic habit you will not be aware that it is happening even while you’re reading this.  Thought alone will not help, a cognitive trigger is needed.  We give patients stickers “please do not touch” and ask then to consider a relaxed jaw posture.  Each time you see a sticker, see instructions sheet, think “are my teeth touching?” If yes, say and do, “lips together, teeth resting apart, breathing through my nose.”  Teeth will touch some times when you swallow, all other times that teeth touch you must consider that clenching and grinding.

Night time clenching and grinding can sometimes be heard by others, otherwise you will be unaware of the action, except for symptoms.  Once clenching and grinding when sleeping has been established (or the teeth are just too worn) your dentist may recommend a dental splint.  Sometimes the way your teeth meet has gone beyond what your body can adapt to.  It is important to have your dentist show you how your Bite is “out” so that you will not be surprised when the condition is healing.  After an Occlusal Analysis with a leaf gauge, models and a face bow is recommended.

There are many types of splints available (these are never soft splints like mouth guards as they rely on a neuromuscular release that can only be obtained with a hard surface)  Common splints are sectional splints like NTI-tts or traditional full coverage splints that are adjusted over weeks and months.  They both have advantages (please note that all splints are to be worn only while asleep).  If a segmental, NTI, or anterior splint is used rather than a full coverage splint it is important to note that this will not move the teeth, but it will show up a Bite discrepancy.  However if you think a segmental splint has moved your teeth stop wearing it immediately and contact your dentist.

You may need an Occlusal Analysis.  It’s advisable to bring any Bite splint you have to your six monthly appointment for assessment.

Most people have a positive experience with dental splints and report a reduction in the symptoms of facial pains and TMJ dysfunction.  A lot of people have what dentists call an Anterior Open Bite and most can adapt to this to eat.  Sometimes people cannot adapt to this and Orthodontics or Corrective Orthognathic jaw surgery is required.  Even orthodontics may not be accurate enough to help and an Equilibration may be required.

Please ask your dentist or dental specialist what this involves.

Some of the symptoms of TMJ and Bite problems:

  • Facial Pain – in the muscles or face of mastication
  • Clicking and popping sounds of the TMJ disc
  • Tooth nerve pain that can develop into a root fillings, Endodontic treatment + crown
  • Tooth cracking and even splitting.  This is the most severe symptom of Bite problems ans is a common cause for the need of a crown or CEREC Inlay if caught early enough.
  • Tooth wear is relative and dependent on the rate and prognosis.  Sometimes this needs to be treated with a whole mouth rehabilitation.

Jaw and Facial Pain

It is important to assess these well as there are many diagnoses and combination of diagnoses. Radiographs are always necessary to assist with diagnosis.

  • TMJ, Bite and Splint Treatments
  • Migraine
  • Muscle Pain
  • Cluster Headaches
  • Clenching and Grinding
  • Toothache
  • Tooth Abscess
  • Gum Abscess
  • Wisdom Teeth
  • Medical

Occlusal Analysis / Bite

The Occlusal Analysis is an analysis of the “Bite”, the way the teeth fit together in harmony with the jaw joints (TMJs = Temporomandibular Joints) and the chewing muscles (Muscles of Mastication).

The need for this usually centres around the diagnosis of Facial Pain and Migraines. Jaw locks, clenching and grinding, tooth wear, tooth cracks, split teeth and tooth sensitivity to hot cold and chewing. If left too long a tooth may not survive or require endodontic treatment. Finding out the reason why is the best help to making the correct diagnosis.

For an Occlusal Analysis the first appointment usually consists of making two sets of dental models, bite records with a leaf gauge and a Face Bow record for mounting on a dental articulator. These models are tested for mechanics and one set of models is commonly adjusted to assess if the teeth can fit together easily with an Equilibration, crown and bridge restorations, orthodontics or sometimes with specific extractions or Orthognathic surgery where the jaws are repositioned.

This process is a measurement to test what options you, the patient, have to correct a developing problem. There are many simple options but treatment depends on your wishes and expectations.

If you would like more information on jaw or facial pain or to book an appointment, please contact the Wendouree Dental team on 03 5339 3770.