by Clayton A. Chan, D.D.S. – General Dentist
Over the past 24 years it has become apparent to me as a clinical dentist that it just take one good intra oral appliance to stabilize the cranio-mandibular/TMJ pain dysfunctional problem case. Nature’s design is to develop one good set of teeth and one good occlusion to stabilize the bodies posture – to allow it to function optimally. The dental profession is fraught with confusion as to how best to remedy the numerous musculoskeletal occlusal and TMJ paining problems. Dentists have come up with a constellation of modalities, techniques and numerous appliances in an attempt to address the TMJ problem such as masticatory pain, headache pain, cervical pain, facial pain, clicking and popping joints, jaw restriction problems, clenching and grinding problems and the list goes on.
Many different kind of appliances and intra oral devices have been devised to address these problems, but are often based on the dentists occlusal and TMJ philosophy, understanding and experience about orofacial pain, musculoskeletal occlusal and temporomandibular joint dysfunctional issues.
The lower anatomical orthotic is the one appliance that has been proven successful, consistent and able to meet the needs of most of my TMJ pain patients. I don’t advocate a night time splint or a day time guard. Why? If one can accurately identify by objective measurements the correct physiologic bite relationship (relating the maxillary to mandibular arches in an optimal manner) and properly adjust the orthotic to physiologic parameters so that the appliance can be worn 24/7 during the day and or during the night and the patient feels comfortable with it during speaking, eating, play and work, then it can be assumed that the one orthotic appliance based on gneuromuscular (GNM) science and technology must have some validity to this approach.
A properly designed and adjusted intra oral orthotic (Optimized GNM Orthotic) is all that is required to stabilize the dysfunctional TMD case in most cases.
The only time an additional appliance or prosthesis is required is when there exists missing opposing teeth. In these situations an opposing stay plate, retainer with teeth, or a partial denture and in fully edentualous cases a full arch denture may be required to oppose the lower anatomical orthotic appliance.
A fixed semi-bonded orthosis in these particular instances may be required, yet are the exceptions:
- Individuals that have had previous extensive restorative full mouth dentistry with increased vertical opening and their vertical dimension of occlusion is already infringing on “physiologic” parameters.
- Individuals that do not have a deficient “physiologic” vertical dimension of occlusion (objectively measured and confirmed by jaw tracking tests) may be better treated with a fixed orthosis.
- Individuals who have normal healthy dentition at a normal vertical dimension, but posterior (back) teeth have been inadvertently been ground down (equilibrated) – with minor lost of posterior occlusal support.
© 2009 Clayton A. Chan, DDS. All Rights Reserved.