The Anatomical Removable Orthosis
The lower anatomical orthosis I advocate is a specialized dental appliance that is orthopedically designed to match the physiologic function of the patient’s jaw and head posture. (Read more….). It is scientifically determined using computerized jaw tracking technology, low frequency TENS and EMG data technology is used to determine and confirm the bite registration which is key to establishing an “Optimized” jaw relationship. Patient’s who experience, jaw pain, headaches, neck aches, facial pain and or has an over-closed bite can benefit from this therapy.
Dentist Responsibilities to Making the Orthosis Treatment Effective
In today’s arena of TMJ treatment arena there are many types of splints and appliances (upper splints, lower splints, anterior deprogramers, flat plane splints, MORA’s, discluders, soft splints, lower splints, pivot appliances, etc.) that dentist have attempted to use for their paining patients as a means to try to help remedy the various muscular and jaw joints symptoms. Many of these appliances have produced varying results – some effective, others ineffective.
It has become common knowledge among patients that not all splints including orthotics work. Why is this?
Dentist often assume that opening one’s bite to some vertical dimension is supposedly suppose to help the patient. Although, this may seemingly be a good thing in an attempt separate the teeth from coming together and also allowing the musculature and TM Joints to relax at a better relationship the vertical dimension of these appliances is opened by some educated guess often by the dentist and never really “physiologically” relaxed and measured objectively with low frequency TENS and or determined with physiologic measuring technology.
It is the dentists responsibility to identify the correct mandibular to maxillary jaw relationship (the vertical, antero-posterior, frontal/lateral, pitch, yaw and roll). If a correct jaw relationship is physiologically determined (not just established to a habitual accommodated jaw position) and also properly adjusted, why would any dentist need to use multiple appliances (day time wear, night time wear) to resolve TMD/craniofacial pain? Nature didn’t give us day time set of teeth to wear and for night, a night time wearing set of teeth. One good and properly adjusted orthotic appliance should suffice to meet both the gnathologic as well as neuromuscular requiements to reduce the spastic muscle tension.
It is the dentist responsibility to make sure the orthosis or any appliance that is being implemented is properly adjusted so that the orthosis feels comfortable and does not feeling like an irritating foreign object in the mouth. It’s the design of the orthotic and how the occlusal biting surfaces are adjusted that makes the difference.
The patient should know within 24 hours whether the orthosis/appliances is properly adjusted or not, whether it feels comfortable or not. The patient should not feel like they have feeling like they have to tolerate an appliance that does not feel right when the bite their teeth together. The orthosis should be properly adjusted so the patient can chew and eat food with the orthosis. It should not cause teeth to be sensitive, if it does, ask your dentist to check the bite and make the proper adjustments. The orthosis should not cause more TMJ and muscular pain. If it does ask your dentist to identify, mark and adjust the occlusal premature interferences that are triggering the imbalanced muscle responses.
One good thing about a removable orthosis – If it doesnt’ feel right you can always take it out and let your dentist know that something is wrong. Be patient with your dentist so they can troubleshoot the biting occluding problem so you can get the resolution you are seeking.
© 2009 Clayton A. Chan, DDS. All Rights Reserved.