The Role of Oral Splints

I was invited by Dr. Sushil Koirala, Founder and Coordinator – MiCD Global Academy, Chief- Editor of MiCD Clinical Journal, as one of many globally renowned clinicians, academicians and researchers to answer 15 exclusive interview question for their clinical e-journal sharing my experience, clinical and research findings on the subjective of “TMDs – Confusion & Consensus: Expert’s Advice“. The following is the ninth of 15 responses to their questions.

9. Do you see the role of Oral Splint in the management of TMDs? If yes, what type of occlusal splint do you suggest to our readers?

Dental appliances to correct the mal relationships of dental occlusion are widely accepted as therapeutic. They are a conservative non-invasive first step in the diagnosis and treatment of occlusal therapy (Zhang FY, Wang XG, Dong J, Zhang JF, Lu YL. , 2013). Not all intra oral appliances (splints) are the same or equivalent in their effectiveness. A splint is defined as “a rigid or flexible appliance for the fixation of displaced or movable parts”. “Splints” are technically used to protect the teeth and or immobilize the jaw. It may be custom formed to fit over the teeth, but are not intended to precisely re-position one’s jaw relationship.

An orthosis is a custom-fabricated or custom-fitted device or support designed to align, correct, treat muscles, joints or skeletal parts which are weak, ineffective to prevent neuromuscular or musculoskeletal dysfunction, disease, injury, or deformity. An orthosis fits over the teeth to realign the jaw and associated structures to a functional and orthopedic position. An orthosis when properly adjusted should eliminate masticatory dysfunctions and enhance functional health and stability. A key point: the orthosis I design and fabricate for my patients is based on a bite registration that is precisely measured within tenths of millimeters using the K7 kineseograph combined with the simultaneous use of the J5 low frequency dental TENS (Myotronics, Kent, WA). Based on objectively recorded data, I am able to identify my patients specific physiologic jaw position to then design the lower anatomical orthosis based on accurate measurements. This orthosis is able to support a mandibular position that allows optimal physiologic resting modes as well as optimal function once the orthotic is properly adjusting using micro-occlusal GNM protocols. I do not guess or assume my patient’s mandibular position when treating my patients with a lower anatomical orthosis. My orthosis implements all the gnathic and neuromuscular occlusal principles to address the simple to more complex problems that involved cervical dysfunctions, TMJ primary problems, retrognathic and prognathic problems as well as anterior open bite problems. My occlusal philosophy suggests that an occlusal appliance should be able to address these problems effectively and therapeutically. One appliance is all I need for my patients that addresses their day time and night time needs.

Treatment of common myogenic oriented orofacial pain in dentistry using occlusal orthotics has been shown to be effective in reducing masticatory muscle discomfort and dysfunction. Dental literature recognizes that occlusal interferences diminish normal musculoskeletal movement and are harmful. Diagnosis of these problems using precise technology can aid the dentist in correcting these structural problems confirmed with objective occlusal analysis. Dentists have the responsibility in assessing and diagnosing the structural component of each patient’s musculoskeletal occlusal system. Precise occlusal adjustments and management of the orthosis implemented in restorative dentistry, orthodontics, and orthognathic surgery can assist in reducing temporomandibular dysfunction (TMD) headaches pain and dysfunction if done correctly. Understanding neuromuscular stress reduction protocols are key in orthotic appliance design and occlusal management in order to help the biomechanical efficiency, chewing ability and, reduction of the numerous signs and symptoms of TMD patients.

As an advancing advocate and leader in TMD and occlusal treatment, I suggest all clinicians to begin measuring their TMD patients jaw relationships when a more accurate and physiologic mandibular to maxillary jaw relationship is desired. Computerized digital occlusal analysis provides objective data of occlusal contacts and muscle force to accurately assess diagnosis and treatment, as monitored with computerized jaw tracking and electromyography (EMG). The rationale and requirements for proper orthosis fabrication is based on a verified objectively measured therapeutic occlusion. Further details and discussion of this is presented, in my paper titled Physiologic State of Occlusal Orthotics and the Diagnosis of Myogenous Orofacial Pain in Reducing TMD Headaches and other Symptoms. Clayton A. Chan, D.D.S.* and Brian E. Hale, D.D.S.: Gneuromuscular Orthopedics (A Publication for Advanced Learning). July, 2020. https://occlusionconnections.com/dr-chans-published-articles/).

Clayton A. Chan, D.D.S. – Founder/Director