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Orthotic Appliances

Woman lying in bed, holding her jaw and face with a pained expression, possibly experiencing discomfort or pain.

Problems with your jaw joint and the muscles in your head, face, and neck that can affect it are known as Temporomandibular Joint Disorders (TMD). It is often referred to as TMJ, which is actually the jaw joint itself, or the “hinge” that connects your lower jaw to the temporal bone of your skull and is located directly in front of each ear.

Dental appliances, commonly referred to as splints or mouth guards, are recommended and specifically designed to treat different disorders related to the jaw (TMJ) and/or facial muscles

When an orthotic appliance is the treatment of choice, it’s important for the dentist to determine why it is being used, when the patient should wear it, what is to be accomplished while using it, and how should it be designed.  They can be prescribed for wear during nighttime, daytime, some combination of both, or 24/7 depending on the diagnosis.

FAQs

What are Orthotic Appliances?

Orthotic Appliances are removable devices that are usually made of a durable acrylic material and fit over the (biting) occlusal surfaces of either the maxillary (upper) or mandibular (lower) teeth. The goal is to create a precise bite relationship with the opposing teeth to treat a specific TMD condition which may include:

  • Relaxing fatigued jaw muscles or those in spasm

  • Realigning misalignment of the upper and lower jaws and correcting imbalance in jaw musculature

  • Repositioning TMJoint discs that are dislocated

  • More favorably posturing the head with the neck and shoulder

  • Protecting the teeth from abnormal forces that may create a tooth fracture or breakage of restorations

  • Providing protection for the teeth from daytime and nightime  bruxism (clenching or grinding the teeth)

What are the Symptoms for Treating TMD with Orthotic Appliances?

Orthotic appliances are most often considered when the jaw joint makes a clicking sound ,when there is difficulty and limitation in opening or closing the jaw, usually due to a “dislocation” of the disc or when muscles in the head or face are tight and sore.  Often, there may be discomfort while talking, chewing or opening wide.

What are the common symptoms of Temporomandibular Joint Disorder?

Common symptoms of Temporomandibular Joint Disorder include: 

  • Pain or tenderness in your face,  jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide

  • Problems when you try to open your mouth wide

  • Jaws that get "stuck" or "lock" in the open- or closed-mouth position

  • Clicking, popping, or grating sounds in the jaw joint when you open or close your mouth or chew (this may or may not be painful)

  • A tired feeling in your face

  • Trouble chewing or a sudden uncomfortable bite  change where the upper and lower teeth are not fitting together properly

  • Swelling on the side of your face

  • Tinnitus (ringing in ears)

  • Toothache, headache, neck ache, dizziness, ear achesor stuffiness feeling in the ear hearing problems, and upper shoulder pain

Can dental mouthguards, worn over the teeth during sleep, stop teeth grinding or clenching (termed bruxism)?

When a dental patient has evidence of enamel wear on their teeth particularly in the upper and/or lower six anterior teeth they are often made a dental “mouthguard” for nighttime wear to cover the upper or lower teeth.. The understanding by the patient is that the “mouthguard” will STOP them from grinding the teeth that would cause further wear to the tooth structure. It is a myth that the “mouthguard” will STOP the grinding habit. At most it will protect the teeth from further wear if the habit is current and the patient continues to clench/grind.

Bruxism can occur during sleep and /or wake times. The precipitating factor may be related to stress, use of stimulants like caffeine and nicotine or use of certain medications particularly anti-depressants (SSRIs and SNRIs) and ADHD meds (Amphetamine based).  If the bruxism occurs during sleep it may be a protective reflex to allow better breathing. The lower jaw slides forward enabling the lower and upper front teeth to clench against each other. The tongue, which is attached by a muscle to the lower jaw, is also repositioned forward keeping the nighttime airway more open.

If a patient is symptomatic from bruxism ie having soreness to the jaw muscles in the cheek, temples, neck etc or discomfort in the TMJoint(s) then the “mouthguard” can be therapeutic if it is designed properly. The functional mouthguard ie orthotic appliance can decrease the intensity of the clenching habit thereby relaxing the jaw muscles and reducing pressure in the TMJoints.

On a side note injecting Botox into a sore jaw muscle does NOT stop it from contracting or stop the clenching habit but merely weakens the muscle as it contracts to lessen the symptom. Care must be taken when using Botox as repeated use over time to the same muscle group can progressively weaken the muscle. The affected muscle, if in the cheeks, can cause it to “droop” and appear similar to “boxer jowls” or ,if in the forehead, can result in “heavy eyelids”