Bruxism is believed by most researchers to be one of the leading causes of temporomandibular disorders (TMD) (Blaros, Tabacchii & Glass, 1998; Israel et. al., 1999;Yustin et. al., 1993).

         THE FIRST WARNING SIGNS OF TMD

         • TMJ discomfort or pain

         • Soreness of jaws and muscles

         • Clicking or popping sounds when opening jaws or chewing

         • Difficulty in fully opening mouth

Let’s begin with a few key points:

• Grinding or clenching breaks down enamel and can eventually reduce teeth to stumps.

• Absence of enamel makes it easier for bacteria to penetrate the softer part of teeth and produce cavities.

• As long as bruxism continues, the situation keeps getting worse.

“Although no hard and fast figures on the frequency of bruxism are available currently, it is known that 80% of all bruxers may be unaware of the habit (Thompson, Blount, and Krumholtz, 1994) or ashamed of it… and that evidence of the self-destructive behavior (worn teeth) may take years to actually appear.

Estimates of the prevalence ranges from 5% to 100% …but it can safely be said that at the very least, one out of twenty Americans brux. Most likely, one in four.”

Dental Sleep Medicine: The Advanced Course 8 CE Credits

Splints are generally classified according to their intended function. The two most common types of splints are the disengaging occlusal correcting splints and the mandibular or anterior repositioning splints.

Disengaging splints eliminate chronic and acute malocclusion and induce relaxation of the masticatory muscles. This is accomplished by introducing an optimum occlusal position, thus allowing a reorganization of the neuromuscular reflex activity and a deprogramming of the musculature.

Mandibular repositioning splints are used to prevent the disc-condyle complexes from returning to the fully occluded position…or to set the condyles in a more favorable condyle disc relationship in the fossa so that normal function can be established.

These splints are removable appliances. Typically constructed of hard acrylic, they fit over the occlusal surface of either the auxiliary or mandibular dentition to create a precise occlusal relationship with the teeth of the opposing arch.  A properly designed splint can:  

As our society continues to increase in complexity, the incidence of Bruxism and Temporomandibular Joint Dysfunction (TMJD) continues to rise. 

Nocturnal Bruxism may constitute the most destructive form of bruxism (due largely to the fact that the patient tends to be unaware of the habit until it is too late) and TMJD is an extremely complex problem that impacts an increasingly significant percentage of the population.

Although a wide variety of treatment approaches and appliance designs are available for the treatment of these disorders, the most common appliance of choice is a splint.

The biggest problem observed in adult dental patients is ABNORMAL OCCLUSAL WEAR.  This ends up causing a decrease in the vertical dimension of the patient -- wearing down teeth to the point where full mouth reconstruction is inevitable.

Best solution: deliver an orthotic or splint earlier in their care to prevent the problems from occurring in the first place.

According to the National Sleep Foundation, sleep apnea affects as many as 18 million Americans. Left untreated, it can lead to a multitude of health problems, including cardiovascular disease, memory loss, severe headaches, weight gain, and more. In many cases, sleep apnea results from a blocking or collapse of the individual’s airway during sleep. This, in turn, causes the sleeper to awaken dozens or even hundreds of times during the night.

Dentists can help their patients effectively manage sleep apnea by selecting from an array of mandibular advancement appliances which push the lower jaw forward, keeping the airway open during sleep.

Whether you are treating a bruxism problem or a joint dysfunction, splint therapy is almost always your first line of defense. Why? Because splint therapy is generally reversible, non-invasive and exceedingly effective at reducing symptoms.

There are several varieties of splints. Each appliance is designed to address and eliminate a specific causative factor. To select the right splint, you must first accurately identify the factor. Therefore, the importance of a thorough history, exam and diagnosis cannot be overemphasized in the interest of arriving at a sound diagnosis.

Breakdown in the system may occur at the level of the teeth in the form of wear; at the periodontium in the form of mobility; or at the TMJ in the form of muscle spasms or splinting.

This examination should include:

1. Radiographic information (FMX, Panorex, Cephalogram, Tomograms).
2. A physical exam that includes palpation of the muscles; listening to joint sounds; observation of the mandible during functional movements; and a thorough investigation of the timing and duration of the pain.

Splints are something that EVERY dentist in EVERY practice should be using EVERY single day.

BEFORE YOU BEGIN…IT IS ABSOLUTELY CRITICAL THAT YOU PERFORM AN AIRWAY ANALYSIS.

WHY? Because bruxism may, in fact, be a sign that your patient does have a serious airway issue – one that will need to be addressed prior to treatment.

Why Splint Therapy? Because in terms of versatility, ease of use, comfort and overall retention effectiveness, splints have no equal.

There is a splint for virtually every purpose – combating the deleterious effects of bruxism, TMJD, periodontal trauma recovery, or orthodontic de-stabilization, to name a few.  And treatment employing just one type of splint per week could add over $25,000 to your bottom line at year’s end.