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Occlusal Splints for Temporomandibular Disorders (TMD), Bruxism, or Clenching
Purpose
The purpose of splint therapy is to allow your lower and upper jaw to come together without tooth contact, and to reduce muscle pain. Many situations cause the malfunction of your lower jaw. Examples are accidents, surgery, developmental defects, peculiar oral habits, many fillings placed over numerous years, naturally occurring malocclusion (poor bite), orthodontics, psychological stress, clenching or bruxing (grinding teeth), and other conditions.
Rationale for Splint Use
You will receive a plastic bite splint (Occlusal splint). This treatment has been used for many years to keep from contacting during chewing and to allow the lower jaw to return to a comfortable hinge position without interference and guidance from the teeth. When the splint has been worn for a few days the jaw functions freely.
Wearing Splint
Temporomandibular Disorders
If your condition is temporomandibular disorder, you should wear the splint at all times including while eating, unless directed otherwise. If you remove the splint to eat, your treatment may not be as effective. Many fillings placed in your mouth over the years or other conditions have caused your teeth to meet in a position your jaws cannot tolerate. The splint eliminates tooth-to-tooth contact. Your symptoms will gradually disappear while you are wearing the splint; and your natural teeth, bridges, and/or fillings will be adjusted to the new bite by us. This procedure is called occlusal equilibration. After equilibration, you will wear your splint only at night. After a period of time, you will not wear the splint at all. This described treatment usually requires a few weeks to several months.
Bruxism and Clenching
If your condition is Bruxism (grinding of teeth) or clenching, you should wear your splint at night when you cannot control your jaw movements or during time of psychological stress. During the daytime, make sure your splint is placed in water to avoid warping.
Cleaning the Splint and Teeth
Food will accumulate around and under the splint. At least one time each day, brush and floss your teeth very thoroughly. Brush and rinse the inside and outside of the splint, and then return it to your mouth. Dental decay will initiate if you are not careful about cleanliness of your mouth and splint. If you have a high dental decay potential, fluoride-containing rinses or gels are useful when placed into your splint once per day.
When the Splint Is Out of the Mouth
If the splint is out of your mouth for any reason, your teeth may not meet in harmony. This situation is to be expected because of muscle and jaw relaxation while you were wearing the splint. Occlusal equilibration will eliminate this improper meeting of the teeth (malocclusion). If the splint is out of your mouth, place it in a container of water to prevent it from warping. You may desire to soak it occasionally in a commercially available denture cleanser.
The Most Common Ways A Splint Is Lost/Broken Or Damaged
- Eaten by a dog or cat.
- Putting the appliance in your pocket.
- Taking the appliance out at night.
- Putting the appliance in a napkin when eating in a restaurant.
- Improper removal of insertion of the appliance.
- Improper cleaning techniques.
Lost Appliances
Because the impression and models are destroyed when making the appliance, we have to start over when an appliance is lost. All of the adjustments that were made to the appliance will also have to be redone. Under these conditions a charge for a new splint is necessary.
Please call if you have any questions. Thank you
Appliance Tips
Throughout your treatment, we will instruct you on how to wear the specific orthodontic appliance necessary for your treatment. Please feel free to call us if you have any questions or concerns. For your convenience, instructions for wearing each orthodontic appliance are provided below in chronological order. You may not need some of the following appliances depending on your treatment plan.
Spacers (Separators)
The first step in your orthodontic treatment is to obtain separation by placing spacers in between your teeth. During the next few days you may experience some discomfort as the teeth begin their initial movements. Generally, discomfort is mild and subsides within a couple of days. Common pain relievers, such as Advil, can be taken if needed.
The spacers generally stay intact until your banding appointment. In the coming weeks, please call us for replacement evaluation if any of your spacers come out sooner than the day before your banding appointment.
To minimize losing spacers, please:
• Avoid sticky foods (for example: candy and gum) that could pull the separator out of place.
• Avoid flossing the areas that have spacers.
• Brush gently around the spacers.
• Keep the spacers in place even if they feel loose.
We will make every effort to ensure that you are comfortable. Please call us with any questions you may have.
Removable Expander
The removable expander will be worn for several months to widen your upper jaw. The expander must be adjusted to be effective.
*Please adjust the screw ONCE every week.
Following these guidelines will ensure effective treatment:
• Wear the expander 14 hours a day after school; starting the very first day.
• Every morning take the expander out and brush it in cold water. Never use hot water. Be sure to place the expander back in its case, and store it in a safe drawer in your bathroom.
• Bring your expander to every appointment so that we can check it and make the necessary adjustments.
• Never leave the expander outside of its case. This is a very common way of losing it.
• Please call us as soon as you can if your expander does not fit or it is lost. Your teeth can move quickly, and if you wait too long we may not be able to adjust your expander.
Palatal Expander
The palatal expander will be worn for several months to widen your upper jaw. The expander must be adjusted to be effective:
* Please adjust the screw on your UPPER expander ONCE everyday for 27 days.
* Please adjust the screw on your LOWER expander ONCE every OTHER day for 27 days.
The best time for the adjustment is the first thing in the morning or right after dinner. This way, you will have time to get used to the tightness before you begin the day’s activities or before you go to sleep. Please call us if you have difficulty adjusting your expander.
While wearing your expander you may notice:
• Extra space between your upper front teeth. This is temporary and the space will close within a few weeks.
• Speech and swallowing difficulties. These difficulties are also temporary, and should improve within a few days. Reading out loud will help improve your speech.
• Sore areas on the cheeks and tongue during the first few days. Please use the wax provided to smooth the surface of the expander.
Following these guidelines will ensure effective treatment:
• Brush and floss you teeth and the expander frequently.
• To prevent breakage, avoid sticky or hard foods (for example: candy, gum, hard crusts, apples, carrots, popcorn, ect.)
• Adjust the expander very gently and remove the key after the adjustment to stop the hole from moving.
• If the expander loosens up on one side: Push it back up and call to set up an appointment.
• If the expander loosens up on both sides: Take it out and bring it to your next appointment.
Please call us if you have any questions or concerns.
Headgear
Headgear corrects an “over bite” or an “under bite” by creating a pushing or pulling action, respectively, to guide the growth of the teeth and jaws. Headgear is effective when the upper and lower jaws are growing. The growth generally slows down around the age of 12 or 13, and mitigates the desired correction achieved by headgear.
How to wear the headgear:
It is important to wear your headgear everyday for 14 hours, most of it while sleeping. By not wearing your headgear consistently everyday, you will compromise your orthodontic treatment. We recommend you wear the headgear as follows:
• Two hours after school, the first day.
• Four hours after school, the second day.
• Overnight for the next 5 days.
• Finally, 14 hours a day; for four hours after school and about 10 hours during sleep time.
The hours the headgear should be worn are cumulative; therefore if you did not wear it as much during the week, try to make up the hours by wearing it more on the weekend.
We ask that you record the number of hours that you wear the headgear.
If the headgear is attached to a retainer:
• Wear the retainer 14 hours a day after school; starting the very first day.
• Every morning take the retainers out and brush them in cold water. Never use hot water. Be sure to place the retainers back in their case, and store them in a safe drawer in your bathroom.
Remember:
• Bring your headgear to every appointment so that we can check it and make the necessary adjustments. The headgear is a very delicate instrument and is individually fitted and adjusted. You should not make any adjustments to your headgear. Please call us if you feel it is not fitting properly.
• It is normal to experience tenderness the first few days. Don’t be discouraged because the tenderness will diminish as your teeth adjust to the new pressure. Call us if you continue to have discomfort.
• Do not play with your headgear or allow others to snap or pull it. Mistreatment of your headgear could result in harm to you or someone else. Always remove the strap before pulling the bow out from your teeth.
• Do not wear your headgear when running, swimming, or playing and contact sports.
It is important that you follow all these instructions. You’ll be done with your treatment sooner than you think! Please feel free to call us if you have any questions or concerns.
Elastics (Rubber Bands)
One of the most important phases of your orthodontic treatment is when you are wearing your elastics. Elastics move your teeth and jaws into the desired position and create a proper bite by applying a small but continuous amount of pressure on the teeth and jaws. We recommend that you wear your elastics all the time, except when eating or brushing your teeth. Consistent wear of your elastics during the day and at night will minimize your treatment time. Replace your elastics with new ones at least four times a day.
Please note the following guidelines:
• Poor or inconsistent wear of your elastics will prolong your orthodontic treatment. This is because the force that moves your teeth in the proper position is applied through your elastics. Failure to wear the elastics as directed, in many cases, will make your treatment goals impossible to achieve.
• Wear your elastics as instructed and your treatment time will be shorter. Dr. Park. Will occasionally change how you wear your elastics.
• Our goals are to maintain your progress, so if you cannot wear your elastics as directed, or run out of elastics, don’t wait for your next appointment. Please call us as soon as you can.
• Minor discomfort and sore teeth are expected during the time you are getting used to the elastics. However, consistent wear of the elastics will diminish it significantly.
Retainers
When your braces are removed, the teeth inside the jaw bone are very loose; thus they can easily move. Therefore, it is very important to wear your retainers as directed, otherwise, your teeth will reposition themselves, and we will not be able to move them back to the proper position with retainers.
Your treatment fee will cover one set of retainers for the upper and lower teeth, which should last you a lifetime. We will follow up with you for two years to make sure your teeth are stable and steady, and that you got into the habit of wearing your retainers as recommended.
Please protect the time, effort, and money you have invested during your orthodontic treatment by complying with the following instructions:
• Wear your retainers for 14 hours a day for the first six months. If you attend school, wear them after school and at bedtime.
• Your teeth move throughout your life. Therefore, to maintain the best results you can achieve, wear your retainer only at night after the first six months.
• Every morning take the retainers out and brush them in cold water. Never use hot water. Be sure to place the retainers back in their case, and store them in a safe drawer in your bathroom.
• Children attending school should never take their retainers to school. However, adults can take them to work and wear them at work.
• Please call our office as soon as you can if you lose your retainer. Your teeth can move quickly, and if you wait too long the retainers cannot move them back to their original position.
• If retainers are lost or broken, the fee to replace them is $150 per retainer. This fee includes an appointment to take a new impression, the lab fee to make your retainer, and the appointment to deliver your retainer.
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