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Orthotic Appliances


Problems with your jaw joint and the muscles in your head, face, and neck that can affect it are known as Temporomandibular Joint Disorder (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 mouthguards, 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.

What are orthotic appliances?

Orthotic Appliances are removable devices that are usually made of 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 the 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 nighttime bruxism (clenching or grinding the teeth)

Treating TMD symptoms 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.

Treating TMD symptoms with orthotic appliances

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 –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, earaches, hearing problems, and upper shoulder pain

Treating TMD -Alternatives to surgery

Before considering any surgery on the jaw joint, it’s important to fully understand the risks. There are many alternative options available that can alleviate your pain while avoiding surgery.

Dental Orthotic appliances may be used stand-alone to treat a TMJ disorder or in conjunction with other needed modalities to achieve the most therapeutic effect.

At Pittsburgh Dental Sleep Medicine, adjunctive treatments may include:

  • Unique muscle and TMJoint injections with innovative anti-inflammatory or regenerative materials
  • Manipulation of the jaw for unlocking
  • Therapeutic exercises
  • Laser therapy
  • Ultrasound therapy
  • Electromyography (measure muscle contraction intensity)
  • Appropriate medications

When there is a postural concern contributing to the patient’s symptoms, collaborative care working with physical or chiropractic therapy can also be helpful.

What is bruxism?

In people who exhibit a great amount of stress or anxiety, there may be an increased incidence of bruxism. Bruxism is a condition in which you grind, gnash or clench your teeth. This can lead to enamel wear, fractured teeth, tooth mobility, gum recession, flattening of the chewing surfaces, and can also cause TMJ dysfunction.

Nighttime bruxism can be quite destructive because most people are unaware of the habit until it is too late and TMD signs and symptoms have already developed. An orthotic appliance can protect teeth against the destructive forces of nocturnal bruxism and act as a diagnostic treatment tool in the management of temporomandibular joint dysfunction. Early intervention can prevent many of the severe problems associated with bruxism and TMJ dysfunction.

TMD in combination with a sleep disorder

A sleep-related breathing disorder can be the cause of teeth clenching as the body’s reflex to help keep the jaw forward for better breathing. The sleep breathing disorder must be confirmed or ruled out in the evaluation of a TMJ disorder.

If a sleep-breathing problem is confirmed it can be managed at the same time as the TMJ disorder so that it does not impede the progress of that treatment or cause recurrence of symptoms. Research shows that the source of 60% of TMJ (jaw) problems is an underlying breathing problem during sleep. If this concern is not suspected or ruled out by diagnostic testing, then the appropriate dental orthotic appliance is selected that can help reduce the intensity of the clenching habit and relax the related jaw and neck muscles that are often sore on awakening.

At Pittsburgh Dental Sleep Medicine, Michael F. Hnat, DMD, Craniofacial Pain and TMJ Specialist has extensive education in providing treatment for TMJ disorders.

If you are ready to treat your TMJ Pain, call Pittsburgh Dental Sleep Medicine today at (724) 935-6670 for a new patient appointment or more information.