Splint Therapy – TMJDS Management Options

What is Splint Therapy?

Splint therapy is the foundation of and an integral part of a comprehensive TMJ treatment plan. It is the primary and most important therapeutic device for many TMJ conditions. Splints may be used for stabilizing the bite, for treatment of temporomandibular disorders, or to prevent wear and trauma to the dentition...

A common goal of occlusal splint treatment is to protect the TMJ discs from dysfunctional forces that may lead to perforations or permanent displacements. Other goals of treatment are to improve jaw-muscle function and to relieve associated pain by creating a stable balanced bite.

What is the Purpose of Using a Splint to Treat TMJ Problems?

Dentists may offer different reasons for proposing the use of a splint in treating your jaw problem. There are two broad categories:

A. The splint is intended to provide relief from pain or other symptoms relating to parafunction, to prevent signs of parafunction such as tooth wear and mobile teeth, and to improve jaw joint function so that it can move smoothly.

B. The splint is intended to be a first step in a multi-step procedure. Wearing it may produce changes in the bite and in jaw positions for other dental treatments, such as orthodontics, crowning teeth, bite rehabilitation etc. to establish a new tooth/jaw position.

Some signs or symptoms that suggest you might need TMJ Splint Therapy:

• Pain/clicks/grinding sensation in TMJ/ear area
• Difficulty with opening or closing your mouth (due to muscular pain or TMJ disc dislocation)
• Facial, head, neck or shoulder pain
• Clenching and grinding (known as parafunction)
• Fillings or teeth breaking
• Sudden development of a localised gum issue
• Tender tooth for no apparent reason
• Periodontal case with excellent oral hygiene not responding as expected to treatment
• Excessive wear on the teeth, often with widespread sensitivity

Types of Splints

There are several types of splints and you Dentist will recommend which is best for your specific needs and mouth.

Anterior Deprogrammer/Lucia jig/Nociceptive Trigeminal Inhibition Tension Suppression System (NTI-TSS)
• This appliance fits on the upper or lower front teeth and can be used for several purposes, often including treatment of acute pain either from a tooth or the TMJ. Often this will only be used for a short period of time, regularly prior to provision of a centric relation appliance (CRA) or hard acrylic splint. This type of splint can be made in the surgery, and does not generally require further adjustment once fitted.

Soft occlusal splint
This appliance is a soft clear splint which fits over the top of all the upper or lower teeth and acts as a cushion to help absorb the pressures from clenching or grinding. An impression of the teeth is necessary to allow the splint to be custom made in the laboratory. No adjustment is generally required once this splint is fitted.

Semi-hard occlusal splint
• This appliance is also a clear splint, fitting over all the upper or lower teeth It has an intermediate hardness between that of the soft splint mentioned above and a hard acrylic splint, and it can be used to cushion the teeth from the pressures of clenching and grinding. It is, however, harder wearing than the soft splint, and so can be more durable for individuals that are very actively grinding.

Stabilisation Splint
• This splint fits over the teeth of the upper jaw. While it is fitted to the upper teeth, the bottom of the splint is smooth. This helps prevent the grinding of teeth and can help to ease the ache of sore jaw muscles and joints by reducing the pressure put on them. This splint is designed only for people who grind their teeth and not for those who clench their jaw. As it can be difficult to determine if an individual just clenches, just grinds or both, it’s practical applications can be more limited.

Centric Relation Appliance
• The Centric Relation Appliance or CRA is the gold standard of splints and is made out of acrylic. This splint is fitted and adjusted to allow correct positioning of the TMJs in relation to how the teeth meet and function across each other. Serial adjustments over the initial few days and weeks following fitting allow resolution of any inflammation of the TMJs, hence it can be very effective in treating the symptoms of TMJDS where there is a strong TMJ involvement. Following treatment there can be a resulting increased patient awareness of how their teeth meet. This may lead to the need to consider equilibration.

Equilibration
• This is the process by which the very precise adjustment of the bite surfaces of teeth can be made to allow the improvement in function and comfort of the bite. It is normally carried out once any symptoms of TMJDS (in particular TMJ symptoms) have resolved and normally follows use of a CRA. Individuals would still be advised to wear a CRA at night to protect against parafunctional related damage.

Benefits
• Safe and effective
• Affordable
• Fully customized to each patient for maximum comfort

To refer a patient or to self-refer click hereTMJDS – Splint Therapy Fees