Although many of our TMD patients have heard of the use of splints or orthotics in treating TMD, few are knowledgeable of just how effective this treatment can be when utilized properly. In fact, most doctors are not fully trained to integrate splint therapy to its full potential as part of a TMD treatment regimen. Consequently, many TMD sufferers have not benefited much from previous splint applications.
After appropriate diagnostics are completed, and that patient’s unique jaw joint problems are confirmed, it is imperative that interferences in joint function be resolved. This can be accomplished by adjusting the splint; the lower jaw can be advanced, rotated, moved bodily and otherwise repositioned to an optimal relationship to the maxilla, or upper jaw. When properly executed this splint therapy is extremely effective in helping eliminate temporomandibular joint dysfunction.
Orthotics or splints which have not been designed specifically for that patient’s unique problems are doomed to failure. Splints must be designed to be worn full time – 24/7, especially when chewing food; there is more forceful action in the jaw joints during chewing than when the jaws are at rest (if a patient with a broken leg removed their cast while walking, the fractured limb would obviously never heal).
So, properly designed splints are worn full time, except when cleaning one’s teeth. Patients are given appropriate instructions to accomplish this comfortably. In addition, these splints MUST be monitored and adjusted at specific intervals if jaw joint function is to be restored without interference.
Often, informed intelligent hands-on physical therapy is utilized during this initial phase, particularly if a patient has cervical dysfunction also.
The essential criteria for success in the initial Phase of treatment for TMD is:
- render patient without symptom or complaint
- no discomfort on palpation
- restore function without extra- or intra-capsular interference
- each case requires a specific period of stability
- for the younger patient, radiographic proof of the beginning of reversal of the osteogenic degeneration
When this criteria has been met during the initial phase, we can initiate a finishing phase.
This finishing phase may have an orthodontic component; this will necessitate the repositioning of the patient’s natural teeth to hold and stabilize the maxilla/mandible relationship (upper jaw to lower jaw) attained during the initial phase of treatment.
There may be some cases where a finishing phase would involve only a weaning off of the splint; this would be carefully programmed and monitored by the treating clinician.
Another finishing phase option may involve a restorative component.
Each finishing phase will be specifically planned for each case. The TMD doctor will determine the nature of the finishing phase when he approaches the end of the initial phase of treatment.