Have the dentist mark the high spots on your splint in your mouth in a sitting up position

need advice on the adjustment of Splint

“Words can’t adequately describe
The pain I feel inside
I can say it’s drilling in my head
A relentless feeling that I dread
Or that it’s like pulling my teeth
With no novacaine for relief
My sinuses burn like a lava lake
Flaring with every breath I take
Even with the pictures this creates
You still can’t know the pain I hate
It is there every day
Haunting me in so many ways
It’s fickle ways are hard to bear
As it picks and chooses when to flare
Words fail me as I try to cope
All the while living with hope
Some day someone will help me
And from this pain I will be freed”
Dr Clayton A. Chan’s advice on the adjustment of Splint
Can a dentist take an accurate impression of your lower teeth and mold a 2.0 vacuum formed splint over the cast? so you can try wearing it….to see if it can fit your teeth first…don’t worry about the occluding bite yet…Just get something that fits over your teeth accurately. That is step one!
Can you make it less bulky? By trimming it yourself?
Ah…relief of pain… That is a good thing right?
Now with the later joint pain….
Tell me where it is bulky?
Can you carefully adjust the high spots so the bite and splint feels even and comfortable for you?
See there is hope!
You have to have the dentist mark the high spots on your splint in your mouth in a sitting up position…not laying down.
Make sure you do not retrude your mandible back…its better to allow the jaw to relax down and forward but not forced…forcing it will not be good, just like making it bite back will also not be good.
Most likely the dentist will not adjust your splint with TENS involuntarily
TENSing involuntary marks is best…but that takes skill and understanding on the part of the dentist.
Well, just have them get your splint adjusted correctly so when you are sitting up it feels right.. and when you are shifting your jaw to the left and right you need canine rise to disclude the back teeth. Make sure nothing is hitting in the posterior region when your jaw shits to the sides.
Next…after that is all feeling perfect…you then check the laying down position and check any high premature spots on your orthotic…make sure the retrusive contacts are balanced….


Discussion


Bjørn Hogstad
Personally I check splint in supine, sitting, standing and after walking to make sure it is stable on all these positions

Amit Alok Pandey
Bjørn Hogstad, any plans of coming to India? You are welcome.

Bjørn Hogstad
Would love to come but not any plans yet😊

John Mew

Dear Amit, so few people are rational about TMD and Occlusal pain. All teeth have an automatic mechanism that allows them to indrude when they are in contact for more than eight hours or erupt if they are in contact for less than 4 hours. (Interpolating Profit’s work on dental eruption, your teeth intrude during a meal and erupt over night).
All the patients in pain that I have examined have irregular contacts; so all they need to do is to keep them in gentle contact for between 4 and eight hours, then the high contacts will intrude and the low ones will erupt. This will create a level occlusal pain which meshes evenly front and back.
A splint provides very effective rest but worsens the position if worn long-term. So stop wearing them and endure discomfort for a few days while you teach yourself how to achieve four to eight hours of gentle contact (no clenching). Prof John Mew.

Amit Alok Pandey
Dear John Mew , what u teach is good n work when muscles are healthy . The wrong habitual bite keeps the muscles in spasm n every effort in training the muscles is short term n in the long run go futile. Thanks!

Bjørn Hogstad
John what about the patients that have had the pain for years? Vertually all the patients have precontacts in centric relation with slide into maximum intercuspation. Those patient due to the nature of the slide develope hyperfunction in the closing av positional muscles involved in the movemet of the jaw and then develope hyperfunction i digasticus, strocleido matoideus, neck muscles and trapezius, pectoralis aln latissimus dorsi as well. Then on top of this you have structural discrepencise in the shoulder/hip area that again produces hyperfunction as a result in associate muscles.Then developes myfacial active triggerpoints . The problem is much more coimplex than just related to the teeth and jaw position. THe level occlusion you tall about will be in maximum intercuspoation but this psoition in the first plase is an adapted position due to the effects of the precontacts in centric relation that sets up the slkide from centric to maximum intercuspation in the first place. I do not see how your procedure will alter this .Could you please expand on that?

Pete Robinson
John whilst i hate wearing my splint as it has messed up my bite even further …i need it to protect my teeth as my front teeth come together and are being severely damaged.

John Mew
Dear Bjorn, I understand your approach which is somewhat traditional but this is not my ‘procedure’ but what our ancestors did for thousands of years which is why they did not have TMD (to judge from their skulls) and no sign of occlusal problems either. We have messed up our life style and just need to think a bit more rationally. Prof John Mew.

Bjørn Hogstad
John Mew I see your point, but there are few point to consider. 1.Most people very seldom lived past the age of 35. 2,their food was much coarser then ours and most ” eldrely” peolpe ha flat occlusal surfeces ,which leaves few if any interferrences. My next question would be . How can you judge the effects of occlusion on the muscles when the only thing thats left are the bones and no there are no muscles. Often you find the scull in excavations and the mandible is missing .Usually the effect of occlusal interferences create an effect on the hyperfunction of muscles and creation of active myofascial triggerpoints . Which then creates the pain pattern that the patient experience is their pain. If my line of thought is correct your would not be able to know anything about that. I have observed when I do functional analysis of the studymodels which are mounted with a facebow registration and a centric occlusal record that the shift of the mandible varies on the left and the right side depending on where the occlusal prematurities are located in centric realtion and which way they force the lower jaw into the adapted maximal intercuspation which is maximum intercuspation and what the patient experience as their natural bite. What I have noticed is that the side which has the longest slide from centric relation to maximum intercuspation also is the sides where you find the greatest muscular hyperfunction and tenderness to palpation in masseter, trapezius, pterygoid medialis. And these are the closing muscles of the jaw that position the condyle up into the fossa. In addition this side is also side that have the greatest tenderness in the lateral pterygoid and the sides you most likely are going to find the disc displacement. If you follow my line of thinking there therefor appear to be a logical link between the occlusion prematureties in centric realtion to the slide into the addapted maximal intercuspation, which again give an logical anatomical and physilogical explanation to the development of muscular hyperfunction and deveopment of myofascial triggerpoints and reffered pain and disc displacement as a consequence . That also give logic to why you in different persons have the pain in the right side and in the next person on the left side depending what the prematurities forces the lower jaw to end up. And also to the disc displacement issue. I would love to hear your comments on my observations.

John Mew
Dear Bjorn, I think we will have to agree to disagree. I believe the shape of the bones and the occlusion is created by the muscles and the problems arise when the muscles are used incorrectly; such as the almost universal modern habit of keeping the tongue between the teeth for long periods. Prof John Mew.

Jonas Deichmann Bengtsson
John, going slightly off topic but I still think it’s relevant and I would like to hear your opinion on it.
Tongue tie – what’s your general opinion on this subject? Why does it exsist? Many children are observed to have tongue tie right from birth and it’s obvious that this will cause the tongue, and therefore also the swallowing pattern, to not function properly.

Bjørn Hogstad
John at least we agree that the muscles are involved as a major factor. I would recommend you look into the analysing the models. If you want more information Please let me know. I would love to share. If you do then you could see for your self. The results forced me to take whole New look . What I learned was fascinating As I wrote – love to share.It also raised a lot of New set of questions.

Patrick Dupuy
Chercher l’origine embryologique du problème…
Les articulations sont des zones d’adaptation à une fonction…
Si la fonction est perturbé (respiration déglutition phonation) le corps s’adapte grâce à cette merveilleuse articulation
Jusqu’au moment où le stress est trop intense…
Faisons de la prévention chez nos jeunes patients en traitant les fonctions perturbées très tôt (4 à 6 ans) et soulagons nos adultes en les remettant dans leur déséquilibre précaire….

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