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Oral Appliances
Oral appliances are custom-made mouthpieces that help treat issues related to the temporomandibular joint (TMJ) and jaw muscles. They fit over the upper and/or lower teeth and can help reduce pain, improve jaw alignment, and prevent teeth grinding or clenching. Oral appliances work by stabilizing the jaw in a more relaxed position. They are a typical conservative treatment approach for TMJ disorders.
Splints
Splints are an oral device made of hard and/or soft thermo-formed plastic that fits over the upper or lower teeth. Splints redistribute biting forces more evenly across the jaw, realign the TMJ for decompression, and provide some relief from tooth-contact stimulated muscle contraction pain. They are often used for short-term pain relief, cushion teeth during clenching or grinding, and decompress the TMJ. These are often used in conjunction with cognitive behavioral therapy.
Bite Planes
Bite planes are oral appliances made of hard acrylic covering all the teeth on either the top or bottom. Bite planes change how the upper and lower teeth come together, improving jaw alignment and function. This decreases muscle strain and uneven bite forces that contribute to TMJ disorders. Bite planes can reduce jaw joint pressure and relax the facial muscles. They are a conservative approach to realigning the bite and relieving TMJ pain. Bite planes are often used to diagnose a malocclusion which would require dental work to correct.
Dr. Hart uses these bite planes the most with new dentures that have caused TMJ or facial pain.
GELB Orthotic Brace
The Gelb is an oral orthotic named after Dr. Michael Gelb. It is customized to fit the lower teeth and designed to improve the position of the TMJ disc that lies between the jawbone and skull. The Gelb can help move displaced discs back into proper alignment and reduce clicking, popping, and pain in the jaw joint. It also promotes muscular balance in the jaw. The Gelb is useful for reducing TMJ disc displacement issues.
This is Dr Hart’s preferred orthotic for most intracapsular TMJ disorders.
Kois Deprogrammer
The Kois Deprogrammer is an oral device that fits over the upper or lower teeth. It is designed for people with general jaw muscle pain or tension headaches but an otherwise healthy jaw joint. The Kois Deprogrammer positions the lower jaw downward and forward to put the muscles at rest. This reduces facial muscle tension and clenching. It can help relieve chronic headaches and facial pain caused by muscle strain and myofascial disorders of the craniofacial region.
Dr. Hart likes to use this orthotic in conjunction with cognitive behavioral therapy.
NTI
The NTI covers the front upper teeth and prevents the back teeth from touching. The NTI oral orthotic can be used short term to relieve acute TMJ pain. It helps reduce muscle tension and teeth grinding. The NTI exploits the normal jaw reflex that occurs in instances like accidentally biting down on your fork and your jaw reflexes open. This orthotic is used similarly to the hawley headache. It can be slightly more effective, but its use has a higher risk of bite changes.
Dr. Hart likes to use this orthotic in conjunction with cognitive behavioral therapy.
The MORA
The mandibular orthopedic repositioning appliance (MORA) realigns the lower jaw position for longer therapy. Repositioning the jaw joint can help restore balanced jaw muscle function. The MORA can reduce teeth clenching and grinding. It can also reduce TMJ pressure and pain caused by uneven biting forces. The MORA helps correct the jaw muscle imbalance, intracapsular defects, malocclusions, and associated TMJ disorders.
Posterior Guidance Orthotic Brace
The posterior guidance device resembles the Gelb but has additional lingual wings that stabilize and guide the movement of the lower jaw. It retrains the muscles used for chewing and swallowing to improve coordination and function. The posterior guidance orthotic brace is designed to enhance jaw stability and reprogram the muscles of mastication. It can be helpful for TMJ disorders involving muscle dysfunction, dystonias, and dyskinesias.
Farrar Anterior Positioning Orthotic
This orthotic resembles a splint, but with an added fin on the tongue side that helps hold the lower jaw in a forward position. Most often used just at night, but the doctor will give you specific instructions.
Dr. Hart likes to use this appliance for patients with arthritis, CPAP when a sleep apnea appliance is not warranted, and patients that have developed a pseudodisc in the TMJ.
Oral appliance therapy, sometimes referred to as mandibular advancement therapy (MAT) for OSA, has many different appliances to choose from. Experienced practitioners of dental sleep medicine, like Dr. Hart, can help you choose the appliance that best fits your needs and work with you until it is comfortable and functional.