Aaaaaah, the holidays!
My wife thrives on all things festive; decorating the tree, shopping for the perfect gift for everyone we are related to (as well as their dogs), poring through recipes to find which cocktail to serve for; present opening, before Christmas lunch, during the meal, with dessert (which involves some weird British tradition of setting a fruitcake on fire with brandy).
A time of peace on earth and goodwill to all men – unless you’re related to them, and they’re coming to stay for two weeks, with their cat. The reality of holiday time (for me), is often a lot of stress, and biting my tongue and gnashing my teeth at family members, because the turkey is not cooking fast enough/too fast/too dry/still frozen and the gravy is now lumpy. Sometimes I do feel like I am in a Chevy Chase movie, except maybe without the gift wrapped feline.
Instead of monogramming initials on plush robes and pairs of slippers, L.L. Bean should seriously consider making customized Times New Roman bite splints to go into everyone’s stocking. They could still legitimately use the fluffy Labrador Retriever puppy in the catalog’s marketing photos, because most of the calls we get about replacing a mouth guard are due to a destructo-dog at home.
Don’t we all need a little therapy over the holidays?
Yes, we do. So let’s talk a bit about bite splint therapy. I am a dentist, after all.
‘Bruxism’ actually comes from the Greek word ‘bryx’, which literally means “gnashing of teeth.” There are as many reasons why people grind or brux, as there are implications of how it affects your teeth. You know you have a bad bite (or if you want to sound fancy, ‘malocclusion’) when your jaw is sore, muscles are tight, and teeth are chipped, worn and/or cracked. However, other clues there might be something slightly ‘off’ are noticeable if you are unable to bite thick breads easily (bagels and baguettes are now harder to get through than an episode of the “The Kardashians”), or you’re unable to chew rice with your back teeth.
Bite Splint Therapy?
Eating, shopping, sitting on a couch talking about your feelings, laying on your couch while eating a bag of Doritos and watching the entire season of ‘Sons of Anarchy,’ are all different kinds of therapy to treat the problems of (my) daily living. I like to think of the design and function of a dental splint as the marriage between art and science for activities of daily grinding and gnashing.
One function for prescribing a bite splint is to achieve “centric relation” which means that the relationship of the mandible (your lower jaw) to the maxilla (the upper) has the condyle (the ‘ball’ part of the ball and socket) properly aligned with the disc (aka the socket). This reduces the cause and effect of the muscle in co-ordination. A properly designed appliance can “unlock” your bite by eliminating any interference from the opposing teeth during contact (they are usually a minimum of 3mm thick in order to achieve optimum separation).
It’s important to remember that splints don’t actually prevent bruxism, rather they manage and redistribute the biting forces across your jaw allowing the lower jaw bone to properly “seat” in the joint. They can decrease the frequency, just not the intensity, of bruxing episodes. The good news is that by improving the bite position, you will actually become more coordinated in your jaw muscles, though sadly, it will not help to improve your electric slide technique.
The process of building a custom bite is a little more involved than picking out what you want at the mall and walking out with it in half an hour or less. There are several different types of splints commonly prescribed in dentistry, all of which can vary depending on your symptoms and label; “Terminal Tooth Chipper,” “All Flat (Molars) in Back,” “Poppin’ Da’ Jaw,” “My Achey, Breaky Headache,” or “Muscles in a Meltdown.”
A bite splint is typically used on one arch, primarily the maxilla (upper). However, in cases of missing teeth, it can be made to accommodate that arch in order to provide more stability by creating additional contact points.
A muscle deprogrammer is a ‘permissive appliance’ and is made of smoothed off acrylic that allows your opposing arch (typically the lower teeth) to glide unimpeded over the biting surface. The goal of a permissive appliance is to position your mandible (aka the jawbone) in a very specific and ideal relationship to the maxilla (which would be your uppers).
The muscle deprogrammer/anterior mid-point bite plane is worn over the maxillary (front upper) teeth which only touches the mandibular anteriors (your lower fronts) and has no posterior contact. The whole purpose is to stop the back teeth from touching, eliminating their influence on the function (and dysfunction) of biting and chewing. As there is no contact with the posteriors, it also allows a key muscle (the lateral pterygoid – there’s a new vocab. word to put in your Scrabble arsenal) to release, enabling the condyle to seat properly. A “branded” name is the NTI, which has only been approved to treat acute migraines.
A full contact splint (imagine a plastic horseshoe covering all of your teeth) protects the entire arch, because it creates a larger surface area, which dissipates the forces placed on individual teeth.
A posterior bite plane covers only your upper molars. It is a hard acrylic appliance connected by a metal bar. The treatment goal with this splint is mandibular (that’s your lower jaw again) repositioning.
A non-permissive or directive splint has divots in the surface that correspond to your opposing teeth so that they actually ‘lock in’ to the contact surface, preventing any kind of side to side movement. This aids in ‘centric relation’ (that sweet spot position where your jaw hinges into the part of your skull just in front of your ear). An example of a commonly prescribed non-permissive splint is an anterior repositioning appliance (ARA) which positions your mandible in specific relation to the maxilla.
“Hallelujah! Where’s the Tylenol?”
So if you’re like me, and you leave your holiday shopping until the last minute, it’s probably too late to get the all your family members their monogrammed bite splints in time to put them under the tree.
However, there are plenty of OTC options you can use in the short term. I plan to purchase mine at the airport’s Duty Free on the way to see my in-laws.