13 June, 2017
TMJ Mouthpiece Options
Doctors often prescribe a mouthpiece, guard or splint to treat their patients suffering from temporomandibular disorders -- TMD, which involves the masticatory, or chewing, muscles and TMJ, which involves the jaw joints. These conditions cause non-dental pain that can be amplified by certain psychological factors, particularly as the pain becomes more chronic.
TMJ is a psychogenic illness, meaning that it has an emotional rather than a physical cause. Stressors such as depression, anxiety and prolonged negative feelings can heighten your level of tension, insecurity or distressful feelings. Those stressful feelings can strain your masticatory system, increasing the pressure on your parafunctional habits -- the movements connected to speech, breathing and chewing. For instance, you may suffer from the habitual clenching or grinding of your teeth, called bruxism.
As your condition deteriorates, the pain eventually can become difficult to tolerate and manage. Your dentist may choose a treatment strategy that includes some combination of mouth guards, medication, cognitive therapy and surgery. Interocclusal splints, orthotic bite guards, bite planes, night guards, and bruxism appliances are routinely used in the treatment of temporomandibular disorders, and results vary widely between patients.
Three types of TMJ mouthpieces are commonly prescribed: soft acrylic guards, hard acrylic guards and the Talon splint. If your condition is mild or moderate, your doctor may suggest a soft acrylic guard. It molds to the shape of your mouth, but you may bite through it over time. A hard acrylic guard provides more durability and is appropriate if you suffer from severe clenching. The Talon splint is composed of hard acrylic on the outside and softer acrylic on the tooth side. Researchers do not agree on how splints work or the most effective design. Although patients report that using a mouthpiece provides greater comfort, mouth guards should not be worn 24/7. Instead, splints are advised for nighttime use in almost all cases.
Studies of therapies with these appliances generally have reported that patients experience a reduction in the level of facial pain, mouth pain and other symptoms; however, most studies involve small sample sizes, short-term outcomes and inadequate control groups. Several articles report mildly favorable results, but the devices performed no better than other dental appliances or other types of therapies such as behavioral modification or self-management strategies.
- Orofacial Pain - Guidelines for Asssessment, Diagnosis, and Management, Fourth Edition; Reny de Leeuw
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