Last month, I discussed how severe ear pain, head pain and migraine-like symptoms can be caused by the way the teeth come together in the column “Understanding pain can solve mysteries.”
This column is about the different kinds of bite guards used by dentists. I have been doing plastic appliances for more than 40 years and have used almost every type available.
The NTI came to market about 20 years ago. It’s a small piece of plastic that’s prefabricated then customized to clip onto the upper front teeth. Because the biting surface of the NTI is like a smooth table, it successfully allows the lower jaw to move side to side and back and forth without any teeth hitting. This separation of the teeth protects them during sleep on patients who grind and clench.
What makes the NTI popular and successful is its simplicity, cost and ability to help with pain in the temples. You can check out its effectiveness by placing your fingers on your temples while biting on your back teeth. You will feel the temple muscles bulge out.
Now, place a pencil in-between your front teeth and bite with the same pressure. You can feel that the muscle doesn’t fire in the temple area.
When one wears the NTI, it keeps the teeth apart and decreases muscle activity and decreases pain in some patients.
It is well known in dentistry that a very small percentage of people wearing a NTI over time can end up with an open bite.
An open bite is where the upper front teeth cannot touch the lower front teeth when biting down. This is one of several reasons I quit using it.
Upper or lower night guards
The most common are night guards that snap on the top or bottom teeth. Their job is mostly to keep the teeth from hitting one another at night. The idea behind them is that it is better to grind plastic down than teeth.
The science of how and when teeth should hit is called occlusion. This science is incredibly complicated and, unfortunately, not taught in dental school.
The night guards must comply with the science of occlusion in order to be both comfortable and kind to the teeth.
If they are not made correctly, they cause discomfort and, therefore, are not worn by the patient.
In my opinion, and I have made thousands of them, they are deficient because they do not take into consideration the complicated movements of the lower jaw during sleep.
Over the counter/internet
Everyone likes saving money and no one likes going to the dentist, so self-treatment sounds like a good idea.
After a dentists tells them about the need for some kind of appliance, they buy a boil-and-bite sports guard; after all, they do keep the teeth apart.
My opinion of the boil-and-bite is, yes, they cover the teeth but usually create more clenching because of the softness of the plastic.
This will ultimately create too much damaging pressure on the teeth and muscles and will not help with TMJ/TMD pain.
A neuromuscular orthotic takes a different approach than just keeping the teeth apart. Dentists trained in neuromuscular dentistry understand there is an ideal relationship between the upper and lower jaw and are trained on how to find it.
If your feet need to hit the ground in a balanced manner to make standing, walking and running comfortable and nonpainful, your teeth need to do the same while swallowing and chewing.
Like the feet, sometimes teeth don’t hit correctly. This imbalance of feet and teeth can be corrected by proper and sophisticated plastic orthotics.
On closing, hitting front teeth first or hitting one side before the other is an unbalanced bite. As an example, let’s say the front teeth hit first. In order for the back teeth to hit, the muscles have to pull the jaw back. When the jaw comes back, it brings the joint back too far.
Since the ear canal is one millimeter from the jaw joint, the pain from the joint is transferred to the ear.
Not only do the joint and ear hurt, the muscles making the constant, unnatural movement are overworked and can go into painful spasm. This is a classic TMD/TMJ scenario.
Unfortunately, people feel it is a medical problem instead of a dental one. Seeking help from a wmedical doctor only ends up in expensive exams and prescriptions of pain medication with no positive outcome.
A neuromuscular orthotic is made to compensate for either and all issues of jaw closure.
Front teeth contacting first created the wear. The wear patterns show me where the jaw wants to be when it closes.
The problem with this comfortable position for joint and muscle is the back teeth don’t hit.
With the orthotic in place, the patient is able to close to her comfortable, forward position and the orthotic fills in all spaces in the back, allowing all back teeth to hit evenly both left and right.
End result is the lower jaw is allowed to go where it wants to go and the plastic, removable orthotic perfectly balances the bite.
This relaxes the muscles and removes pressure from the ear area resulting in a patient happy to be out of pain.