Device Descriptions
Dandy TMJ appliances are intraoral devices used for treating TMD and TMJ (temporomandibular joint) pain. They consist of a single custom fitted tray, or a dual arch design. The goal of these devices is to support the TMJ and in some cases retrain muscles to avoid harmful movements.
These devices are custom made for each patient, and are sold by prescription only. The dentist is expected to evaluate the patient and assess which treatment path is most appropriate. If treatment includes an intraoral appliance, the dentist will determine which one is best suited for the individual case.
ANTERIOR DEPROGRAMMER
The anterior deprogrammer is a device that covers the entire arch and discludes the posteriors via an anterior ramp to retrain jaw muscles and prevent bruxing. The device is primarily used on the upper arch. It better protects teeth due to coverage of the full arch as well as greater retention than an NTI given its full coverage. There may be some occlusion which will interfere with retraining the jaw muscles.
Pros
√ Better protects teeth due to full arch coverage
√ Provides greater retention than the NTI given the full arch coverage.
Cons
Due to the coverage on the posteriors, there may be some occlusion which will interfere with retraining the jaw muscles.
Lab Specifications
+ Price: $169
+ TAT: 6 total days (4 days in lab + 2 days shipping)
NTI
The NTI device is a small unobtrusive device on the anteriors that avoids occlusion of the posterior teeth to inhibit bruxism and relieve stress. It is important to note that the NTI device only covers only teeth #7 - #10 on the upper arch.
Pros
√ Completely prevents occlusion so it retrains patient’s muscles to not brux at all.
Cons
Given the small size, some patients may struggle with retention
Lab Specifications
+ Price: $169
+ TAT: 7 total days (5 days in lab + 2 days shipping)
DAWSON B-SPLINT
Device that covers both arches and avoids occlusion of the posteriors to inhibit bruxism and relieve stress while allowing horizontal movement.
Pros
√ Provides coverage of both the upper and lower arches, providing complete protection.
√ Facilitates and supports lateral and excursive movements.
Cons
֣Does not retrain patients’ muscles to actually prevent the root cause.
Lab Specifications
+ Price: $229
+ TAT: 6 total days (4 days in lab + 2 days shipping)
GELB APPLIANCE
The Gelb Appliance sits on the posteriors and repositions to mandible to control the positioning of the jaw and avoid excess force. In addition to controling the positioning of the jaw, it also maintains the mandible arch shape. It also brings the condyle into a more anterior, resulting in an inferior position in the fossa and increases the vertical opening, which can relieve pain
Pros
√ Provides complete protection for the posteriors
√ Allows for more tongue space by cutting away the anterior coverage which is beneficial for patients
who snore, have sleep apnea, and/or have a large tongue
Cons
֣Does not retrain patients’ muscles to actually prevent the root cause
Lab Specifications
+ Price: $169
+ TAT: 6 total days (4 days in lab + 2 days shipping)
Appliance Selection
The correct treatment often hinges on the root cause of the problem. In order to properly diagnose the patient, it is important to take proper imaging, either X-rays or CBCT scans. This is in addition to standard exam questions; example questions can be found below. It is key to understand if the root cause of the issue is due to muscle spasms or damage in the joint (the joint can erode or move out of proper alignment, cartilage can be damaged, or the joint could be damaged from impact).
Here are ideal use cases by appliance:
ANTERIOR DEPROGRAMMER
√ The Anterior Deprogrammer works well for cases where you want full arch coverage and protection, but also to prevent occlusion
√ Good for treating TMD cases where the root cause is a muscle problem but can also treat all cases
NTI
√ The NTI works well for cases where the goal is to prevent any form bruxism, rather than mitigate the impact or pain
√ Very helpful for temporal headache patients
√ Good for treating TMD cases where the root cause is a muscle problem
DAWSON B SPLINT
√ The NTI works well for cases where the goal is to prevent any form bruxism, rather than mitigate the impact or pain
√ Very helpful for temporal headache patients
√ Good for treating TMD cases where the root cause is a muscle problem
GELB APPLIANCE
√ The Gelb is a good fit for cases where it is important to provide support and relieve pain in the TMJ √ It also works well for patients who struggle with airway obstruction given the anterior design
EXAMPLE EXAM QUESTIONS
Do you have frequent or regular headaches? When?
Are your jaw muscles ever sore or tender?
When you eat or chew, are your joints sore or tender?
Does your jaw make any noise such as snapping, clicking, or popping?
Does your jaw lock when you are trying to open or close?
Do you have any teeth that are sensitive, sore, aching, or uncomfortable? Have you worn a splint or nightguard previously? If yes, please describe. Are you taking or have you taken any medication for these symptoms? If yes, which ones? Have you ever had a jaw or face injury? If yes, please describe.
Have you ever seen a dentist or a TMJ specialist for treatment of any of the above symptoms? If yes: How many?
Indications for use
Dandy TMJ Appliances are intended to reduce pain and discomfort in the TMJ and in some cases help re-train muscles to avoid these movements. The devices are worn while sleeping to support patients’ TMJ in the position prescribed by the dentists. The appliances are removable by the patient.
Appliance Fit & Adjustments
The dental staff or dentist should remove the appliance from packaging and rinse under water. Then place the device in the patient’s mouth, checking for proper fit and function of the appliance. The appliance adjustments should always be performed by the prescribing dentist. Any adjustments in the fit of the device should easily be made chairside to ensure that their patient is pleased with the fit and function of their new appliance.
Operating Instructions
CLEANING
√ Brush with a toothbrush before each use.
STORAGE
√ Dry and store in the provided case when not in use.
FIT ADJUSTMENT
√ All adjustments should be done by the prescribing dentist or physician.
REMOVAL INSTRUCTIONS
√ To properly remove the appliance, using both index fingers, pull down in the front area of the upper appliance.
√ For Dawson B-splint, do this for the upper first; second, for the lower, pull up in the front area.
√ To avoid breakage, do not pull down the back of the appliance.
FIT ADJUSTMENT
√ Expect a 2-3 year product life with the appliance.
√ Appliance replacement signs are; cracks in the acrylic and failure of the device to maintain retention in the patient’s mouth.
Contraindications
For the select subset of patients that have surgery to treat TMD or any TMJ issues, any further treatment with TMJ appliances / splints should be prescribed by the surgeon.
Warnings and Precautions
WARNINGS
√ Tooth movement or changes in dental occlusion
√ Gingival or dental soreness
√ Pain or soreness to the temporomandibular joint
√ Obstruction of oral breathing
√ Excessive salivation
PRECAUTIONS
Dentists should consider the medical history of their patients, including history of arthritis, surgery, impact trauma, any previous TMJ treatment, or respiratory disorders, or other relevant health problems, and refer the patient to the appropriate healthcare provider before prescribing the device.