Choosing the Correct TMD Appliance for Your Patient

When determining which TMD appliance is right for your patient, it is key to understand the root cause of the patient's chief complaint. The root cause will generally fall into two major buckets:

  1. Muscular 
  2. Joint damage, caused by either:
    • Joint erosion
    • Improper alignment
    • Damaged cartilage
    • Trauma

Exam Recommendations

To properly diagnose the patient, it is important to take proper imaging, which can include:

  • X-rays
  • CBCT scans

In addition to proper imaging, the following exam questions should help you determine the root cause:

  • 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? 

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 Dawson B-splint is a good fit for cases where it is important to provide full arch coverage and support excursive movements, rather than prevent them. 

  • It is good for long term use and protection for those with significant parafunction.
  • It eliminates the possibility of posterior super eruption.

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.
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