Posted by Clint on March 23, 1999 at 17:19:15:
In Reply to: Re: tmj posted by Susan on March 22, 1999 at 12:28:23:
Dear Susan,
I would agree that there are many poorly made "splints"
delivered which do the patient no good and often more
harm than good. Most dentists graduate from dental school
with a woefully inadequate understanding of harmony
of the masticatory system. We became good "tooth
doctors", but poor physicians of the masticatory
system.
Because of this, most of us don't even realize when
we are placing restorations in our patients mouths
that will create imbalance in the delicate neuromuscular
system, resulting in muscle spasm, TMJ problems, tooth
wear, fractured teeth, bruxism, and so on.
An appropriate splint can not be constructed without
first determining where the lower jaw belongs; i.e.,
determining where the position of the TMJ's where the
muscles are at rest. This is not a difficult thing to
do, but most dentists were never taught to do it in
school (see my previous note above).
The goal of a splint is to achieve neuromuscular balance;
to freedom of movement of the jaws without tooth contacts
triggering muscle spasm. The posterior teeth should only
contact when the joints are fully seated, and should not contact
the splint at all when the jaw slides to the side or
forwards.
Bottom line: the medical community is much further
along in treating orthopedic conditions and neuromuscular
balance than the overall dental community.
Splints are effective when properly made. They are not
proper treatement for cluster headaches. If someone
suffers from both TMJ problems and CH, then a splint
can be a useful therapy for at least the TMJ, which
will worsen during CH exacerbations
Clint Wilkinson, D.M.D. cwilk@iu.net