Splint Therapy Flashcards
(66 cards)
1
Q
what is bruxism
A
a repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible
2
Q
when can bruxism occur
A
during sleep or awake
3
Q
can be _____ or ________ ranging from:
A
asymptomatic; symptomatic; tooth sensitivity and chronic pain to destruction of the dentition
4
Q
do occlusal splints stop patients from bruxing
A
no
5
Q
what is sleep bruxism associated with
A
microarousals- obstructive sleep apnea
- psychosocial factors
- genetics
6
Q
what is the code for billing for occlusal orthotic device
A
D7880
7
Q
what do you do if a state insurance plan does not cover for bruxism
A
do not include it in your dx
8
Q
what is required in california for an occlusal orthotic device to be covered
A
- a corrected lateral tomography or a radiological report
- written documentation that must includeL
- specific TMJ conditions addressed by the procedure
- the rationale demonstrating the need
- any pertinent history
9
Q
medi caid in california believes that occlusal orthotic devices is a benefit for______ and not a benefit for_____
A
benefit for diagnosed TMJ dysfunction
- not a benefit for the treatment of bruxism
10
Q
orthopedic appliance therapy is commonly referred to as:
A
- nightguards
- occlusal guards
- occlusal orthotic device
- interocclusal splints
- bite guards or bite planes
- orthotics or orthoses
- bruxism appliances
- splints
11
Q
orthopedic appliance therapy is routinely used in:
A
treatment of TMD
12
Q
what are orthopedic appliances made of
A
removable acrylic resin
13
Q
orthopedic appliances cover:
A
the teeth on one arch
14
Q
do orthopedic appliances alter occlusal realtionships
A
yes
15
Q
what does orthopedic appliances do to occlusal forces
A
redistributes them
16
Q
what is another name for centric relation
A
retruded contact position
17
Q
what is CR
A
point of initial tooth contact when the condyles are guided along the posterior slope of the articular eminence into their most superior position on jaw closure
18
Q
what is another name for Centric occlusion
A
- intercuspal position
- maximum intercuspal position
- maximum intercuspation
- intercuspal position
19
Q
describe the impressions technique for occlusal guard
A
- take alginate impressions of maxillary and mandibular arch
- pour up in dental stone
- impressions must be taken within 2 weeks of turning models into lab due to teeth shifting
20
Q
describe how to take bite registration in MIP
A
- dentsply TRUBYTE wax (type II regular)
- dip into warm water bath
- fold wax in half and press on hard surface
- cut to size of maxillary arch
21
Q
what is the lab technique for making occlusal guards
A
- mount upper/lower casts using wax bite registration or other registration type
- turn in mounted models of maxillary/mandibular arches to lab
- have primary attending faculty fill out and sign lab slip
- lab instructions: posterior splint thickness 3-4mm. may add 4 ball clasps or make a flex liner or all acrylic or dual laminate
22
Q
how do you use the Trios scanner for occlusal guards
A
- bite registration needs to open posterior bite by 3mm posteriorly
- can use SomnoMed bite fork with or without horseshoe wax to obtain bite
23
Q
what are the functions of appliance therapy
A
- treats masticatory muscle and TMJ pain and dusyfunction
- alters functional relationships in the TMJ
- prevents tooth wear and mobility
24
Q
what is NOT a function of appliance therapy
A
reduce bruxism and parafunction
25
occlusal splints can minimize the strain on the TMJ by:
lowering the intensity, frequency, or length of time spent on non functional oral activities and protect the teeth and restorations
26
occlusal splints are fabricated using:
two primary material types distinguished by their level of firmness
27
what are the types of materials used for splints
- hard acrylic resin
- soft occlusal splints
- dual laminated
28
how are hard acrylic resin splints made
through chemical curing or by the application of heat and pressure
29
how are soft occlusal splints made
using pliable plastics resulting in a splint with a flexible surface
30
what is dual laminated splints made of
a hard acrylic resin on the occlusal surface and a softer interior liner
31
what are the 4 types of splint therapy
- soft splint
- anterior repositioning splint
- stabilization splint
- anterior bite splint
32
what are the two types of splints for adults
- acrylic flat plane stabilization splint
- anterior repositioning splint
33
what do acrylic flat plane stabilization splints treat
muscle and TMJ disorders: myalgia, myofascial pain, arthralgia, osteoarthritis and ligamentitis
34
what does anterior repositioning splint treat
acute anterior disc displacement without reduction and intermittent non reduction by unloading posterior attachment
- has indexing or indentations holding jaw anteriorly to reduce inflammation on the posterior attachment reducing acute pain
35
what are the indications for stabilization splints
- myalgia or myofascial pain
- capsulitis/synovitis
- osteo/rheumatoid arthritis
- anterior disc displacement with reduction
- attrition prevention
36
what are the instructions to the patient for the stabilization splint
- when removing splint from mouth tell pt it may take a few minutes to find their normal bite
- the patient should be accustomed to appliance within 1-2 weeks
- pain and symptoms should begin to improve within 3-4 weeks but may take longer and up to 2-3 months
- keep appliance in case when not wearing
- keep appliance moist by placing small amount of water in case
- hide from dogs
37
what are the functions of stabilization appliances
- provide joint stabilization
- provide stable occlusion
- alters rest position of jaw to a more relaxed, open position
- relaxes the elevator (closing) muscles
- increases awareness of jaw habits
38
what are the stabilization splint patient instructions
- do not wear more than 8-12 hours per 24 hours
- wear night time if pain is worse on awakening
- wear daytime if pain is worse during day or at end of the day but remove at mealtime
- clean appliance with toothbrush, toothpaste or soak in efferdent or orthodontic retainer solution unless there is a soft liner inside the appliance
39
what are the symptom improvements
- failure to show an initial positive response may be related to:
- noncompliance
- chronic pain behavior/bruxism
- degree of TMJ pathology
- misdiagnosis
40
in the anterior repositioning splint what arch is it on
mandibular
41
what does indexing do for the anterior repositioning splint
- holds jaw anteriorly to unload posterior attachment, improve pain unloading posterior attachment and possibly improve disc position to seat onto condyle
42
how is bite registration taken for anterior repositioning splint
by moving mandible forward by 1-2mm listen with stethoscope to see if click is eliminated temporarily with opening and closing
43
where is indexing on anterior repositioning splint
on occlusal surface
44
what are the indications for anterior repositioning splint
- primarily indicated for acute TMJ pain associated with disc displacement with reduction
- anterior disc displacement with intermittent non reduction (catching)
- anterior disc displacement without reduction with significant pain in TMJ
45
anterior repositioning appliance may affect TMJ disc displacement in 3 ways:
- alters adverse loading in the TMJ (unloads the posterior attachment)
- alters the structural condyle-disc relationship
- reduces associated muscle splinting
46
describe the anterior repositioning splint
- not always successful in recapturing disc or eliminating TMJ noises
- night time wear is indicated if jaw locking primarily occurs on awakening
- day time wear is indicated if locking with pain primarily occurs in daytime
- replace with stabilization splint in 6-12 weeks once joint pain/dysfunction is controlled
47
what is NTI and what does it stand for
- Nociceptive trigeminal inhibition tension suppression system
- involves a small segment of the maxillary anterior teeth, typically 2-4 incisors
48
what is the risk with NTIs
risk of negative dental effects from the use of the NTI-tss over an extended and continuous duration is considerable
49
what are the specific issues seen with partial coverage appliances (NTI-tss)
- may lead to irreversible changes in the occlusion over time if not adequately supervised by a dentist
- a chance for overeruption of the unopposed premolars and molars which may lead to an anterior open bite
- mobility of the mandibular anterior teeth
- occlusal forces may lead to the displacement of the maxillary anterior teeth
- may lead to mouth dryness during sleep as it keeps the mouth slightly open
- it could be swallowed or inhaled
50
who benefits more from a soft splint
children
51
describe soft splints
- protects teeth from trauma
- does not decrease bruxism; may increase bruxism in adults
- may be helpful for short term use
- inexpensive
52
why can only a soft splint be used in peds pts
- the soft splint will not block the eruption of the permanent teeth
- an acrylic splint is rigid and may block the eruption of the permanent teeth and it will not fit after the teeth erupt
- the soft splint is very inexpensive but inform parents that after the permanent teeth erupt a new acrylic splint is needed so they know the cost up front
53
schedule _____ appt to deliver nightguard
30 min
54
what supplies do you need to deliver nightguard
- occlude
- mouth mirror
- cotton rolls
- sterile gauze
- blue/red articulating paper
- articulating paper holders
- #4 or #6 round bur
- pineapple acrylic bur
- slow speed handpiece
- forceps
55
what are the home care instructions for splints
- when not being worn keep in case to keep it moist. clean case with lysol wipe once per week
- clean appliance with toothbrush. if hard appliance soak in polident or efferdent dentuer disinfecting tablet
- put appliance in mouth and remove in morning. only drink water with appliance
- bring appliance to each appt
- if you require crowns or bridges, bring appliance to dentist before dental work is started so the dental technican can make a crown to fit your appliance
56
what are the follow up appointments for splints
- 2 weeks
- 1 month
- 3months
- 6 months (as long as pt wears the spint)
57
what do you check at follow up appt
- check fit and occlusal balance
- check fit and look for occlusal wear. show pt wear patterns
- follow up with pain and adjust meds and PT
58
what do you look for during adjustment
- wear patterns
- side to side markings indicate bruxism
- fractures in splint due to heavy clenching
- delamination of soft liner
59
what are the complications with excessive or incorrect use
- occlusal changes
- speech difficulties
- caries
- gingival inflammation
- malodor
- psychological dependence
60
why adjust the splint?
- it is your legal responsibility
- to correct for changes in occlusion as pain, muscle activity, inflammation, edema, or soft tissue relations change
- malocclusions due to arthritis must be monitored once per month for 6 months and the splint serves a diagnostic purpose to see if occlusal contacts on splint are stable over time
61
limit wear to _____
8-12 hours long term
62
may ______ clicking but ______
improve; not necesssarily eliminate it
63
splints should decrease:
pain, tightness and locking
64
adjust splint on______
regular basis
65
evaluate patients occlusion to ensure:
it is not changing due to splint wear
66
