Splint therapy Flashcards
(113 cards)
1
Q
If the patients jaw is locking closed, and there range of mobility of 30mm:
A
disc displacement without reduction
2
Q
If the patients jaw is locking closed with a range of mobility of 30mm this is indicative of disc displacement without reduction, and the treatment would be:
A
a splint
3
Q
For disc displacement without reduction, if a splint is used, the outcome is better when the situation is:
A
acute
4
Q
A patients jaw is locking open at 63 mm, (very hyper mobile), would a splint be indicated in this case?
A
No
5
Q
A repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or bracing or thrusting of the mandible
A
Bruxism
6
Q
Bruxism can occur during ____ or during ____
A
sleep (sleep bruxism) or wakefulness (awake bruxism)
7
Q
Bruxism can be _____ or result in _____ ranging from:
A
asymptomatic; symptomatic; tooth sensitivity & chronic pain to destruction of the dentition
8
Q
T/F: Occlusal splints helps stop the patient from bruxing
A
False- occlusal splints DO NOT stop patient from bruising
9
Q
What is the etiology of sleep bruxism?
A
Etiology unknown
10
Q
Although the etiology of sleep bruxism is unknown, it may be associated with: (3)
A
- Microarousals (OSA)
- Psychosocial factors
- Genetics
11
Q
A repetitive jaw muscle activity that combines both clenching & grinding
A
Bruxism
12
Q
Clenching involves what muscles?
A
- Temporalis
- Masseter
13
Q
Grinding (lateral movements & protrusion) involves what muscles:
A
Medial & Lateral Pterygoids
14
Q
Temporomandibular disorders are more common in:
A
females
15
Q
T/F: Pain is not always associated with bruxism
A
true
16
Q
Why do we see scalloping of the tongue with OSA
A
because many times the tongue is too large for the size of the mouth
17
Q
Scalloping of the tongue can be an indication of:
A
obstructive sleep apnea
18
Q
When is botox indicated for bruxism (into masseters & temporalis):
A
- patient is awakening with headaches
- unresolved by other medications
- tooth fracture
19
Q
If a patient asks “if you make me a night guard, that will stop me from clenching & grinding”
What might you respond?
A
No- because its considered to be a nocturnal event primarily and it can be very similar to restless leg syndrome (involuntary movements during the night)
20
Q
What typically needs to be done prior to fabricating a night guard/occlusal splint?
A
Pre-authorization (due to some insurance companies requiring that)
21
Q
In what situation would state sponsored dental coverage benefits cover a nightguard/ occlusal splint?
A
If patient has a TMD diagnosis
22
Q
An occlusal splint may also be termed:
A
occlusal orthotic
23
Q
Why do we need to specify a diagnosis of a TMD disorder for coverage of a night guard/ occlusal splint rather than diagnosing the patient with bruxism?
A
Insurance will claim that bruxism is a dental diagnosis/dental problem not a medical code (to which we are billing to)
24
Q
Billing code for occlusal orthotic device:
A
D7880
25
What questions might we ask a patient insurance that is considered "private insurance"
1. Is an occlusal orthotic covered
2. Is TMD covered under the plan
3. What is the cost (if any) to the patient (a co-payment)
26
What questions might we ask a patient insurance that is considered "state insurance"
1. Is an occlusal orthotic covered for specific TMJ condition?
2. Is is not covered for bruxism
27
If a patient that needs an occlusal guard has a state insurance plan that does not cover the cost if its for bruxism diagnosis:
You should NOT include bruxism in your diagnosis
28
Orthopedic appliance therapy is commonly referred to as:
1. nightguards
2. occlusal guards
3. OCCLUSAL ORTHOTIC DEVICE
4. Interocclusal splints
5. Biteguards/Biteplanes
6. Orthotics or orthoses
7. Bruxism appliances
8. Splints
29
Describe an occlusal guard:
A removable acrylic resin appliance that covers all of the teeth on one arch
30
The occlusal guard will alter the:
occlusal relationships
31
How does an occlusal guard effect the occlusal forces?
redistributes the occlusal loading forces
32
Orthopedic appliance therapy is routinely used in:
TMD
33
Centric Relation (CR) =
Retruded contact positions (RCP)
34
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
CR/RCP
35
Centric relation occlusion may also be termed:
Retruded contact position
36
When making an occlusal splint, we use _____ as the cuspal position:
Centric occlusion (CO)
37
Centric occlusion (CO) =
Intercuspal Position (ICP)
38
Mandiular position with the most complete interdigitation of opposing teeth independent of condylar position:
Centric occlusion (CO)/ ICP
39
Maximum Intercuspal Position (MIP) may also be termed:
Maximum intercuspation, intercuspal position
40
When making an occlusal guard, impressions must be taken within ____ of turning models into lab due to ____
2 weeks; teeth shifting
41
When making an occlusal guard, after we take the impression or scan, the next step is taking the:
Bite registration (in MIP) (ICP)
42
How much thickness or separation between the teeth do we want when making an occlusal guard?
3 mm
43
When making an occlusal guard we ask the lab to make the posterior thickness to about:
3-4 mm
44
When making an occlusal guard, we ask the lab to make the posterior thickness about 3-4mm but this is also dependent on:
The curve of spee
45
What do we refer to as the "flex liner"
Dual laminate
46
For OSA we _____ the mandible ____
advance forward
47
Bite registration needs to open posterior bite by:
3mm POSTERIORLY
48
Functions of appliance therapy:
1. Treats masticatory muscles and TMJ pain and dysfunction
2. Alters functional relationships in the TMJ
3. Prevents tooth wear and mobility
49
Does appliance therapy reduce bruxism & parafunction?
NO
50
Occlusal splints can mimics the strain on the TMJ by lowering the intensity, frequency, or length of tie spent on _____ and protect the teeth and restorations
non-functional oral activities
51
Occlusal splints are typically fabricated using two primary material types, distinguished by:
their level of firmness
52
____ splints are less likely to stain and are less susceptible to the build up of food particles
hard acrylic resin
53
What are the two types of material used to fabricate an occlusal splint:
1. Hard acrylic resin
2. Pliable plastics
54
Hard acrylic resin splints can be created through ____ or by the ____
chemical curing; application of heat and pressure
55
Soft occlusal splints are made using pliable plastics resulting in a splint with a:
flexible surface
56
A combined material referred to as _____, merges the characteristics of a hard acrylic resin and a soft occlusal splint
Dual laminated
57
Describe a dual-laminated splint:
consists of a hard acrylic resin on the occlusal surface and a softer interior liner
58
4 types of splint therapy:
1. soft splint
2. stabilization splint
3. anterior repositioning splint
4. anterior bite splint (NTI)
59
Why do we not use an anterior bite splint?
its partial coverage
60
With an acrylic splint with ball clasps, where are the ball clasps placed and why?
between the molar and premolar and this would give retention if needed
61
Two types of splints for adults:
1. Acrylic flat plane stabilization splint
2. Anterior repositioning splint
62
Adult splint that treats muscle and TMJ disorders such as myalgia myofascial pain, orthoalgia, and clenching
Acrylic flat plane stabilization splint
63
Adult splint that treats anterior disc displacement WITHOUT reduction and intermittent non-reduction by unloading posterior attachment:
Anterior repositioning splint
64
Give examples of when an acrylic flat plane stabilization splint may be used?
in cases of:
myalgia
myofascial plane
orthalgia
clenching
65
Describe an anterior repositioning splint:
Has indexing or indentation holding jaw anteriorly to reduce inflammation on the posterior attachment reducing acute pain
66
Has indexing or indentations holding jaw anteriorly to reduce inflammation on the posterior attachment reducing acute pain
Anterior repositioning splint
67
What type of splint for an adult would treat anterior disc displacement without reduction?
Anterior repositioning splint
68
Does an antihero repositioning splint work better on acute or chronic cases?
acute
69
A patient comes in with intermittent non-reduction. What should you do and why does this work?
Anterior repositioning splint; unloading posterior attachment
70
How is the indexing and indentations on an anterior repositioning splint determined?
based off of bite registration you send to lab
71
Also known as a Michigan splint is custom-made for either the maxillary or mandibular arch
Full-coverage flat plane stabilization appliance
72
The optimal positioning of a stabilizing appliance should result in only slight modification to:
maxillomandibular relationship
72
The most widely used type of oral appliance:
full-coverage flat plane stabilization appliance
73
What type of appliance carries the smallest risk of negative consequences to other oral structures?
full-coverage flat plane stabilization appliance (Michigan splint)
74
Why does Dr. Roche tend to like mandibular appliances better than maxillary?
Because patient can wear it during the day time and speak normally with it
75
List some indications for a stabilization splint:
1. myalgia or myofascial pain
2. capsulitis/ synovitis
3. osteo/rheumatoid arthritis
4. anterior disc displacement with reduction
5. attrition prevention
76
What instructions should you give a patient when delivering a stablilzaiton splint:
1. When removing splint from mouth, tell patient that it may take a few minute to "find their normal bite"
2. the patient should be accustomed to the appliance within 1-2 weeks
3. Pain and symptoms should begin to improve within 3-4 weeks (but may take longer)
77
T/F: When patient takes any type appliance out of their mouth it may take a moment for them to find their bite
true
78
What is the risk associated with getting a softer home-made splint from amazon?
The softer material has the ability to move their teeth
79
Give some examples of stabilization appliances (3)
1. flat plane
2. gnathologic
3. muscle or relaxation
80
What type of splint is good for bruxism/clenching?
Stabilization appliance
81
Type of splint that reduces symptoms in 70-90% of TMDs:
Stabilization appliance
82
Give the instructions for a patient with a stabilization splint:
1. Do NOT wear for more than 8-12 hours per day
2. Wear at night time if pain is worse upon awakening
3. Wear at day time if pain is worse during day or at end of day, but remove at mealtime
4. Clean appliance with toothbrush, toothpaste, or soak in Efferent or ortho retainer solution, UNLESS there is a soft liner inside of the appliance
83
After giving patient a stabilization splint and they come back complaining that its not working, what might be the issue?
1. Noncompliance
2. Chronic pain behavior/bruxism
3. Degree of TMJ pathology
4. Misdiagnosis
84
Also known as anterior positioning splint or mandibular orthopedic repositioning appliance (MORAs):
anterior repositioning appliance
85
The interdigitation on an anterior repositioning splint should be ____ deep
1-2 mm
86
In anterior repositioning splint, the ____ holds the jaw anteriorly to unload posterior attachment, imporve pain, and possibly improve disc position to seat onto the condyle
indexing
87
In an anterior repositioning splint, in what positioning does the indexing hold the jaw and why?
Holds jaw anteriorly to unload posterior attachment
88
For anterior repositioning when advancing the mandible we should:
listen with stethoscope
89
Anterior repositioning splint indications:
1. Primarily indicated for ACUTE TMJ pain associated with disc discplacement with reduction
2. Anterior disc discplacement with intermittent non-reduction (catching)
2. Anterior disc discplacement without reduction with significant pain in TMJ
90
The anterior repositioning appliance may affect the TMJ disc displacements in 3 ways including:
1. Alters adverse loading in the TMJ (unloads posterior attachment)
2. Alters the structural condyle-disc relationship
3. Reduces associated muscle splinting
91
With anterior repositioning splint, it is key to tell your patients:
We can not always guarantee recapturing the disc or eliminate TMJ noises
92
With an anterior repositioning splint, how might we decide whether the patient needs to be a daytime or nighttime wearer?
night time wear is indicated if the jaw locking primarily occurs on awakening
day time wear is indicated if locking with pain primarily occurs during the day time
93
An anterior repositioning splint should be replaced with ____ in ____ weeks once joint pain/dysfunction is controlled
Stabilization splint
94
Ideally, how long would someone wear an anterior repositioning splint?
6-12 weeks
95
What type of splint do we never make?
Partial coverage
96
Involves a small segment of the maxillary anterior teeth , typically 2-4 incisors:
Nociceptive Trigeminal Inhibition Tension Suppression System (NTI-tss)
97
There are risks of negative dental effects with use from ____ over an extended and continuous duration
NTI-tss
98
The idea is that if the posterior teeth are not occluding, then the patient will not be able to clench or grind:
NTI-tss
99
- Irreversible changes in occlusion
- Overerruption of the opposing molars and premolars
- anterior open bite
- discplacement of maxillary anterior teeth
- device could be swallowed or inhaled
- may lead to mouth dryness during sleep
These are all potential consequences of:
NTI-tss
100
Your patient comes in complaining of dry mouth and night. Your radiographs show supra eruption of the patients maxillary premolars. What is a likely cause?
NTI-tss
101
We find that a lot of children will clench and grind their teeth in the ____ stage
Mixed dentition
102
- Effective in pediatric patients
- Less effective in adults
- Protects teeth from trauma
-Does NOT decrease bruxism; and may even increase bruxism in adults
- May be helpful for short-term use
- Inexpensive
Soft Splint
103
How is a soft splint effective in pediatric patients with mixed dentition? (specifically the SOFT part)
Because its SOFT and will NOT block the eruption of the permanent teeth
104
A Soft splint is useful in treating:
Myalgia, Arthralgia, and clenching/bruxism
105
Splint therapy "Do's"
1. Always take an occlusal record
2. Limit splint wear to 8-14 hours per day
3. Always have full arch coverage
4. Experiment with night or daytime wear
5. Anterior repositioning should additionally be warn in daytime for 4 hours
6. Recheck occlusion periodically to rule out occlusal changes from splint wear
106
Why would we counsel the patient to not wear a splint for 24 hours per day long term?
Due to major chances in occlusion (Open bite), especially with partial-arch coverage
107
Splint follow-up appointment schedule:
- 2 weeks
- 1 month
- 3 months
- 6 months
108
What are we checking for at splint follow-up appointments?
1. Check fit and occlusal balance
2. Check fit and look for occlusal wear
3. Follow up with pain an adjust medications
4. Follow up with PT
109
What are the complications with excessive or incorrect splint use?
1. Occlusal changes (open bite)
2. Speech changes
3. Caries
4. Gingival inflammation
5. Malodor
6. Psychological dependence
110
Malocclusion 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)
111
Summary slide for splint:
1. Limit wear to:
2. May improve clicking but:
3. Do NOT promise the patient that it will:
4. Should decrease:
5. Adjust splint on:
6. Evaluate the patient's occlusion to ensure that its not
1) 8-12 hours long term
2) not necessarily eliminate it
3) "cure" their symptoms
4) pain, tightness, & locking
5) regular basis
6) changing occlusion due to splint wear
112
