Splint Therapy Flashcards
(116 cards)
1
Q
If the patients jaw is locking closed, with a range of mobility of 30mm this would be diagnosed as:
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 63mm (very hypermobile), 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)
Wakefulness (awake bruxism)
7
Q
Bruxism can be ____ or result in ____ ranging from:
A
asymptomatic; symptomatic; tooth sensitivity and chronic pain to destruction of the dentition
8
Q
T/F: Occlusal splints help stop the patient from bruxing
A
False- occlusal splints DO NOT stop the patient from bruxing
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
- microarrousals (OSA)
- psychosocial factors
- genetics
11
Q
A repetitive jaw-muscle activity that combines both clenching and grinding:
A
12
Q
Clenching involves what muscles?
A
- temporalis
- masseter
13
Q
Grinding (lateral movements & protrustion) involves what muscles?
A
- medial pterygoids
- 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 may be an indication of:
A
OSA
18
Q
When is botox indicated for patients with bruxism (into masseters & temporalis) are primarily:
A
- patient is awakening with headaches
- unresolved with other medications
- fracturing teeth
19
Q
If a patient asks, “if you make me a nightguard that will stop me from clenching and grinding?” what might you respond to that?
A
No- because it is 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 woudl state sponsored dental coverage benefits cover a night guard or 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 is a dental diagnosis/dental problem and not a medical code (to which we are billing to)
24
Q
Billing code for occlusal/orthotic device:
A
D7880
25
26
27
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)
28
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 it not covered for bruxism
29
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
30
Orthopedic appliance therapy is commonly referred to as:
1. night guard
2. occlusal guards
3. OCCLUSAL ORTHOTIC DEVICE
4. interocclusal splints
5. bite guards/bite planes
6. orthotics or orthoses
7. bruxism appliances
8. splints
31
Describe an occlusal guard:
a removable acrylic resin appliance that covers all of the teeth on one arch
32
The occlusal guard will alter the:
occlusal relationships
33
How does an occlusal guard effect the occlusal forces?
Redistributes the occlusal forces
34
Orthopedic appliance therapy is routinely used in treatment of:
TMD
35
Centric relation (CR) =
Retruded contact position (RCP)
36
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
37
Centric relation occlusion may also be termed:
Retruded contact position
38
When making an occlusal splint, we used _____ as the cuspal position
Centric occlusion (CO)
39
Centric occlusion (CO) =
Intercuspal position (ICP)
40
Mandibular position with the most complete interdigitation of opposing teeth independent of condylar position:
Centric occlusinon (CO)/ Intercuspal position (ICP)
41
Maximum intercupsal position (MIP) may also be termed:
maximum intercuspation intercuspal position
42
When making an occlusal guard, impressions must be taken within ______ of turning models into lab due to ____
2 weeks; teeth shifting
43
When making an occlusal guard, after we take the impression or scan, the next step is taking the:
Bite registration in MIP (ICP)
44
How much thickness/separation do we want in between the teeth when making an occlusal guard?
3mm
45
When making an occlusal guard, we ask the lab to make the posterior thickness to about:
3-4mm
46
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
47
What do we refer to as the "flex liner"
Dual laminate
48
For OSA we ____ the mandible ____
advance; forward
49
Bite registration needs to open posterior bite by:
3mm POSTERIORLY
50
Functions of appliance therapy:
1. treats masticatory muscles & TMJ pain and dysfunction
2. alters functional relationships in the TMJ
3. prevents tooth wear & mobililty
51
Does appliance therapy reduce bruxism and parafunction?
NO it does not
52
Occlusal splints can minimize the strain on the TMJ by lowering the intensity, frequency or length of time spent on _____ and protect the teeth and restorations
non-functional oral activities
53
Occlusal splints are typically fabricated using two primary material types, distinguished by:
their level of firmness
54
________ splints are less likely to stain and are less susceptible to the build up of food particles
hard acrylic resin
55
What are the two types of materials used to fabricate an occlusal splint?
1. hard acrylic resin
2. pliable plastics
56
hard acrylic resin splints can be created through ____ or by the ____
chemical curing; application of heat and pressure
57
soft occlusal splints are made using pliable plastics resulting in a splint with a:
flexible surface
58
A combined material referred to as _____ merges the characteristics of hard acrylic resin and a soft occlusal splint
dual-laminated
59
Describe a dual-laminated splint:
Consists of a hard acrylic resin on the occlusal surface and a softer interior liner
60
4 types of splint therapy:
1. soft splint
2. stabilization splint
3. anterior repositioning splint
4. anterior bite splint (NTI)
61
Why do we note use an anterior bite splint:
because it is partial coverage
62
With an acrylic splint with ball clasps, where are ball clasps placed and why?
Between the molar and premolar & this would give retention if needed
63
Two types of splints for adults:
1. acrylic flat plane stabilization splint
2. anterior repositioning splint
64
Adult splint that treats muscle and TMJ disorders such as myaligia, myofascial pain, orthalgia and clenching:
Acrylic flat plane stabilization splint
65
Adult splint that treats anterior disc discplacement WITHOUT reduction & intermittent non-reduction by unloading posterior attachment:
Anterior repositioning splint
66
Give examples of when an acrylic flat plane stabilization splint may be used:
In cases of:
-myalgia
-myofascial pain
-orthalgia
-clenching
67
Describe an anterior repositioning splint:
Has indexing or indentations holding jaw anteriorly to reduce inflammation on the posterior attachment reducing acute pain
68
Has indexing or indentations holding jaw anteriorly to reduce inflammation on the posterior attachment reducing acute pain:
Anterior repositioning splint
69
What type of splint for an adult would treat anterior disc displacement without reduction?
Anterior repositioning splint
70
Does an anterior repositioning splint work better on acute or chronic cases?
Acute
71
A patient comes in with intermittent non-reduction, what should you do & why does this work?
Anterior respositioning splint; unloading posterior attachment
72
How is the indexing and indentations on an atnerior repositioning splint determined?
Based off bite registration you send to lab
73
Also known as the Michigan splint, is custom-made for either the maxillary or mandibular arch:
Full-coverage flat plane stabilization appliance
74
The optimal positioning of a stabilizing appliance should result in only slight modification to:
maxillomandibular relationship
75
The most widely used type of oral appliance:
Full-coverage flat plane stabilization appliance
76
What type of appliance caries the smallest risk of negative consequences to other oral structures:
Full-coverage flat plane stabilization appliance (michigan splint)
77
Why does Dr. Roche tend to like mandibular appliances better than maxillary?
Because patient can wear it during the daytime and speak normally with it
78
List some indications for stabilization splints:
1. myalgia or myofascial pain
2. capsulitis/synovitis
3. osteo/rheumatoid arthritis
4. anterior disc displacement with reduction
5. attrition prevention
79
What instructions should you give your patient when delivering a stabilization splint:
1. when removing splint from mouth, tell patient that it may take a few minutes to "find their normal bite"
2. the patient should be accustomed to the appliance within 1-2 weeks
3. pain & symptoms should begin to improve within 3-4 weeks (but may take longer)
80
T/F: When a patient takes any type of appliance out of their mouth, it may take moment for them to find their bite
true
81
What is a risk associated with getting a softer home-made splint from amazon?
The softer material has the ability to move their teeth
82
Give some examples of stabilization appliances: (3)
1. flat plane
2. gnathologic
3. muscle or relation splints
83
What type of splint is good for bruxism/clenching?
stabilization appliance
84
Type of splint that reduces symptoms in 70-90% of TMDs:
Stabilization appliance
85
Give the instructions for a patient with a stabilization splint:
1. Do NOT wear for more than 8-12 hours a day
2. Wear at nighttime if pain is worse upon awakening
3. Wear at daytime if pain is worse during the day or at end of the day but remove at meal time
4. Clean appliance with toothbrush, toothpaste or soak in Efferdent or ortho retainer solution UNLESS there is a soft liner inside of the appliance
86
After giving patient a stabilization splint, they come back complaining that it isn't working- what might be the issue?
1. noncompliance
2. chronic pain behavior/bruxism
3. degree of TMJ pathology
4. misdiagnosis
87
Also known as anterior positioning splint or mandibular orthopedic repositioning appliance (MORAS):
Anterior repositioning appliance
88
The interdigitation on an anterior repositioning splint should be _____ deep
1-2mm
89
In an anterior repositioning splint, the ______ holds the jaw anteriorly to unload the posterior attachment, improve pain and possibly improve disc position to seat onto the condyle
Indexing
90
In an anterior repositioning splint, in what positioning does the indexing hold the jaw and why?
Holds jaw anteriorly to unload posterior attachment
91
For anterior repositioning when advancing the mandible we should:
listen with stethescope
92
Anterior repositioning splint indications:
1. primarily indicated for ACUTE TMJ pain associated with disc displacement with reduction
2. anterior disc displacement with intermittent non-rediction (catching)
3. anterior disc displacement without reduction with significant pain & TMJ
93
With anterior repositioning splint, it is key to tell your patients:
We cannot always guarentee recapturing the disc or eliminate TMJ noises
93
The anterior repositioning appliance may affect the TMJ disc displacement in 3 ways including:
1. alters adverse loading in the TMJ (unloads the posterior attachment)
2. alters the structural condyle-disc relationship
3. Reduces associated muscle splinting
94
WIth an anterior repositioning splint, how might we decide whether the patient needs to be a daytime or night time wearer?
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
95
An anterior repostioning splint should be replaced with ____ in _____ weeks once the joint pain/dysfunction is controlled
stablization splint; 6-12 weeks
96
Ideally, how long would someone wear an anterior repositioning splint?
6-12 weeks then will be replaced with stabilization splint
97
What type of splint do we never make?
Partial coverage
98
Involves a small segment of the maxillary anterior teeth, typically 2-4 incisors:
Nociceptive trigeminal inhibition tension suppressive system (NTI-tss)
99
There are risks of negative dental effects with use from _____ over an extended & continuous duration
NTI-tss
100
The idea is that if posterior teeth are not occluding then the patient will not be able to clench or grind:
NTI-tss
101
-Irreversible changes in occlusion
-Overeruptiuon of the unopposed premolars
-anterior open bite
-displacement of maxillary anterior teeth
-device could be swallowed or inhaled
-may lead to mouth dryness during sleep
All potential consequences of NTI-tss
102
Your patient comes in complaining of dry mouth at night. Your radiographs taken show supraeruption of the patients maxillary premolars. What is the likely cause?
Use of NTI-tss
103
We find that a lot of children will clench and grind their teeth in the ____ stage
mixed dentition
104
-Effective in pediatric patients
-Less effective in adults
-Protects teeth from trauma
-Does not decrease bruxism & may even increase bruxism in adults
-may be helpful for short-term use
-Inexpensive
Soft splint
105
How is a soft splint effective in pediatric patients with mixed dentition? (specifically the soft part)
Because it is soft and will NOT block the eruption of the permanent teeth
106
A soft splint is useful in treating:
Myalgia, arthralgia and clenching/bruxism
107
Splint therapy "Do's":
1. Always take an occlusal record
2. Limit splint wear to 8-14 hours a day
3. Always have full arch coverage
4. Experiment with night or day time wear
5. Anterior repositioning should additionally be worn in daytime for 4 hours
6. Recheck occlusion periodically to rule out occlusal changes from splint wear
108
Why would we counsel the patient to not wear a splint for 24 hours a day long term?
Due to major changes in occlusion (open bite), especially with partial-arch coverage
109
Splint follow-up appointment schedule:
-2 weeks
-1 month
-3 months
-6 months
110
What are we checking for at splint follow-up appointments?
1. check fit and occlusal balance
2. check fit and occlusal wear
3. follow up with pain and adjust medications
4. follow up with physical therapy
111
What are the complications with incorrect splint use?
1. occlusal changes (open bite)
2. speech changes
3. caries
4. gingival inflammation
5. malodor
6. psychological dependence
112
Malocclusion due to arthritis must be monitored:
Once per month for six months
(& the splint serves as a diagnostic purpose to see if occlusal contact on the splint are stable over time)
113
Summary slide for splints:
1. Limit wear to _____ long term
114
115
