Any of you who regularly read my blog know I regularly treat TMD in my practice, both occluso-muscle disorders and joint issues. The first line of defense for many of these patients is an occlusal appliance or orthotic and the design of that device is dependent on the results of a joint, muscle and occlusal exam. Appliances fall into one of six categories based on design, regardless of the name that may be attached to it.
- Anterior Only
- Posterior Only
- Full Coverage Flat Plane (Universal)
- Full Coverage Anatomic
- Full Coverage Soft
- Anterior Repositioning
I also have a group of patients who have obvious occlusal wear from attrition, but healthy joints and healthy muscles. The challenge for me is helping this group of patients wear something that will protect their teeth. The challenge is a balance between their understanding of what is happening to their teeth and the cost and inconvenience of wearing a nightguard. I use the term nightguard to design a protective appliance designed only to slow or stop the wear to the teeth.
Editors Note: Dreamgard is no longer in business
I have recently delivered a small number of nightguards from a new company called Dreamgard. At first I was skeptical when they said I only needed an upper impression, that it was quick and easy, my patients would love and they are cost effective for patients and dentists. My experience has been they delivered everything they promised. We took an upper putty wash impression and got back the nightguard. It was delivered in under ten minutes. The patients have told me they are the most comfortable nightguard they have ever worn.
The retention is excellent, and the delivery process creates an even MIP occlusion. Your excursive guidance will vary depending on the angle of the individual patients eminence, so you will see a range between anterior guidance and group function, but the Dreamgard is designed to protect against wear, not for patients with muscle or joint pain. I am thrilled to have a device that overcomes the barriers of cost and comfort and offers my patients a nightguard they will wear.
Bryan Laskin says
Great article. I’ve found My patients (and I) find the Dreamgards very comfortable too, and provides an nice cost effective solution for many patients with almost no doctor time needed. I’ve been pleasantly surprised.
Tom Draper says
Hi Leeann – In this month’s Dental Town magazine, I read a dentist quoting another dentist as saying somewhere around 1/3 of people do well with occlusal guards, 1/3 stay the same, and 1/3 get worse.
I seem to have fairly good success with the hard/soft occlusal guards that most labs make.
Is the possible problem that most dentists do not find the specific guard for each specific patient?
Thanks for sharing all of your knowledge on this blog!
Lee Ann Brady says
Not every patient has issues that are related to their occlusion and doing a thorough joint, muscle and occlusal exam and determining which appliance of the six designs you believe is the best to address that person’s occlusion is critical to their success. If you simply make a full coverage passive appliance for everyone, and do not tailor the appliance design to the patient’s present condition then expecting resolution of their symptoms is a guess and will work some of the time and not work some of the time. I’d also add that the patients response to the appliance is important diagnostic information that should lead to the next step in their treatment, including if they get worse. You have to ask yourself why? Did the appliance increase joint load, strain muscles, pinch retrodiscal tissue?
Tom Draper says
Thanks Lee Ann. Looking forward to the treatment planning course tomorrow, travel safely!
It doesn’t look like Dreamgard is still around. Can you confirm?
Lee Ann Brady says
Dreamguard no longer exists, unfortunately the company could not make a go of it.
Dreamgard is no longer around. Several companies are trying to work out a similar material combo.