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.