Appliance Selection

Appliance selection should be based on patients needs not the training bias of school, school thought, or limited training of dentist.

A proper diagnosis of the problem, then selection of appliance that fulfills that need.

APPLIANCE SELECTION = NOT BASED ON SCIENCE 1) One appliance fits all 2) Appliance with best marketing 3) Appliance of guru #3 4) Only appliance taught by Dental School, 5) HYPE-latest and greatest 6) Appliance easiest to deliver 7) Appliance lab provided told you appliance 8) Appliance makes most money 9) Appliance requested by patient

Are you caring for patients needs or just selling an appliance.

Read "Confusing Appliances" or do your own research into science of appliances.

The purpose of each piece MAGIC plastic is hidden somewhere in all that sales rhetoric. Beware there is always limited science in there somewhere, but like all brain washing it is full of half truths. What do you think internet or stores are doing, offering a service ??? You do realize there is no agency that regulates appliances; so, let's invent the "Raleigh appliance" and add some extra plastic for creativity. Our appliance is design to help your wallet loose weight. Boy does that leave bad taste in my mouth !!!

Improve your health by requesting right appliance for your needs 1) What is your health concern 2) What appliance satisfies that need 3) Protecting teeth (dental) or muscle/joint (medical) 4) Preventing recession, cervical erosion, or sensitivity 5) Prevent breakage expensive dental work 6) Discerning outside nerve verses inside nerve 7) Preventing tension headache 8 )Reducing inflammation setting off migraines

TYPES APPLIANCES: 1) Biteguard (BG) 2) Hybrid (HB) 3) Nightguard (NG) 4) Orthotic (OR)

Orthotic is not stand-alone appliance, it requires chewing system orthopedics to be effective against destructive grind-clench,

The Orthotic gets it's superb benefits due proper design for chewing system, hard material throughout, and superb accuracy. It is in accuracy of orthotic that 3 years of orofacial residency is necessary.

Concern-problems-needs: why appliances are prescribed:

  1. Chip-broken-crack teeth
  2. Mild to Mod Clench/Grind
  3. Chewing muscle pain
  4. Sensitivity-recession-bone loss w/o infection
  5. Moderate-severe Wear
  6. Mild-Mod-Sev TMJ damage
  7. Child grinding & Pediatric HA
  8. Tension Headaches
  9. Dual bite/Interferences/Occlusion
  10. Destructive grind-clench
  11. Broken fillings-crowns-implants-bridges
  12. Cervical erosion-mobility/
  13. Broken retainers-nightguards-spacers-Hawley
  14. Atypical toothache
  15. Retainers on grinder-clencher
  16. Atypical earache

Places to acquire appliances: 1) Dentist 2) Specialist 3) Internet 4) Stores

Beware: Majority OTC & Internet appliances are not worn due discomfort, no benefits, or poor fit; thus, the cost saving you hoped for ends up being waste money and you still have problem.

Please research appliance science:

  1. Symptoms of grind/clench
  2. Symptoms of TMJ Damage
  3. Chronic verses acute pain
  4.  Durability, adaptability, longevity appliance
  5.  Material, Design, Accuracy
  6. Early symptoms of clench/grind
  7.  Information: Selling or Science
  8.  Purpose of appliance
  9.  Value, cost, benefit, length service
  10. Affect on airway
  11. Side effects
  12. Changes my bite

Following is a review of how to choose a device/appliance by the following symptoms: this science is to provide for your safety, protection, cost effective.

     1) Sensitivity: 2) Parafunction 3. Damage to TMJ

  1. Early sensitivity =bite guard a. mild clench/grind = soft biteguard i) mild damage =hybrid
  2. Mod sensitivity = hybrid & NG b) mod clench/grind = hybrid & NG ii) mod damage=nightguard
  3. Progressive sensitivity = orthotic c) destructive grind = orthotic iii) severe damage=orthotic

Appliances side effects 1) soft bite guard:== increase grinding, bulky, difficult breath night, difficult wear         2) Hybrid (soft/ hard): increase clench, can’t reline, cannot repair, cannot adapt to new crown or implant             3) Nightguard - ineffective dual bites, ineffective destructive grinding, breaks/cracks/wears out destructive grind 4) Orthotic-cost, needs refining 6 months, 1 tool ineffective on destructive grind, need for specialist

Biteguard

  1. Soft
  2. OTC, Internet, Dentist
  3. Bulky
  4. Can be uncomfortable OTC & Internet
  5. Dentist can adjust
  6. Crowd tongue & impedes airway
  7. Use when there is no TMJ damage

Soft Biteguards increase clenching and grinding.

Hybrid

  1. Soft inside-hard outside biteguard
  2. Can’t reline for crown & bridge
  3. Increases Clench-Grind
  4. Used for mild or moderate clench/grind
  5. Soft lining allow compressibility
  6. Make new one with new crowns
  7. Protects teeth
  8. Reduces muscle recruitment slightly
  9. Do not use in restricted opening or destructive grind
  10. Decrease accuracy due soft lining
  11. Use with mild damage TMJ

Hard/soft-Hybrid Appliance has to be remade every time you get new crown or implant.

Hybrid soft inner lining cause some increase grind-clench.

Night guard

1. Use for mild to mild (+) damage TMJ 2. Design: mostly full coverage, hard throughout, accuracy varies 3. Provides more accurate bite w/o expensive Cr & Br 4. Clenching decreases by degree accuracy 5. Training nightguards at Dawson-Pankey training 6. Do not use on destructive bruxers, they can break them 7. Do not use restricted opening-not accurate or powerful enough

Nightguard is the best dental appliance for reducing grind & clench.

Orthotic

1. Appliance used w/ chewing system orthopedics 2. Requires high degree accuracy 3. Requires 2-3 years as resident to train level of accuracy 4. Design: full coverage, hard throughout, flat post plane, anterior guidance 5. Used for Restricted opening, Osteoarthritis, Destructive parafunction, Chronic jaw pain, Trauma 6. Orthotic is not stand-alone appliance, it requires chewing system orthopedics to be effective 7. What makes orthotic have more benefits: design, material, accuracy

Orthotic protects all 4 of chewing structures, espcecially muscles and joints. Being orthopedic device it is medical.

Miscellaneous appliances

NTI-Anterior Deprogrammer 1. Partial coverage on anterior teeth 2. Changes bite if worn too long 3. Decrease muscle power 4. Do not use in destructive grinder 5. Fo short term or in office use 6. Never use on restricted opening, effusion, or osteoarthritis 7. Good test for atypical toothache 8) Do not use moderate to severe damage TMJ 9) Increase loading on TMJ's

NTI is great appliance for dentist to use in "short term" management muscle or minor jaw joint damage cases.

ARS (Anterior Repositioning Splint) 1. Major changes to bite 2. Need braces or reconstruction to fix bite changes 3. Sets condyle on slippery incline down eminence 4. Causes unstable bite 5. Muscle brace to hold condyle on slick slope 6. Add this muscle bracing to all other muscle recruiters 7. Do not wear 24/7 for prolong period 8) Benefit pulls condyle away inflamed retrodiscal tissue 9) Do not use destructive grinders 10) Do not use on moderate to severe damage TMJ

ARS-LVI Appliances change your bite.

ARS-LVI Appliances are contraindicated in osteoarthritis and completely displaced disc.

Sources of appliance training:

  1. Dental school training == soft biteguard
  2. NO training == internet sales companies
  3. Training nightguards == Pankey & Dawson
  4. Hybrid == soft inner lining less delivery time
  5. Orthotic == extensive accuracy training in 3 yr residency

Dentist appliance training:

  1. Side effects are not reported by company
  2. Dental school does not teach appliance science
  3. Dentist are too busy to keep up appliances
  4. Parafunction is not considered a disease
  5. Should be prescribed by science
  6. Dentist uses one appliance for all patients

Appliances that increase clenching & grinding: 1. Biteguard: soft 2. Hybrid: Soft Hard 3. Nightguard: inaccurate

Facts about appliances

  1. No appliance fixes “TMD”.
  2. Soft biteguards treat teeth
  3. Hard appliances treat teeth, minor TMD
  4. Orthotic treats moderate to severe TMD
  5. NG & BG treat symptom not cause

CAUTION: ARS & NTI:   Can cause bite changes that cost thousands to correct. 1) ARS: anterior repositioning appliance: brings jaw joint down and forward from it's proper place on slick incline held muscles causing posterior open bite, which has to be treated with braces or crown/bridge. This was invented by self appointed guru, who decided how "he" would treat TMD regardless of science. You decide if these slick salesman based on no science have right to put your jaw joint where a unproven machine says it should go. 2) NTI: prefab anterior deprogrammer: a button plastic on front teeth; deprograms muscles to reduce contraction rate and power, best use is in muscle pain cases or mild damage to jaw joint. The major concern when NTI first came out we did not know the side effect of the appliance. If a patient is worn NTI all time, it can change bite. Most conscientious dentist warn the patient not wear NTI full time, but few patients did not return for guidance and cause anterior open bite.

THE PENNY PINCHER: The patient was told by hygienist and dentist that she needed a nightguard for her clench-grind. She asked cost of the hard nightguard, then researched internet for cost of soft biteguard. She ordered soft biteguard after taking her own impressions without researching purpose of different appliances. The cost difference between the biteguard and the nightguard was several hundred dollars; so, thinking she was getting the same appliance for less he bought biteguard. After 2 weeks of wearing biteguard, her clench/grind increased, tightness in her jaw, and increase in temple headaches. Not only did she waste money buying soft biteguard but she had increase jaw pain and tension headaches which required extensive management.

Purpose orthotic & chewing system orthopedics

  1. Restricted opening 2. Destructive grinding 3. Moderate-Severe damage 4. Tension Headache 5. Trauma 6. Atypical toothache 7. Atypical earache 8. Oral nerve pain 9. Dual bite. 10. High anxiety 11. Severe wear 12. Crack-broken-chip teeth 13. Break or Wearout BG & NG 14. Cosmetics-square jaw look women

With all this science needed to select right appliance, what are chances of getting internet appliance to be effective at treating your specific problem. As grandpa use to say, it be like Blind hog finding an acorn.

SPECIALTY & APPLIANCES

  1. Pediatrics: mod wear on primary & 1st molar, broken. retainers, crack teeth, tension HA
  2. Peridontics: recession, mobility, sensitivity, bone loss, cervical erosion w/o infection
  3. Endodontics: frequent root canals, root canals not relieving tooth pain, root canals w/ Expand PDL
  4. Rheumatology: rheumatoid arthritis to guard & protect TMJ
  5. ENT: frequent atypical earache w/o infection

Appliance selection should be based on patients needs not the training bias of school, school thought, or limited training of dentist.

A proper diagnosis of the problem, then selection of appliance that fulfills that need.

APPLIANCE SELECTION = NOT BASED ON SCIENCE 1) One appliance fits all 2) Appliance with best marketing 3) Appliance of guru #3 4) Only appliance taught by Dental School, 5) HYPE-latest and greatest 6) Appliance easiest to deliver 7) Appliance lab provided told you appliance 8) Appliance makes most money 9) Appliance requested by patient

Are you caring for patients needs or just selling an appliance.

Read "Confusing Appliances" or do your own research into science of appliances.

The purpose of each piece MAGIC plastic is hidden somewhere in all that sales rhetoric. Beware there is always limited science in there somewhere, but like all brain washing it is full of half truths. What do you think internet or stores are doing, offering a service ??? You do realize there is no agency that regulates appliances; so, let's invent the "Raleigh appliance" and add some extra plastic for creativity. Our appliance is design to help your wallet loose weight. Boy does that leave bad taste in my mouth !!!

Improve your health by requesting right appliance for your needs 1) What is your health concern 2) What appliance satisfies that need 3) Protecting teeth (dental) or muscle/joint (medical) 4) Preventing recession, cervical erosion, or sensitivity 5) Prevent breakage expensive dental work 6) Discerning outside nerve verses inside nerve 7) Preventing tension headache 8 )Reducing inflammation setting off migraines

TYPES APPLIANCES: 1) Biteguard (BG) 2) Hybrid (HB) 3) Nightguard (NG) 4) Orthotic (OR)

Orthotic is not stand-alone appliance, it requires chewing system orthopedics to be effective against destructive grind-clench,

The Orthotic gets it's superb benefits due proper design for chewing system, hard material throughout, and superb accuracy. It is in accuracy of orthotic that 3 years of orofacial residency is necessary.

Concern-problems-needs: why appliances are prescribed:

  1. Chip-broken-crack teeth
  2. Mild to Mod Clench/Grind
  3. Chewing muscle pain
  4. Sensitivity-recession-bone loss w/o infection
  5. Moderate-severe Wear
  6. Mild-Mod-Sev TMJ damage
  7. Child grinding & Pediatric HA
  8. Tension Headaches
  9. Dual bite/Interferences/Occlusion
  10. Destructive grind-clench
  11. Broken fillings-crowns-implants-bridges
  12. Cervical erosion-mobility/
  13. Broken retainers-nightguards-spacers-Hawley
  14. Atypical toothache
  15. Retainers on grinder-clencher
  16. Atypical earache

Places to acquire appliances: 1) Dentist 2) Specialist 3) Internet 4) Stores

Beware: Majority OTC & Internet appliances are not worn due discomfort, no benefits, or poor fit; thus, the cost saving you hoped for ends up being waste money and you still have problem.

Please research appliance science:

  1. Symptoms of grind/clench
  2. Symptoms of TMJ Damage
  3. Chronic verses acute pain
  4.  Durability, adaptability, longevity appliance
  5.  Material, Design, Accuracy
  6. Early symptoms of clench/grind
  7.  Information: Selling or Science
  8.  Purpose of appliance
  9.  Value, cost, benefit, length service
  10. Affect on airway
  11. Side effects
  12. Changes my bite

Following is a review of how to choose a device/appliance by the following symptoms: this science is to provide for your safety, protection, cost effective.

     1) Sensitivity: 2) Parafunction 3. Damage to TMJ

  1. Early sensitivity =bite guard a. mild clench/grind = soft biteguard i) mild damage =hybrid
  2. Mod sensitivity = hybrid & NG b) mod clench/grind = hybrid & NG ii) mod damage=nightguard
  3. Progressive sensitivity = orthotic c) destructive grind = orthotic iii) severe damage=orthotic

Appliances side effects 1) soft bite guard:== increase grinding, bulky, difficult breath night, difficult wear         2) Hybrid (soft/ hard): increase clench, can’t reline, cannot repair, cannot adapt to new crown or implant             3) Nightguard - ineffective dual bites, ineffective destructive grinding, breaks/cracks/wears out destructive grind 4) Orthotic-cost, needs refining 6 months, 1 tool ineffective on destructive grind, need for specialist

Biteguard

  1. Soft
  2. OTC, Internet, Dentist
  3. Bulky
  4. Can be uncomfortable OTC & Internet
  5. Dentist can adjust
  6. Crowd tongue & impedes airway
  7. Use when there is no TMJ damage

Soft Biteguards increase clenching and grinding.

Hybrid

  1. Soft inside-hard outside biteguard
  2. Can’t reline for crown & bridge
  3. Increases Clench-Grind
  4. Used for mild or moderate clench/grind
  5. Soft lining allow compressibility
  6. Make new one with new crowns
  7. Protects teeth
  8. Reduces muscle recruitment slightly
  9. Do not use in restricted opening or destructive grind
  10. Decrease accuracy due soft lining
  11. Use with mild damage TMJ

Hard/soft-Hybrid Appliance has to be remade every time you get new crown or implant.

Hybrid soft inner lining cause some increase grind-clench.

Night guard

1. Use for mild to mild (+) damage TMJ 2. Design: mostly full coverage, hard throughout, accuracy varies 3. Provides more accurate bite w/o expensive Cr & Br 4. Clenching decreases by degree accuracy 5. Training nightguards at Dawson-Pankey training 6. Do not use on destructive bruxers, they can break them 7. Do not use restricted opening-not accurate or powerful enough

Nightguard is the best dental appliance for reducing grind & clench.

Orthotic

1. Appliance used w/ chewing system orthopedics 2. Requires high degree accuracy 3. Requires 2-3 years as resident to train level of accuracy 4. Design: full coverage, hard throughout, flat post plane, anterior guidance 5. Used for Restricted opening, Osteoarthritis, Destructive parafunction, Chronic jaw pain, Trauma 6. Orthotic is not stand-alone appliance, it requires chewing system orthopedics to be effective 7. What makes orthotic have more benefits: design, material, accuracy

Orthotic protects all 4 of chewing structures, espcecially muscles and joints. Being orthopedic device it is medical.

Miscellaneous appliances

NTI-Anterior Deprogrammer 1. Partial coverage on anterior teeth 2. Changes bite if worn too long 3. Decrease muscle power 4. Do not use in destructive grinder 5. Fo short term or in office use 6. Never use on restricted opening, effusion, or osteoarthritis 7. Good test for atypical toothache 8) Do not use moderate to severe damage TMJ 9) Increase loading on TMJ's

NTI is great appliance for dentist to use in "short term" management muscle or minor jaw joint damage cases.

ARS (Anterior Repositioning Splint) 1. Major changes to bite 2. Need braces or reconstruction to fix bite changes 3. Sets condyle on slippery incline down eminence 4. Causes unstable bite 5. Muscle brace to hold condyle on slick slope 6. Add this muscle bracing to all other muscle recruiters 7. Do not wear 24/7 for prolong period 8) Benefit pulls condyle away inflamed retrodiscal tissue 9) Do not use destructive grinders 10) Do not use on moderate to severe damage TMJ

ARS-LVI Appliances change your bite.

ARS-LVI Appliances are contraindicated in osteoarthritis and completely displaced disc.

Sources of appliance training:

  1. Dental school training == soft biteguard
  2. NO training == internet sales companies
  3. Training nightguards == Pankey & Dawson
  4. Hybrid == soft inner lining less delivery time
  5. Orthotic == extensive accuracy training in 3 yr residency

Dentist appliance training:

  1. Side effects are not reported by company
  2. Dental school does not teach appliance science
  3. Dentist are too busy to keep up appliances
  4. Parafunction is not considered a disease
  5. Should be prescribed by science
  6. Dentist uses one appliance for all patients

Appliances that increase clenching & grinding: 1. Biteguard: soft 2. Hybrid: Soft Hard 3. Nightguard: inaccurate

Facts about appliances

  1. No appliance fixes “TMD”.
  2. Soft biteguards treat teeth
  3. Hard appliances treat teeth, minor TMD
  4. Orthotic treats moderate to severe TMD
  5. NG & BG treat symptom not cause

CAUTION: ARS & NTI:   Can cause bite changes that cost thousands to correct. 1) ARS: anterior repositioning appliance: brings jaw joint down and forward from it's proper place on slick incline held muscles causing posterior open bite, which has to be treated with braces or crown/bridge. This was invented by self appointed guru, who decided how "he" would treat TMD regardless of science. You decide if these slick salesman based on no science have right to put your jaw joint where a unproven machine says it should go. 2) NTI: prefab anterior deprogrammer: a button plastic on front teeth; deprograms muscles to reduce contraction rate and power, best use is in muscle pain cases or mild damage to jaw joint. The major concern when NTI first came out we did not know the side effect of the appliance. If a patient is worn NTI all time, it can change bite. Most conscientious dentist warn the patient not wear NTI full time, but few patients did not return for guidance and cause anterior open bite.

THE PENNY PINCHER: The patient was told by hygienist and dentist that she needed a nightguard for her clench-grind. She asked cost of the hard nightguard, then researched internet for cost of soft biteguard. She ordered soft biteguard after taking her own impressions without researching purpose of different appliances. The cost difference between the biteguard and the nightguard was several hundred dollars; so, thinking she was getting the same appliance for less he bought biteguard. After 2 weeks of wearing biteguard, her clench/grind increased, tightness in her jaw, and increase in temple headaches. Not only did she waste money buying soft biteguard but she had increase jaw pain and tension headaches which required extensive management.

Purpose orthotic & chewing system orthopedics

  1. Restricted opening 2. Destructive grinding 3. Moderate-Severe damage 4. Tension Headache 5. Trauma 6. Atypical toothache 7. Atypical earache 8. Oral nerve pain 9. Dual bite. 10. High anxiety 11. Severe wear 12. Crack-broken-chip teeth 13. Break or Wearout BG & NG 14. Cosmetics-square jaw look women

With all this science needed to select right appliance, what are chances of getting internet appliance to be effective at treating your specific problem. As grandpa use to say, it be like Blind hog finding an acorn.

SPECIALTY & APPLIANCES

  1. Pediatrics: mod wear on primary & 1st molar, broken. retainers, crack teeth, tension HA
  2. Peridontics: recession, mobility, sensitivity, bone loss, cervical erosion w/o infection
  3. Endodontics: frequent root canals, root canals not relieving tooth pain, root canals w/ Expand PDL
  4. Rheumatology: rheumatoid arthritis to guard & protect TMJ
  5. ENT: frequent atypical earache w/o infection

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