Orofacial Specialty Tool           

Orthotic is specialized appliance for management of destructive grind/clench & mod to sev damage to TMD. 

Webster Definition: An orthotic is "an externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal system".

Orthotic: 1) highly refined or accurate nightguard 2)covers all teeth, special design 3) hard throughout 4) used in conjunction with chewing system orthopedics 5) It is not a stand alone appliance 6) By itself, does not cure TMD

Orthotics are used treat:

1. Moderate jaw joint damage
2. Protects joint muscles chewing system
3. Destructive parafunction
4. Painmanagement
5. Atypical earache
6. Atypical toothache
7. Rheumatoid-protect jaw joint
8. Pediatric destructive grinders
9. Tension Headache

Orthotic provides more pain relieve by through: Hard Material Scientific Design High Degree Accuracy

The purpose of Orthotic is to:

• Reduce power
• Reduce muscle recruitment
• Reduce lubricant destruction
• Reduce clench/grind
• Decrease joint pressure
• Reduces muscle inflammation
• Reduce tension headaches

In Study by Kemper & Okeson in 1983 in J Pros Dent (49:702): 33 “jaw pain” patients treated with only orthotic: - 64% reduction - 30% remission of their tension headaches.

Reading Orthotic: Orofacial Pain Specialist: why orthotic adjusted weekly or every other week

1. Divets: illustrate wear of grinding at night
2. Deeper divers decrease level accuracy
3. Muscle relaxation changes contacts disbursement
4. More muscle changes the decrease accuracy
5. Looking for evidence Dual Bites (jaw jt bite verses tooth bite)
6. Greater dual bite decrease in accuracy

Ten tools to reduce parafunction at night:

• Orthotic
• Reduce daytime clenching
• Reduce tension muscles
• Reduce stress control over biochemistry-physiology
• Improve depth & quality sleep
• Project to reduce stress
• Reduce neck & head pain
• Reduce stimulants
• Reduce meds increase parafunction
• Reduce emotional hijacking
• Reverse anxiety wiring to pain system

Destructive Grinding-Clenching:

1. Before Orthotic, Grade level of destruction = 8/10
2. After orthotic, reduce destruction level = 5/10
3. Do we still need wear orthotic at night ?  Yes, we still grind/clench
4. Do we need biofeedback & physical therapy for 5/10 level destruction
5. Grinding/clenching is movement disorder, it is never cured, only reduced 
6. You depend on other tools to manage level destruction to 2/10

Orthotic

1. Reveals wear patterns
2. Reveals level parafunction
3. Reveals power grinding in depth of divets
4. Periodic adjusted for refine accuracy
5. Increase accuracy, increase benefits
6. Last 10 to 20 years due adaptive nature
   1. relined: for retention
   2. resurface: due wear
   3. Adapt: new crown-implant
   4. Repaired: Broken-Cracked
7. Reduce cost patient due longevity and adaptability
8. Diagnostic for bone loss in condyle: Prosthodontic
9. Therapy for sudden bite changes: Prosthodontic

Orthotic is required for Arthritis of the TMD

1. Successfully manage osteoarthritis & rheumatoid TMD
2. Frequent refinement for bone loss
3. Reduces condylar bone loss loading last tooth
4. Adaptive material (resurfaced-relined-refined)
5. Stabilized bone loss in condyle area
6. Stabilized occlusion for reconstruction needs
7. Prosthodontist needs orofacial report that bone stabilization
8. Chewing System Orthopedic is necessary before major crown & bridge in Oseteorthritis cases
9. Protects precision & expensive: crown - bridge – implants – veneers-braces

Orthotic is for Destructive Grinders

1. Reduces need for new night guard: Break-Wearout-Grind through
2. Does not cause bite changes
3. Handles excessive power
4. Reduces grinding/clenching
5. Reduced appliance cost
6. Destructive grinding requires all 11 tools
7. Destructive grinding is movement disorder

Orthotic protects: Crown -- Bridge -- Implant--Root canal

1. Protects "your" expensive dentistry
2. Enhances longevity
3. Adaptive to changes
4. Test accuracy Occlusion before reconstruction
5. Helps work out dual bites
6. Helps dentist find centric relation
7. Protects muscle and TM joint
8. Stabilizes bone loss loads posterior teeth

Accuracy requires: 3-year residency orofacial pain

1. Accuracy orthotic is one of the focus residence
2. Researched design – materials - accuracy
3. Professors are masters at pain management
4. Taught how read appliances
5. Determine level parafunction
6. Science of chronic pain
7. Parafunction hidden destructive disease
8. Pharmacology of parafunction

Famous quote from endodontist:  I can teach you how to do root canal in weekend, but it takes 3 years to teach the exceptions. Exceptional accuracy takes 3 years to teach and I would say even 20 years of practice.

THE PENNY PINCHER: A patient needed orthotic for his jaw locking & tension headaches. He ask cost of the orthotic and then called his dentist to ask the cost of his nightguard. The cost difference between the nightguard and the orthotic was several hundred dollars; so, thinking he was getting the same appliance for less he bought nightguard. After 2 weeks of wearing nightguard, his jaw pain increased from 6/10 pain to 8/10 pain. Not only did he waste time reducing his pain, but he increase his pain all in effort save hundreds dollars. Why was he not told by dentist that the nightguard was less accurate and wrong material ? Why did he not do research on difference nightguard and orthotic ? This guy did a years research on his turntable; yet, he did not even read the scientific material provided "Confusing Appliances" given to him at the exam. Consulting with orofacial pain specialist due increase pain, he begged for emergency impressions for orthotic and doctor rush lab to deliver the pain saving device called orthotic. He was excited wearing orthotic because his pain dropped from a 8/10 to 5/10, then after week later reduced to 4/10.