Michael DiTolla, DDS, FAGD
As general dentists, we are involved primarily with only three major diseases or conditions: dental caries, periodontal disease and occlusal conditions. The majority of general dental practices tend to revolve around the restoration and replacement of restorations for teeth affected by caries. Periodontal disease therapy is typically provided by periodontists and the hygienists employed in general dental practices. This column will deal with the often ignored area of occlusal conditions. The key to delivering occlusal splints in an effective manner is to use a material that requires little or no adjustments while providing maximum comfort to the patient to maximize patient compliance. A material that fits both of these requirements is the new Erkoloc-PRO Extra Comfort splint, fabricated from a hard/soft material. The hard material is on the outside to increase longevity and aid in excursive movements, while the soft material is on the inside to aid in fit, comfort, and to prolong its usefulness.
At a state of the industry dental conference, Dr. Gordon Christensen remarked that there are between 500 to 1,000 occlusal splints waiting to be made in every dental office. He estimates that one-third of the population either brux or clench their teeth, resulting in tooth damage. In the January 2001 edition of JADA, Dr. Christensen cites several abnormal conditions related to occlusion, and suggestions relative to the treatment of these conditions. Dr. Christensen feels the solution to both of these conditions is an occlusal splint worn at night, and during periods of psychological stress, in the daytime as well. He states, "If a dentist merely 'watches' patients at they wear their teeth down, he or she is practicing supervised neglect and contributing to continued tooth destruction."
Dr. Christensen also estimates that 80 percent of TMD cases he has treated in his 40 years of practice have been muscular in nature and have responded well to occlusal splint therapy and subsequent occlusal equilibration. Dr. Christensen also reasons that if excessive occlusal forces cause abfraction lesions, can't we prevent further degeneration of these teeth by placing occlusal splints in the mouths of these patients?
Our research has shown that the number of splints fabricated by dental laboratories is much lower than that. The most common complaint voiced by dentists is the cost of fabrication, and the amount of time required to seat the splint. Adjusting the occlusion of the splint can run to about 15 minutes alone, which can be very frustrating for the practitioner.
Bruxism is most commonly defined as the non-purposeful grinding of teeth in eccentric positions that eventually removes canine rise, incisal guidance, and posterior tooth cusp tips. Most bruxism takes place at night, although patients tend to deny this habit. As a result of their advanced tooth wear, most bruxers have a group function occlusion.
Clenching is typically defined as the non-purposeful closing of teeth in centric occlusion. Clenchers are also more active at night, but you may notice them clench at any time by observing their bulging, strongly developed masseter and temporalis muscles in action. Typical clenchers accentuate and deepen centric occlusion tooth contacts. They tend to have steep canine rise, incisal guidance, and posterior tooth cusp tips.
There is no known cure for bruxism or clenching, and as a result, the most successful and predictable techniques are preventive in nature. A bite splint (aka night guard, occlusal splint, etc.) is typically used to stop the wear of upper and lower teeth, since tooth structure is harder than the bite splint material. Splints are commonly worn at night and during psychologically stressful days. Therapy for bruxism and clenching should begin as soon as the condition is visually confirmed in an adult dentition by the dentist. It can be advantageous to inform patients of their bruxing problem during a hygiene appointment and have them observe their habit for a few months before beginning therapy. This assures them that they have the problem, and is helpful for patients who are convinced that they neither clench nor brux, yet their clinical condition tells a different story. When most patients are told that their teeth are being destroyed, they want treatment.
As a result of the Erkoloc-PRO Extra Comfort splint's hard/soft technology, you should expect there to be no adjustments necessary to seat the splint, and perhaps just a minor adjustment to the bite. Unlike delivering hard splints where the patients often winced when the splint was being placed for the first time, the patients are often able to place the splint for the first time by themselves, with no discomfort or feeling that their teeth are being forced out of position. Also, if a patient doesn't wear their splint for a week, there is no pain when they put it back in due to the soft inner layer, a significant benefit for patients who aren't full-time splint wearers.
Dr. Michael DiTolla is director of clinical research and education at Glidewell Labs in Newport Beach, Calif., where he also teaches over-the-shoulder courses on topics such as esthetic restorative dentistry. Dr. DiTolla also teaches a two-day, live-patient, hands-on laser-training course that emphasizes diode and erbium lasers. In addition, he teaches a two-day, hands-on digital photography course emphasizing intraoral and portrait photography, and image manipulation. More information on these and other courses can be found by email at [email protected] or by calling (888) 535-1289.