Orthotic Solutions and Phase II Treatments

Dr. Michael Westman TMJ Pain Solutions, TMJ Treatment

Orthotic Solutions

Therapeutic Orthotics

Therapeutic orthotics are made of clear or tooth colored acrylic, moulded to attach to the lower teeth. (Lower teeth whenever possible, because orthotics attached to lower teeth are more comfortable than those attached to upper teeth.)

The biting surfaces of the orthotic simulate a set of properly positioned teeth. The orthotic bite relaxes the jaw muscles and aligns the jaw joints to bring balance to the jaw muscles and joints in their closure and resting positions. That balance extends to the musculoskeletal systems of the head, neck, shoulders and back, to help provide alignment, stability and comfort to those systems as well.

Exactly how a therapeutic orthotic is designed and how much time it is worn, depends on individual circumstances in each case. Flat-plane versus anatomic; wearing it part-time versus most-of-the-time, versus wearing it full-time including while eating, are all options to be considered. A custom plan is made for each patient after a thorough evaluation and diagnosis by Dr. Westman.

It all starts with a proper diagnosis

Whether it is a non-pain patient who wants to save their teeth from being destroyed by their stressful bite, or a pain patient who needs to get comfortable, or a pain patient who’s goal is to get comfortable and save their deteriorating teeth, a proper diagnosis is essential to providing proper treatment.

It is necessary to differentiate among muscle disorders, tmj disk disorders, inflammatory disorders, chronic hypomobilities, hypermobilities, growth disorders, traumatic injuries, and abnormal jaw closure patterns as being components of each case. Dr. Westman performs a comprehensive clinical examination and uses Computerized Jaw Tracking, EMGs, Sonography, and ultra-low radiation CT-Scan imaging, to evaluate, diagnose, and provide the best treatment options for every patient. We bundle the cost of the diagnostic procedures into the cost of the various orthotic options we offer.

The Non-Pain Patient Therapeutic Orthotic

These provide protection from excessive wear and tear on teeth, dental restorations and periodontal tissues that are caused clenching and grinding or gnashing of teeth. They are meant for part time use only. These orthotics are made to a rested jaw muscle position that minimizes or eliminates clenching and grinding. We incorporate the use of a physiotherapeutic Ultra-Low Frequency TENS to relax tense jaw muscles and help determine the relaxed bite position for the patient that gives the best support for the jaws and protection from bite stresses while the orthotic is being worn.

The Pain Patient Initial Therapeutic Orthotic

The pain patient has special needs. In order to decrease the suffering caused by a pathological biting position, Ultra Low Frequency TENS is used to relax tense jaw muscles and help determine the relaxed bite position for the patient that has the best potential to optimize head, neck and jaw posture, give the best support for the jaw muscles and joints, and reduce bite stresses on the teeth.

Dr Westman designs initial therapeutic orthotics for pain patients to wear full-time except while eating, and in some cases full-time including while eating. Wearing the initial therapeutic orthotic as prescribed usually eliminates or drastically reduces pain and other related symptoms within a few days to weeks of wearing it.

After the initial healing period, patients may continue wearing their initial therapeutic orthotic as long as it still fits their teeth (it should fit as long as no major dental work is performed). Some patients try to wean off of their orthotic as much as return of their symptoms allows, and they wear their orthotic only when they feel they need it the most. Other patients upgrade to a more durable long-term orthotic that they can use full-time including while eating.

NOTE: Orthotics do not fix teeth. An orthotic by itself does not permanently correct the pathological bite arrangement of the teeth that caused the initial disorder. Therapeutic Orthotics will help bring balance to the jaw and neck muscles, but only while wearing the orthotic.

Think of it this way: if you have poor eyesight and you need glasses to correct your eyesight, you must have your glasses on for them to work. Your glasses will not heal your eyes. If you have flat feet and you need foot orthotics to give you a proper stance, the foot orthotics will only work while in your shoes. Your foot orthotics will not heal your flat feet.

To permanently fix the bite of your teeth so you do not need to rely on a Therapeutic Orthotic for proper alignment, another phase of treatment is required.

Reconstructive Orthotics

For many, the thought of a lifetime wearing a Therapeutic Orthotic is undesirable. While comfortable to wear, Therapeutic Orthotics require care and maintenance and must be replaced if they they wear out, become broken or lost, or don’t fit the teeth anymore (i.e. if major dental work has been performed). Many patients seek a more permanent solution. That solution requires a greater deal of care determining and perfecting the bite position.

Reconstructive Orthotics are the stepping stone toward long-term phase-two treatment solutions consisting of Orthodontic Braces, or Reconstructive Porcelain Restorations (we call Smile Rejuvenation), or a combination of orthodontics and reconstructive porcelain restorations.

There are two main types of reconstructive Orthotics: Removable Clear Acrylic, and Bonded Tooth-Colored. Both have anatomic biting surfaces that mimic an ideal bite position, with cusps which help provide a stable “Home” for the upper and lower jaws to bite or occlude, and allow for the most efficient chewing and the best jaw and posture stability. These orthotics are monitored over several months and adjusted as the jaw muscles relax more, the jaw joints continue to decompress, and the posture continues to improve and stabilize.

Removable Clear Acrylic Reconstructive Orthotics

These are for patients who suffer from more complex TMJ disorder pain issues who wish to have phase-two treatment in the future. As for Pain Patient Therapeutic Orthotics, we use Computerized Jaw Tracking, 8 channel EMGs, jaw joint Sonography, and extremely low radiation CT-Scan imaging to help determine the appropriate bite position for the jaw.

Reconstructive orthotics are worn full-time including while eating, for usually at least three months and sometimes 6 to 18 months or more. The duration depend on the number and extent of bite rebalancing orthotic adjustments that are periodically necessary as jaw muscles relax, jaw joints decompress, and head, neck, and back posture improves and stabilizes.

Bonded Tooth-Colored Reconstructive Orthotics

These are the most comfortable, easiest to wear as they are bonded onto the tooth surfaces of the lower and/or upper teeth. It is very easy to eat, talk, and sing with these orthotics. We provide special home care devices to help keep the teeth and gum tissue healthy while wearing the Bonded Tooth Colored Reconstructive Orthotic. Professional cleanings are required by our hygiene team every 3 months to ensure healthy gum tissue while wearing Bonded Tooth-Colored Reconstructive Orthotics.

These orthotics are practically invisible in your mouth as they blend into your own teeth. They can be in the mouth for up to 2 years with proper care. When the patient’s front teeth were previously worn down, crooked or mis-shaped, the upper orthotic actually looks better then the original teeth and is a preview of what a smile-makeover would look like.

Bonded Tooth-Colored Orthotic is worn for at least three months to relieve symptoms.
Then the second phase of the treatment begins. 

Phase II Treatments

Smile Rejuvenation

Smile Rejuvenation is a term we created to explain the rebuilding of broken, dentally compromised teeth that cannot be corrected with Orthodontic care. Smile Rejuvenation is the use of attractive and modern Porcelain materials to not only give a natural attractive looking set of teeth but to correct the bite problems that lead to the initial TMJ Disorders.

Smile Rejuvenation can be in conjunction with Orthodontic care or by itself. As with all dental care, Smile Rejuvenation is tailored to the patient’s individual needs and time frame. Treatment may be stepped in order to defer costs over a greater period of time.

Orthodontics (Braces)

Many TMJ Disorder patients will choose Orthodontic care as their phase-two treatment.

Dr. Westman is uniquely qualified in providing neuromuscular functional orthodontics as a conservative, less expensive option (compared to the cost of bite reconstruction with porcelain veneers or crowns), and often most effective option, to maintain the comfort in the jaw joints, muscles and general posture that was achieved during phase-one orthotic therapy.

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If you want to get rid of your TMJ symptoms, we can help. Schedule a consultation and we'll outline the TMJ treatment options that can help to alleviate your pain or discomfort. There are no obligations or commitments -- this consultation is absolutely FREE.