Oral Appliance Therapy

There are several factors which influence the design and fabrication of your oral orthopedic appliances (orthotics). We use several designs including increased vertical dimension appliances, anterior repositioning splints, 3-way expansion appliances, Herbst appliances, airway dilating appliances, anterior deprogramming and NTI-type appliances.

Based upon our clinical examination, radiographic interpretation, and analysis of your dental models we determine how to best treat your condition. Appliances can be used to:

  • Decrease compression on the pain sensitive tissues within the posterior retro-discal tissue area. When the disk slips forward, then clenching, swallowing and biting forces are placed onto the primary area of nerve and blood supply. This causes pain and inflammation within the joint. An inflammatory cascade can then start cartilage and bone degeneration. Secondarily, the jaw (and neck) muscles will tighten-up in order to protect the TM joint. By decompressing the joint it allows for decreased pain, improved circulation and muscle relaxation.
  • Re-establish a better condyle-disk relationship. As the disk slips forward and to the side it interferes with the movement of the condyle within the joint fossa. This causes limitations and/or deviations when opening and closing the mouth. By altering this adverse anatomic relationship it decreases the chances of a permanent or repeated dislocation of the disk.
  • Realign the mandible into a physiologic maxillo-mandibular relationship. The dental bite, the jaw muscles, head posture and the TMJ all determine the relative jaw position.  When one or more of these factors is dysfunctional secondary to genetic, developmental, traumatic factors it can alter the relationship between the upper and lower jaw causing further pain and dysfunction in the other areas. By reestablishing proper physiologic positioning it allows the body to heal and decreases the chances of further pain and dysfunction.
  • Decrease adverse behaviors such as clenching and grinding. When a joint or muscles are injured they need to be able to rest in order to heal. When a person is clenching or grinding their teeth they can exert up to 300 pounds per square inch of pressure onto their teeth and jaws. Studies have shown that up to 95% of the population clenches or grinds their teeth. Oral appliances cannot only act as a behavioral reminder they can also be designed to take advantage of the body’s natural ability to inhibit jaw muscle contraction.
  • Open the airway space thereby decreasing sympathetic arousal at night and decreasing Bruxism.
  • Protect the teeth, supporting bone and periodontal structures.  The adverse load on the teeth is one of the major causes of tooth pain, tooth fracture and tooth loss.  Additionally it can increase bone loss and periodontal recession.  This can necessitate crowns, root canals, periodontal surgery, tooth extractions and resulting in replacement with bridges, dentures and implants.

Many of our patients have either been previously given a nightguard appliance and found it ineffective, or initially found it helpful but due to a change of factors no longer find it beneficial.  Nightguards are typically designed to only provide a thin layer of protection over the teeth in order to prevent tooth wear and are not designed to change mandibular load dynamics.

Research and experience has also shown that nightguards can sometimes increase teeth clenching and can worsen TMJ disk displacements by causing jaw clicking to progress to jaw locking. Additionally, nightguards have also been shown to make snoring and sleep apnea significantly worse.

Dr. Pehling’s appliances are not designed in most cases to permanently change your bite and their use can usually be weaned down over time as healing occurs. There is the possibility of changes in your bite as the TMJ adapts. However there are instances when due to structural and functional factors you can experience some bite change but the majority of these can be remedied through minor bite adjustments.

There are instances where it is clear that someone’s bite is contributing to their pain and dysfunction and bite correction is necessary. This will usually be done in conjunction with  your dentist or an  Orthodontist or Prosthodontist.