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A Study of the Best-Bite Discluder and 160 Patients
With Complaints of Head, Neck and Facial Pain
Abstract/Key Words:
Aims: The purpose of this study is to evaluate patients reporting head, neck or facial pain as to whether the pain is due to muscle spasm from a conflict between the biting surface of the teeth and the jaw joints.
Methods: One hundred and sixty patients entering the dental practice were screened for signs and/or symptoms of head, neck or facial pain and for dental evidence of tooth clenching or grinding. Based on the results of a clinical examination, patients whose pain could be due to muscle spasm were fitted with the Best-Bite™ Discluder to determine if neutralizing the conflict between the biting surfaces of the teeth and the jaw joints would reduce the muscle spasm and pain.
Results: In ninety-two of one hundred and three patients identified as likely to have pain due to tooth clenching and/or grinding, wearing the Best-Bite™ Discluder relieved the subjective report of pain as well as the objectively measurable muscle spasm.
Conclusion: The Best-Bite™ Discluder is a fast and reliable method to identify patients whose pain is due to jaw muscle spasm, provide immediate, temporary relief and predict whether treating the occlusion will result in long term pain reduction.
Key Words: Best-Bite™ Discluder, TMJ Dysfunction, Deflective Tooth Contacts, RUM Position, Muscle Spasm Pain
Introduction:
Head, neck and facial pain is one of the most common complaints of patients presenting to health care providers (1,2,3). Because the initial diagnosis is actually made by the patient, based on their perception of the source of the pain, the patients may self-diagnose themselves into the wrong specialists office.
Many times, the patients pain is actually due to muscle spasm pain caused by a conflict between the biting surfaces of the teeth and the jaw joints. This muscle spasm pain can be quickly diagnosed and relieved by eliminating the conflict between the teeth and jaw joints.
This article describes a new device designed to quickly and easily do this, even for practitioners who have minimal training in treating TMJ dysfunction.
Materials & Methods:
One hundred and sixty patients with a complaint of head, neck or facial pain were examined in accordance with the six step protocol developed by Best-Bite to identify patients in pain whose symptoms could be due to muscle contraction pain from tooth clenching or grinding (Figure 1).
Once the patients were identified as having pain that could possibly be due to a conflict between the biting surfaces of their teeth and their jaw joints, they were fitted with the Best-Bite™ Discluder.
The Best-Bite™ Discluder is a custom fitted device than can be made by anyone, including clinicians that have no training in actually treating TMJ dysfunction, that immediately prevents the deflective inclines on the biting surfaces of the teeth from wedging the jaw out of position and assists the condyles in achieving centric relation condylar position.
In a normal relationship between the teeth and the TM Joint, the joints can be centered in the fossa when all the teeth touch. (Figure 2) A diagrammatic representation of an imbalance between the biting surfaces of the teeth and the TM joints shows that with the joint centered in the glenoid fossa only one incline on one tooth contacts. (Figure 3) Then, when the teeth are closed into a position of maximum intercuspation, the inclined planes of the teeth force the jaw out of its normal position. (Figure 4) These diagrams are only two dimensional drawings and show only one condyle and just a few teeth. In reality, these inclined planes can deflect the jaw in any of three dimensions-forward and back, left and right, and superior and inferior. In actuality, it is generally a combination of all three(4).
The treatment of TMJ dysfunction essentially is to neutralize these inclined planes so that the teeth can all touch equally and simultaneously without deflecting the jaw out of its natural position in the glenoid fossa (5). This position is the rear most, upper most, mid most (RUM) position of the condyle in the articular fossa where the entire TMJ system can function in comfort and not stimulate the erasure pattern of tooth clenching and grinding. As a result, the dentition is free of damage to the teeth, ie: excessive occlusal wear, cracking, chipping and abftactures, and damage to the bone and supporting structures, ie: bone loss and gum recession. The muscles are free of pain from hyperactivity (6).
Figure 5 and Figure 6 show how the occlusion that throws the condyle out of position when the teeth are in a position of maximum intercuspation can be corrected with a traditional bite splint that covers all the biting surfaces of the teeth (7,8,9,10) (Figure 5) or by occlusal equilibration where the biting surfaces of the teeth have been reshaped to eliminate the deflective inclines (11) (Figure 6). Occasionally orthodontic tooth movement, restorative dental procedures and rarely orthognathic surgery may additionally be needed, depending on the specific requirement of the patients dentition.
Figure 7 shows how the Best-Bite™ Discluder eliminates any deflective inclines from throwing the jaw off and allows the condyles to naturally seat into the articular fossa.
The only requirements for the patients to utilize the Best-Bite discluder are that the top and bottom front teeth are stable or have stable replacements and that the upper front teeth are free of mobility beyond class 11 and do not have significant undercuts due to large unfilled carious areas or severe recession that could lock the device onto the teeth.
The Best-Bite™ discluder kit includes three components:
- Bite Former: This is a plastic device that will provide the biting surface for the lower front teeth. In addition it has an extension so that a retention leash can be secured and worn around the neck like a whistle. This is designed to prevent accidentally dropping or getting the Best-Bite™ discluder caught in the throat. The interior of the Best-Bite™ discluder also has two rows of three parallel retention grooves to retain the custom liner material. As a result, this patented retention system allows the custom liner material to be retained during use and to be removed and refitted as needed.
- Custom Liner Material: This is a poly vinyl siloxane impression material. The A and B putty components are iffixed and placed in the bite former to custom fit the bite former to the upper front teeth. This material is stable for several weeks and can provide an excellent, stable fit. If for any reason the liner material must be replaced, it is easily removed and replaced by a fresh mix of liner material.
- Retention Leash: This is fitted through the retention loop on the bite former and placed around the patients neck before the discluder is placed into the mouth.
Figure 8 shows the bite former. Figure 9 shows the bite former after is has been custom fitted to the upper front teeth with the custom liner material. Figure 10 shows that the Best-Bite™ discluder can allow the jaw to achieve centric relation by eliminating the deflective occlusal contacts.
The one hundred and sixty patients were asked to report their subjective assessment of pain from 1 to 10. The examiner palpated their jaw muscles, especially the lateral pterygoids and rated the pain from 1 to 10. The patient was instructed to palpate their own lateral pterygoid muscles and rate any discomfort as well.
Then the Best-Bite™ Discluder bite former was filled with custom liner material and placed on the teeth. The patient was told to relax and gently tap their teeth together, aiming for their back teeth and report how they felt. After two minutes, the examiner palpated the patients lateral pterygoid muscles and instructed the patient to do the same. Both the examiner and the patient rated the level of pain again. Then the discluder was removed from the teeth and the patient was instructed to clench or grind their teeth into a position of maximal intercuspation to re-stirnulate the muscle spasm and test again. Lastly, the discluder was placed on the teeth again for three to five minutes or until the pain was at least 90% gone.
Results:
Of the one hundred and three patients who had been identified as probably having pain due to a conflict between the biting surfaces of their teeth and their jaw joints, ninety-two experienced rapid and significant relief of pain, both in terms of their own perception and in terms of tenderness to palpation of the lateral pterygoid muscles by the examiner.
Within two to five minutes the ninety-two patients reported their jaws felt more relaxed and a diniinution of pain. This jaw muscle pain began to return almost immediately after the Best-Bite™ Discluder was removed. When the discluder was replaced, the pain was relieved again.
This 90% success ratio was achieved because participating doctors carefully screened the patients based on the six step process, not because of expertise in the use of the discluder. This is not meant to imply that 90% of all headaches are due to TMJ dysfunction. Further studies must be done using randomly selected patients with complaints of head, neck or facial pain without using the six step screening process to estimate the potential percentage of patients whose pain is due to TMJ dysfunction in the general headache population.
In addition, further studies need to be done to determine if a patient with headache pain due to a conflict between the biting surfaces of their teeth and jaw joints can be maintained relatively free of pain by using the Best-Bite™ Discluder episodically over a longer time period as needed to interrupt muscle spasm.
Conclusion:
A conflict between the teeth and jaw joints will often stimulate muscle clenching and grinding. This muscular hyperactivity can lead to head, neck and facial pain. If the pain problems are due to occlusal imbalance, the only solution is to eliminate the occlusal conflict between the teeth and jaw joints. Achieving a pain free condylar position is not always easy for a dentist trained in TMJ dysfunction, but beyond the scope of the physicians and untrained practitioners often consulted by patients with head, neck and facial pain.
The patented Best-Bite Discluder makes it easy for any clinician to eliminate the conflict between the teeth and jaw joints and simplify diagnosis and ultimate treatment.
References
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