DNA Appliance vs Splint Treatment vs Occlusal Guard?
So called “splint therapy” has been the gold standard for non surgical temporomandibular joint dysfunction or TMD. Newer TMJ appliances such as the DNA appliance have made it possible to not only correct sleep apnea, but also stop tooth and jaw clenching and all the other symptoms and pain called “TMJ.” The DNA corrects the underlying cause of the problems by balancing the bite and increasing the size of the upper airway. Research and clinical practice has shown that bruxism and tooth clenching are really just symptoms of upper airway restriction syndrome and sleep apnea.
Corrective therapy such as the DNA is preferable to splint therapy, but there are some situations where conventional splint treatment may be more practical and appropriate.
Splint Therapy is best treatment for TMJ when:
- There are bridged, connected or splinted teeth that go around the front of the mouth. For example, an implant bridge that spans all the upper front teeth.
- A patient who has large numbers of implants vs natural teeth
- There are lots of bridged or connected teeth in general
- when there is lots of joint soreness and muscle tension that has been around for a long time. It this case, the splint treatment should preceed any definitive DNA therapy.
DNA Appliance is the best treatment
in most other situations except when there are many missing teeth. Growing bone (what the treatment does) is stimulated by putting small amounts or pressure on teeth and the jaw bones. Without teeth, it becomes very difficult to put pressure on teeth to grow bone. Other appliance do exist such as the ALF appliance and the Homeoblock appliance (both examples of dental orthopedic appliances).
Much of bone growth during DNA therapy is grown at the connections between the right and left palatal bones. If bridges span around the front teeth, it is impossible to put pressure in the right direction to get the jaws to grow properly. It cases were there are bridged teeth, sometimes the bridges can be sectioned and later re-done or replaced with implants when corrective temporomandibular treatment is complete.
When there is a lot of longstanding pain in the TMJ, jaws and the all the facial muscles, it is not a great idea to start changing the bite and bone structure right away. It is better to try a new bite position and put the jaw muscles into a more relaxed state prior to changing any structures. Putting the jaws into a more favorable position where the muscles can get much needed rest is much of the goal of splint therapy. Splint therapy can be definitive and final treatment if:
- The splint appliance is worn as directed and indefinitely at night time, forever.
- If the goal is to stay out of pain, manage tmj symptoms, and not necessarily correct the underlying cause of the problem.
Night Guards are the least expensive treatment but only prevent wear by placing a protective plastic barrier to reduce direct wear on the teeth during clenching episodes during sleep. There are many different kinds of tooth wear but most of the time, the primary cause is bruxism during sleep cause by UARS or upper airway restriction syndrome.