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Old 06-04-2012, 10:28 AM   #1
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Lower Splint vs. Upper Splint

I have a question about the differences between upper repositioning splints and lower ones. I've been going to an NM dentist since Feb. He diagnosed TMJD with a CT scan and made me a hard acrylic repositioning splint you wear over the top teeth. I'm having a terrible time with it as I feel it's too bulky. I didn't wear it hardly at all the first month or so because I couldn't talk and be understood. I was told I would get used to it in a week or so. I've been wearing it at home and at night and over long weekends, but not at work or when I'm in situations where I need to talk to people. I still can't be understood and even my own family says "huh?" when I'm talking to them.

I've noticed a lot of people here have the lower repositioning splint. I imagine it's easier to talk with and get used to if it's on the bottom? I also hate the fact that it's so noticeable because it's on the top.

What's the difference between the two and did anyone who has the upper splint have a difficult time adjusting to it like I've been having?

Thanks in advance.

 
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Old 06-04-2012, 12:14 PM   #2
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types of splints

Hi there,

Sorry to hear about your difficulty speaking - really hard to function normally when people can't understand what you're saying. I had trouble speaking for the first week in my lower, 24/7 repositional splint, but thankfully I adapted quickly. The lower repositional splints aren't too bulky - mine was fairly streamlined and easy to get used to. It's concerning that yours is so difficult to wear- you may not derive the intended benefits if you don't wear it consistently.

I guess the first thing I'm wondering is what your specific problem is causing your TMJ. Did the NM dentist explain what the splint was going to do or why s/he recommended that particular one? Was the splint recommended to decrease pain (relax muscles), reposition the bite or both?

There are different kinds of splints and I'm wondering what specifically yours is and why your NM dentist chose it. Here is a quick 101 on different types of splints:


•Stabilization or flat plane splint. This one covers all the upper teeth. Because it's flat, it helps minimize tooth grinding and it works to decrease pain by relaxing your sore jaw muscles. It doesn't help with clenching since the lower teeth are still able to touch it. Because of the clenching factor, some people find their condition worsened by this splint.

•Modified Hawley splint. This guy fits on the upper jaw and touches only the six lower front teeth. It totally prevents the back teeth from touch and stops both clenching and grinding. A concern is that the back teeth will shift so it's usually only worn at night.

•NTI-tss (Nociceptive Trigeminal Inhibition Tension Suppression System). I think this one is less common... It goes over the upper front teeth and is supposed to stop tooth clenching and grinding. The fact that it goes over a few teeth can really stress out those teeth and possibly cause problems. It comes off at night because it's so small that there is a choking risk.

•Repositioning splint. This is the lower splint that is commonly worn by people on this site. It's called repositional because it moves the lower jaw forward or backward. It's purpose is to reposition the jaw into a healthier position and find the optimal position for your bite. For this reason it is the most aggressive form of splint treatment and it can take a good 4-6 months to start feeling results. Usually once this optimal position is found, you will experience a decrease in symptoms as your jaw is finally more comfortable. Then the NM dentist will use orthodontics (braces) to make this position permanent. At this stage, there are other options, but braces is the most common.

I had really severy TMJD and lived a really hellish existence. I had to go through a couple NM dentists until I found one who I felt offered me a treatment that would help. After a few months in my repositional splint, I felt a drastic reduction in pain and symptoms! I am now in my second months of braces and things are a lot better for me.

If you are unsure if you are getting the right treatment, I would really encourage you to find the best NM dentist in your state and get a second opinion. TMJ is so painful to experience and really tricky to treat - often the wrong treatments leave us in pain longer than need be or worsen our situation. This was the case with me and I'd hate anyone else to experience this if they don't have to.

Hope this helps...if you can, let us know what kind of splint you have and how it's meant to address your TMJ issues.

Wish you the best in your recovery

 
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Old 06-04-2012, 01:19 PM   #3
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Re: Lower Splint vs. Upper Splint

Thanks for that very informative reply. It seems I have the first one that you described. It's a flat plane splint that covers all my top teeth. My NM dentist said it was a repositioning splint that is worn for 4-6 months to discover the correct bite. We then move on to braces or crowns to make the new position permanent. He said the goal of this splint is to move the jaw forward, relax the muscles and to find the correct bite.
He also said something about trying to recapture the condile on the left side. I'm totally confused...

This is like my 7th dentist in my journey to find a TMJ diagnosis and treatment. He has over 30 years of experience in treating patients with TMJD. I just wonder the reason I don't have the lower splint. I'm seeing him tomorrow so will ask then.

Last edited by Administrator; 07-14-2012 at 04:23 AM.

 
Old 06-04-2012, 09:31 PM   #4
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Re: Lower Splint vs. Upper Splint

The splint advice is accurate and thorough.

Does your upper splint have bumps on it?

The lower repositioning splints have "bumps" on the top that require you to shift your bite into "correct" positioning in order to bite down. It is worn 24/7. Flat plane splints are flat and usually used to protect teeth when you clench or grind. I'm not sure how they would work to help you reposition your bite.

I had an upper flat plane splint I wore for many years from my dentist. It was to protect my teeth when I brux. When I finally found my current TMJD specialist, I found out the flat plane splint actually "encouraged" my jaw back towards my ear into an incorrect position with the way my teeth "slid around" on it when I was bruxing at night when I slept.
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Old 06-05-2012, 05:47 AM   #5
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Re: Lower Splint vs. Upper Splint

Yes, it has little bumps on both sides of the splint. It creates a snug fit on the teeth. It also has a "ramp" in the front that brings my lower jaw forward and forces it into that position while I bite down. That's actually the part that is making the splint so bulky and hard for me to talk right. The NM dentist says this is not for bruxing, it's to reposition. Bruxing wasn't my problem as I had previously used a lower soft splint from an oral surgeon for months which did nothing. This splint is hard acrylic and very different than the soft splint I had. I am supposed to wear it 24/7, but I haven't been because of the difficulty adjusting to it.
So, I'm still confused as to why everyone else's repositioning splint is a lower one and mine is an upper one. Hmmm.

 
Old 06-05-2012, 10:47 PM   #6
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Re: Lower Splint vs. Upper Splint

I wore an upper splint with a beak and a wedge at night in conjunction with my lower repositioning splint during the day. The nighttime splint held my lower jaw forward while I was sleeping. If your upper splint is anything like mine (before I got upper braces), no wonder you can't talk. I couldn't imagine trying to talk or eat around that one all day.
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Old 06-05-2012, 11:57 PM   #7
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Re: Lower Splint vs. Upper Splint

Just wanted to say that you might consider asking your dentist to refit you with a lower splint - it doesn't sound like the one he's given you is remotely functional and you need something that you can speak, eat, live with! I don't think this is an unreasonable expection. Plus, if you are taking it out because it's not liveable, you won't derive the intended benefits.

Don't be shy to ask or politely insist even...and take a support person with you if you feel it'll be easier. If we don't advocate for ourselves, we can really lose out. You've paid a great deal of money and deserve to have a splint that functions for everyday life.

Good luck and let us know how things go...

PS: I had a soft splint that was meant to stop bruxing and it worsened my clenching and grinding. Essentially, it became a chew toy for me at night. This is quite common apparently. Don't rule bruxing out because the soft splint didn't help...it may still be an issue that's contributing to your condition and needs to be addressed.

 
Old 06-06-2012, 06:57 AM   #8
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Re: Lower Splint vs. Upper Splint

Thank you both for the fine advice.
I'm glad you shared your upper splint experience with me. It was making me feel like I'm going crazy because I seemed to be the only one who was having this much difficulty in adjusting to the splint. It's nice to know that it's possibly the splint and not me.
You are right, being a good self advocate is very important and I did pay a lot of $$ and should be getting something that will work for me. I will ask him about the lower repositioning splint for the daytime and see if he can fit me with one. I'm just hoping he won't think he can then hit me with another costly charge. This should all be included in the $3000 I paid up front. I had to change my appointment and so I won't be seeing him again until next week.
I will keep you posted. In the meantime, I appreciate the replies and good advice!

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Old 06-07-2012, 06:02 AM   #9
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Re: Lower Splint vs. Upper Splint

Thanks Missy...I needed that.

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Old 07-16-2012, 09:02 PM   #10
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Re: Lower Splint vs. Upper Splint

rlat45,

How are you doing? Did you manage to speak to your dentist about getting a new splint?

 
Old 07-17-2012, 07:46 AM   #11
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Re: Lower Splint vs. Upper Splint

When I asked him about a lower splint, he said that the splint should be on the top and this is how he treats TMJ. It's an anterior repositioning splint. It's a hard acrylic splint that covers all of the top teeth. It has a slope behind the front teeth that holds the lower jaw slightly forward. He has adjusted it many times and I keep getting a better fit every time I go in. He has also brought it down in size a lot from when I first got it to reduce the bulkiness of it.
I'm supposed to wear it 24/7, but I must admit that I'm still taking it out during the work day when I'm speaking to people. It has been a very tough adjustment for me, but I'm continuing to try to make it work.
I still sound funny when I talk. Most of my words are OK, it's when I say anything with an S.
My TMJ symptoms are not any better...in fact the other ear is starting to bother me now. I used to have pressure in only the left ear. Now, I can say that they're both bothering me. Sometimes I take the splint out just to get a rest because it's very tiring to wear. My facial muscles get very tired and sore.
I do hope this gets better...not much fun right now.

 
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