This patient came in to see me C/O pain in her jaw especially on the left side. It was worse when she woke up. She had been to the access centre where she had antibiotics and was advised to have her wisdom teeth out. After 2 weeks she had to go back to the access centre again who placed a temporary filling in the LL6.
The above treatments had not eased her symptoms. There was no relevant medical history. An extra-oral examination showed pain around the temporalis insertion on the left side. The intra-oral soft tissue examination showed cheek and tongue ridging. Her oral hygiene was poor and there were failing restorations/caries in a few teeth. In addition, UL8 had over erupted. An occlusal exam showed evidence of tooth wear and jaw displacement in retruded contact due to interference between UL8 mesial and LL7 distal.
To explain her symptoms, I suggested that she was grinding/clenching. In addition she needed to address the occlusal interference from the over erupted UL8. I gave her a plan for short term, medium term and long term treatment for her dental care. In the short term, a laboratory formed occlusal splint was constructed so that her immediate symptoms of temporomandibular joint dysfunction could be relieved. This did have the intended effect and the pain totally subsided within seven days. A further appointment was made to discuss the tooth with the temporary filling but also the wisdom teeth. In addition, the patient also had further restorative requirements together with treatment for chronic periodontitis. The whole treatment took place over 12 months and she was extremely pleased at the care that was provided to her.
Therefore to answer the question of which occlusal splint should dentists use, here is a summary of the main points.
Firstly you have to consider whether an occlusal splint is necessary and and is the patient happy to wear it. Some patients will simply not wear an occlusal splint even if only at night-time.
The next question to ask is if a patient is able to tolerate an occlusal splint. As a general rule the soft acrylic occlusal splints are much more easy to wear and adapt to than the thick hard occlusal splints. Whatever type of splint is constructed, a thinner 1mm to 1.5mm material will be easier for the patient to adapt to than one which is thicker.
Another important factor to consider is if the splint will be a full coverage splint or only a partial coverage splint. There is wide variation in that splints can cover every single tooth in an arch or it may only cover as little as two individual teeth. Needless to say it is always easier for a patient to get accustomed to a minimum coverage device rather than one that has extensive coverage over the teeth.
Dr Muzzafar Zaman 