In the previous article in this series I outlined the more common occlusal appliance options available. In this article I'll provide an overview of the more common reasons for prescribing occlusal appliances. In future segments I will describe which of the appliances may be most appropriate for each of the conditions this article describes.
Fundamentally all clinicians need to realize that there must be a reason for prescribing and fabricating an occlusal appliance; it is in fact the reason you are prescribing the appliance that informs you of which appliance may be the most effective.
1. Diagnosing the etiology of pain: It is not uncommon for a patient to come in complaining of head and neck pain; however, the location and the severity of the pain can vary dramatically from patient to patient. In addition the etiology of the pain may be related to muscle issues, TMJ issues, or a multitude of other causes. Appliances can be very helpful in diagnosing whether alterations in the occlusion will have any effect on the pain, but they can also be extremely useful in helping to differentiate muscle pain from TMJ pain. The key is to use an appliance that will provide that information, as many will not.
2. Treating pain that is muscle, not TMJ based: For the majority of patients who present with head and neck pain, muscles are the source of the pain. There can however be significant differences in the effectiveness of different appliances at resolving muscle pain. Once the diagnosis is made that muscles are the source of the problem, it is possible to outline which appliances may be the best choices.
3. Treating pain that is TMJ based during excursions: The challenge of pain that is originating in the jaw joints is determining where the condyle is when the pain occurs. The pain may occur when the condyle goes to a seated position, but more commonly occurs during excursive movements, such as chewing gum or tough meats. The first component of determining which appliance to use is to diagnose whether the pain is of TMJ origin as opposed to muscle origin. If it is joint based, the next diagnosis to make is whether the pain occurs on the side the mandible is moving towards during chewing, the side it is moving away from, or both. Those findings will then aid in choosing the appliance that potentially can reduce the pain.
4. Treating pain that is TMJ based during condylar seating: There are patients whose pain is joint based, not during mandibular movement, but when the condyle seats in the fossa. These patients may also have excursive pain as well. If not correctly diagnosed many appliances may actually make this patient worse, so the diagnosis and appliance selection is critical.
5. Evaluating occlusal changes prior to restoration or equilibration: Many times dentists and patients want to know if occlusal correction will be successful at eliminating symptoms without the need to ultimately wear an appliance. In these instances appliances that mimic what can be achieved on teeth can be used to test the outcome. Truthfully, no occlusal appliance is completely capable of simulating the identical outcome that will occur on the natural teeth.