Tinnitus and TMD

Tags

Asymmetry, condylar asymmetry recognition, Dentistry, Occlusal device, Occlusal splint, Oral Stability, Temporomandibular joint disorder, Tinnitus, TMJ rehabilitation, Treatment planning

Tinnitus in itself is not an indication for dental intervention. However,if tinnitus is mentioned at an examination of facial pain of either myogeneous or arthrogeneous origin there may be a chance to influence its existence. After reviewing some records of patients some years ago and present experience it is my opinion that it is about one third of the patients suffering tinnitus and TMD who will notice a reduction or even a total elimination of their tinnitus from oral stability initially from a stabilization splint compensating for a temporomandibular joint vertical condylar asymmetry, when present.

As it was just one third who reported a benefit regarding their tinnitus it must be up to the patient to decide if it is worth while to invest in an oral device fighting tinnitus. Objective information regarding a dubious result should precede the decision. It is also  important to tell the patient that very often the relief from tinnitus does not come immediately after the insertion of the device. It is reported by several patients that it could take a couple of months before they noticed a difference in their tinnitus. In conclusion: When a stabilization splint is being delivered  in trying to influence a tinnitus the patient might have to wear the splint several months before a change occurs  and before one actually knows if it was beneficial or not. 

Mounting casts

Tags

Asymmetry, Asymmetry Index, Centric relation, condylar asymmetry recognition, Dental laboratory work, Dentistry, Mounting casts, Occlusal adjustment, Occlusal device, Occlusal splint, Occlusion, Oral rehabilitation, Oral Stability, TMJ rehabilitation, Treatment planning

The other day I had to check the mounting of the casts of the upper and lower jaws of a patient with a condylar asymmetry of about 6%. The reason for my visit to the dental laboratory was that the right side lower four units bridge had been redone and several times before that adjusted. And yet the patient found it too low i.e. her teeth of her right side did not contact in occlusion unless she  forced her mandible to the right.

During the visit at the laboratory it became once again obvious to me from the discussions with two well experienced dental technicians that very often the indices to be used in mounting the casts cannot be used. The indices are perforated and mostly show slides in the material used indicating that the mandible of the patient has not been stable at the time of index registration.  Therefore the technicians try to analyze different facets of the occlusal surfaces of the casts. They try to fake the movements of the patients mouth that have created them and thereafter, still manually, they fix the casts in the position which seems to  be the starting point for the suspected movement.This position usually is looked upon as the intercuspal position and will be used for the subsequent mounting of the casts.

At a condylar asymmetry it is therefore easy to understand that with the above described mounting of the casts the crowns or bridges of the ” shorter condyle ” side will be too low. Clinically oral stability will be lacking despite the insertion of the prosthodontic work. Very often tooth contacts of the ” higher condyle  ” side will be looked upon as occlusal interferences and removed in an ” adjustment “.This actually results in a decrease of the vertical dimension and a not one hundred percentage satisfied patient.

The problem and frustration can easily be avoided if the vertical condylar asymmetry is transferred into the Maaxloc instrument. A registration at the clinic or at the laboratory is made  and used in mounting the casts with the result that mostly the prosthodontic work can be inserted  without any adjustment at its delivery.