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Thursday, December 10, 2009

Facial Pain and Bite Changes after anterior appliance

comments : i wore an anterior nightguard which changed my bite. i now have an open bite. only one molar touches down. a few months into wearing this night guard, i had a sudden onset of excruciating tooth pain which started on one side of my teeth and spread to the other side within one week. the nerves in my face were also affected as my cheeks ache and also my forehead and scalp. my neuro says i do not have TN but my nerves are irritated. the only thing which helped was a lower mandibular splint. it took my teeth pain away within a few weeks however my bite is still open when i do not wear it. what do i do next? how do i take the pain away for good? can a bite change cause al this face pain? i never get headaches, only facial and tooth pain. my TMJ joints are only 4mm, and were pushed up and back into the upper part of my skull. the discs are both displaced. i have no space left in between either joint and the upper part of my skull. i am on an anti convulsant, and an anti
depressant for pain control, it is helping somewhat. please advise. Kristin

Reply
You did not state what symptoms you were having when you started wearing the first nightguard or whether you had an anterior or posterior open bite. It is obviously a long-term condition because of the bilaterally displaced disks. Very often when you wear an oral appliance you have healing of oral structures resulting in bite changes. If the mandibular appliance is controlling the pain you may want to continue to stabilize and refine your bite. The orthotic can be a guide for future definitive correction of the bite.

Very often orthodontics, restorative dentistry, reconstruction or long term orthotics are necessary to complete a case. I usually try to avoid surgical intervention. The anterior appliances like the NTI are easy to make and are ideal for some patients but can lead to loose or sore teeth and orthopedic changes. Long term use of a lower appliance can also make those changes long lasting. For most patients I use neuromuscular orthotics.

In my practice we do a phased treatment.. The first phase is elimination of symptoms. When I use orthotics they are on the mandibular teeth and are worn 24 hours a day. We always explain before starting treatment that a second phase may be necessary to complete the case. When the symptoms are relieved (You are not yet there) we consider long term correction.

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posted by Dr Shapira at 12:49 AM

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