Source
r/Dentistry•
Keysss

Some bruxism observations.

Lost my splint a few days ago.

Unsure if I have been bruxing at night or not since - I usually remember being half awake and gnashing my teeth, or having my mandible advanced so my incisors are 'clenched' (minor overjet present otherwise). I think I've been experiencing the latter, but can't say for sure.

Observations after a night of wearing the splint:

  • Lateral open bites. Sometimes AOB depending on where I position my mandible. If not that, the overbite depth is reduced (is that still classified as AOB?).
  • I'm indifferent between various occlusions that I can force myself in to.
  • If I slide my mandible back into a retruded position, I prop up onto my wisdom teeth, which exacerbates the open bite(s).
  • Teeth feel strong and cusps pronounced.
  • When I do wear my soft splint, I clench very hard while falling asleep, but I wake up with my mouth open, very dry with excessive biofilm formation. Safe to assume the clench is short lived and after that I am mouth breathing.

Daytime observations after not wearing a splint:

  • Teeth feel weak and soft (hopefully psychological).
  • There is a chronic urge to clench my posterior teeth. It is almost crippling. The feeling radiates from the cervical/buccal areas of the teeth.
  • Bite collapses. Overbite is increased. Lateral open bites are visibly reduced, although still present.
  • Can touch the premolars on my left side easier - and by that I mean, they touch sooner when performing lateral excursions.
  • When I retrude my mandible, it doesn't feel like I prop up on wisdom teeth anymore. Maybe this is psychological, too?

When I do slide my mandible forward and backward, when guided by my occlusion, it moves diagonally from R to L.

I used to think the whole transient bite collapsing thing was a direct result of bruxism.

Now I'm thinking the open bite is simply exacerbated by wearing a splint, and this collapsed occlusion that I am experiencing now is how my occlusion should be.

Anyone have any thoughts? I'm stumped.

Posted May 12, 2014, 6:49 PM UTC

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OpenWideSayAahGeneral Dentist•

Pics, yo.

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KeysssOP•

Yo...

I should add that some of the locations where there is moderate wear.. I can't even replicate the occlusion that would have caused them. For example, lower left canine: When I grind left, guidance from the premolars opens my bite before the canines touch.

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LilLessWiseGeneral Dentist•

Canines used to touch until you ground it away, now you're rocking group function so the premolars are doing the disoccluding. At least that's likely the cause.

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wustl07Orthodontist•

Soft splints are just a bad idea as a long term splint. Round file it immediately.

The transient lateral open bite/anterior open you experience in the morning is direct result of the soft splint. It only takes about 4-6 hours with a consistent force to move teeth, and diurnal variations in hormonal factors make tooth movement even more rapid at night. With time, the transient open bite will become a permanent bite change if you continue to wear the splint. Get rid of it.

Assuming you have no underlying issues like OSA causing the bruxism, the most effective management of bruxism is combined treatment with a hard occlusal orthotic and botulinum toxin injections. The two work together synergistically to produce the best possible outcome. The protein produces a highly controlled therapeutic reduction in muscular activity and the splint protects against parafunctional wear patterns and extends the clinical effect of the neuromodulator.

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LilLessWiseGeneral Dentist•

Sounds like you're kind of developing a feel of the Centric relation position versus the Maximum Intercuspation. I know you're fairly well read, but not sure if you've attempted to wade through the murky waters of occlusion yet.

You're not going to develop a true AOB or collapse of dentition in a 24 hour period. What's likely occurring is your TMJ joint is relaxing into a different position, so when you wake up and close your teeth together you kind of have to 'find' your bite again.

Does this sound kind of familiar? Is it a full coverage (all teeth covered) occlusal splint? My personal thoughts on soft splints are that they are useless, but maybe some people have success with them.

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KeysssOP•

It really feels like a unprotected bruxing episodes makes my posterior teeth intrude and the mandible auto rotates into a more closed position. But I doubt that is what is happening because.. 8 hours. I think what it's called is then mandibular plane angle? It feels like that changes.

Can my TMJ relaxing affect the mandibular plane angle?

My first splint was a hard splint made by my dentist. It made me brux a lot more, and I cracked it in 3 places and made 2 holes within 2 months. I made myself a thermoforming tray night guard, and played with it until I got the biting surface fairly smooth so my teeth weren't locked into it upon biting. I prefer it much more. The initial episode of clenching whilst I brux is relaxing, helps me sleep and I assume it isn't doing much damage to my teeth due to the soft nature of it. I worry about my TMJ long term, though.

I am about to upload pics and will post them to the comment below.

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LilLessWiseGeneral Dentist•

Sounds like your first splint was the right kind of material, but not designed properly. The whole point of the splint isn't to lock in your bite. Rather they reduce interferences which sometimes can trigger bruxism, or if you still continue to brux, at least the splint will guide the mandible in nondestructive movements with anterior guidance and canine protection.

You're not going to make significant changes to the hard structures with or without a splint over the course of a night. The change you are feeling is a result of your TMJ and neuromuscular reflexes losing the feel of where your bite is. There are minor adjustments the TMJ and the corresponding MoM make to facilitate how your teeth fit together. If you have something between the teeth for a period of time the muscles/tmj kind of 'forget' how those teeth fit so when you do bite down again without the splint it has to recalibrate.

Does that make any sense?

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KeysssOP•

I didn't mean that the hard splint had interferences, my bad. I meant my soft one did after forming it, so I kind of ironed them out.

But yeah that makes sense. But how does that account for the vertical increase in my LOB/AOBs. I don't think I am imagining it, but I'll entertain the idea and document the changes every morning if I manage to find my splint.

Any idea why the chronic urge to brux exists when I do not sleep with a splint? That's my biggest worry.

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LilLessWiseGeneral Dentist•

Sorry maybe just because it's monday, but what's LOB?

I think it's tough to qualitatively know whether you're changing vertical. I suspect your TMJ is resetting to a more superior/anterior position in the glenoid fossa. This is kind of a de-autorotational movement and often results in an isolated contact on the posterior tooth/teeth (interference from CR-MI). If you really want to dive down the rabbit hole of occlusion we can discuss some of the theories surrounding what having that interference may do.

Occlusion is a bit of a grey area. Lots of theories, lots of research, not much is conclusive. The dental joke with occlusion is it's one of the topics you don't discuss at a convention alongside politics and religion. Some strong opinions out there for sure.

Some think that grinding is a natural way of your body trying to get rid of an interference. Unfortunately it destroys the anterior teeth in the process.

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wustl07Orthodontist•

Your teeth can absolutely move with night time only wear, which is why you have a transient lateral open bite when you wake up with your soft splint. Only about 4-6 hours of constant force produces tooth movement and diurnal variations in hormonal levels lead to more rapid tooth movement at night.

When you have an oral appliance worn only at night that providing an active force, the small movements that are just transient in the beginning eventually become more permanent until the appliance is no longer active.

Lose the soft splint because it is messing with your bite.

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