Fifteen years ago, patients in my dental practice were destroying their occlusal appliances with a force much greater than 350 pounds per square inch (psi), and I couldn’t stop them.

It got to a point where I dreaded evaluating and adjusting these appliances, which only seemed to offer a frustrating and limited outcome. I myself was an expert at grinding down these types of appliances in my sleep. My temporomandibular joint (TMJ) would wake up sore. Yes, there was no teeth-on-teeth contact due to the acrylic thickness, but the underlying cause of inflammation and pain could not be addressed with regular splints.

My patients also presented with a barrage of recurring symptoms that I found difficult to treat with the resources that I had available to me. Some symptoms resulted from prior orthodontic treatment, head and neck trauma, or a “roller coaster” occlusion from a myriad of restorative materials. This imbalance results in migraines, bruxism, excessive forces, wear facets, chronic cervical hypersensitivity, abfractions, recession, bone loss, migration or rotation of the arch form, oblique fractures, broken restorations, and tenderness of associated musculature.

I also frequently completed consultations with patients who were experiencing myofascial pain as well as degenerative signs and symptoms resulting from improper TMJ positioning and associated muscular inflammation. In some cases, the patients’ TMJs experienced popping, clicking, deterioration of the joint, trismus and arthritis. Some with heavy bite forces also created periodontal pocketing with bleeding, a linea alba and tongue ridging.

As dentists, our mission is to help our patients experience a higher quality of life. I found it very difficult to accomplish this when there appeared to be so few solutions.

I desperately tried to understand the etiology of this dilemma to better help my patients. Sitting back and allowing them to continue suffering was not an option. I turned to continuing education courses for answers, but was only given more ideas for single-arch appliances that couldn’t address the etiology of inflammation and pain.

Desperate, I spent hundreds of hours adjusting single-arch appliances with the intention of creating occlusal harmony with proper contacts and disclusion. It was a difficult and time-consuming process, to say the least. I found that these appliances eventually wore down and the occlusal contacts would change, indicating the necessity of even further occlusal adjustments or replacements.

Most single-arch appliances did in fact prevent the upper and lower dentition from grinding against one another, especially while sleeping. However, these appliances only reduced certain symptoms of bruxism and were very limited in their ability to properly position the TMJ and relax associated elevating muscles.

Like myself, my patients in pain were motivated to try anything, especially when their conditions became chronic.

One day, I happened to share my dilemma and frustrations with a dental colleague of mine. He mentioned that he started using an appliance that could relieve muscle strain and provide proper TMJ positioning. When he showed me a sample, I knew I had to try it for myself.

I was my first patient. A simple scan with a maximum protrusive measurement was sent to the lab for fabrication. The design was an incisal one-third, which allowed for passive draw but plenty of retention. Many of my previous unsuccessful appliances were very tight, and I often tossed the appliance from my mouth during the night. It’s never fun trying to find an appliance in a labyrinth of sheets the next morning, so I wanted to make sure this device would fit differently.

Like most doctors, I was initially suspect: Could this appliance really relieve myofascial inflammation and put my TMJ in the centric relation (CR) position? I thought about all of the many patients in my practice who could benefit from such a device. It seemed too good to be true. A comfortable appliance that could allow complete permissiveness of both condyles and drastically improve patients’ lives? Why had I never heard of it before?

When my very first NTI-tss Plus device came back from the lab, I knew it was all true. Upon trying it on, I noted how the anterior stylus enabled the posterior teeth to stay out of contact by moving the TMJ into its natural biological position. The elevating muscles relaxed, which is something my many other occlusal splints could not accomplish.

After seeing the reality of the NTI device firsthand, I developed an NTI protocol. I learned over time that this protocol reduces temporalis inflammation by about 77% in eight weeks as a result of decreased nocioceptive input to the trigeminal nucleus. I simply could not deny the science behind this treatment, and I knew the NTI device would be a standard part of my dental care from that moment on.

Today, the NTI device enables me to help so many people in pain, and it also makes my job easier. Because the NTI-tss Plus is self-adjusting, it rarely needs relining or adjusting. I find that virtually no occlusal adjustments are needed because only the stylus is in contact. Delivery is easy, fast and predictable.

When I deliver the appliance to a patient, I ensure the posterior teeth are not in contact and the protrusive movement does not extend past the stylus. This takes less than five minutes. My dental assistant goes over the device’s daily maintenance and cleaning options. We always encourage patients to bring the device to their next hygiene recall to be cleaned.

I also bring the patient back three weeks after initial delivery. I ask these patients to wear the device when coming into the office first thing in the morning. They can get up in the morning, have something to drink and brush their teeth — but not eat. I want to keep the muscles relaxed without mastication. I remove the device and record the first point of contact, either using a bite registration or digital bite scan.

More recently, I’ve also started prescribing the new NTI OmniSplint^® device. This appliance functions exactly like the NTI-tss Plus, but it does so through a dual, full-arch design. It gives me confidence that the full occlusal support disperses any deleterious anterior force evenly. I use the splint to help place a patient in CR and adjust occlusal surfaces for balance and harmony. I could not and would not perform a complete occlusal adjustment without a patient wearing an NTI device prior to the adjustment.

I prescribe the NTI OmniSplint over and over again each week, and each week, I love the results. The muscles become more relaxed. The clenching force is reduced by 75% in some cases. Implant cases are protected. Beautiful arch forms from previous orthodontic treatments are retained. Class IV malocclusion cases are managed.

My patients love the NTI devices, too. They often report that the NTI device is thinner than their previous occlusal guard and is also more comfortable. Patients who have extreme gag reflex and those who use a continuous positive airway pressure (CPAP) machine do well with the NTI-tss plus due to its minimal footprint. Plus, patients with medical complications or women who are nursing or pregnant can greatly benefit from the non-pharmacological treatment.

I have patients that fly across the country to continue NTI treatment with me. I get referrals from chiropractors and physicians to evaluate patients struggling with myofascial pain and headaches. Often, patients will request two devices, especially if they travel a lot, and I will prescribe the Glidewell Clinical Twinpak^™ on my Rx to save money. Firefighters, for example, often need two — one for their home and one for the firehouse. Ultimately, patients are often desperate and highly motivated to get out of pain. An NTI device is a simple solution for these patients in need.

One of my patients in need, a patient of record named Jeff, recently had tooth #1 removed due to unrestorable caries. After a simple extraction, Jeff experienced intense headaches and myofascial pain. The oral surgeon could not explain the reason for the pain. After several weeks of “debilitating pain,” Jeff was referred to an orofacial pain specialist with minimal success. I suspected that an undiagnosed malocclusion masked by the wisdom tooth had manifested after the extraction. I placed Jeff in an NTI OmniSplint device to unload the condyles and reduce muscle strain. Within a few days, Jeff had reduced inflammation and pain while wearing the appliance.

The NTI OmniSplint device allowed me to perform a predictable, complete occlusal equilibration while in CR. Now, Jeff comes into my office and calls me a “brilliant scientist.” The truth is that the NTI device predictably unloads both condyles and reduces muscle strain. Any dentist is capable of prescribing one.

Only once have I had a patient who I did not treat with an NTI device. I loaded both condyles with gentle pressure and the patient reported pain. My imaging showed disc degeneration, and I referred the patient to an oral and maxillofacial surgeon for evaluation and eventual surgery. The NTI device was then introduced to the patient after surgical correction was completed.

Every dental practice has patients who suffer from migraines or TMJ pain. If we really are dedicated to helping our patients in every way we’re capable of doing, why wouldn’t we add migraine therapy to our practice? The NTI-tss Plus and NTI OmniSplint devices are:

• Designed to prevent migraines, which are the second-leading cause of all global disability¹ and affect women more severely than men²
• Effective substitutes for oral pain medications and injections
• Ideal for women who are nursing or pregnant
• More comfortable than the average bite splint
• Helpful for preventing the effects of nocturnal bruxing and grinding, which have been on the rise during the COVID-19 pandemic
• Vital for practice growth and effective in creating patients for life

These migraine prevention devices have completely changed my treatment methods and how I practice dentistry as a whole.

To learn more about the NTI-tss Plus and the NTI OmniSplint, visit glidewell.com/migraine-prevention or call 866-335-0744.