TENs and orthotic is a diagnostic process.
Once we find the final, comfortable jaw position where your symptoms are better and your scans (measurable evidence that you are stable) are acceptable, then we can look at the options to support your stable jaw position with your own teeth! Generally speaking, you will have several options which include:
1. Do nothing. You can remove the orthotic and your bite will go back to the way it was as this is a reversable process. Your symptoms will return.
2. Wear the orthotic nights only. Your symptoms will likely come back, however, there are some patients in Dr. Heit's practice who wear the orthotic nights only that claim their symptoms have not come back.
3. Keep the orthotic in your mouth as much time as you need to keep your symptoms from coming back (usually full time but some people take it out to eat and they say they are okay). Your bite can change permanently if the orthotic is left in long term as your body maintains the physiologic rest jaw position. Remember, the bite can affect your whole skeletan and the skeleton can accommodate to the new jaw position. In many cases, neck and back pain are resolved as well.
Please be sure to ask Dr. Heit all your questions and concerns. Dr. Heit will refer you to a specialist in medicine or dentistry as needed or wanted and many people like this multidisciplinary collaboration.
4. Finally eliminate the orthotic with dental work to support your jaw in the predetermined position. Many people love how they feel with their new jaw position and how it is supported with their bite. It doesn't matter how many teeth you have or even if you have full dentures. Dr. Heit can do the dentistry you wanted anyway and incorporate the desired jaw position right into the work. Whether it is a new set of dentures, cosmetic veneers, replacing a bunch of old fillings or orthodontics to straighten your teeth, the goal is to support your jaw position in physiologic rest until the dentistry is done. When the work is finished, the orthotic will be gone and your own teeth (fake or not) will be supporting your jaw. Dr. Heit and her team will review your individual case with you and your loved ones and answer all your questions using your own tooth models and anything else you need to understand the procedure and options. It is best to conserve your tooth structure in a conservative way but we will make sure to hear your desires for your own treatment.
Options may be minor such as a coronoplasty-which is the conservative reshaping of your existing teeth. Another conservative option may involve adding to the height of some teeth with a white onlay.
If your comfortable, neuromuscular stable bite is far away from your existing, pathological bite, then more complex reconstruction may be required such as orthodontics or even a full mouth reconstruction that involves crowns/onlays on every tooth. A second opinion from a specialist in prosthodontics is recommended in complex cases.
Some people have very large, old fillings and deteriorated crowns on each tooth or just severely worn teeth from years of grinding. Using neuromuscular dentistry to get the bite right at the same time as doing the work that is needed anyway is an ideal way to obtain a final result that is both stable and optimal cosmetically. It can be done efficiently (all at once) rather than one tooth at a time. This saves both time and money in the long run.
If you are not ready to engage a large treatment plan, then you can wear a removeable, plastic orthotic made to your comfortable, physiologic rest (neuromuscular) position. This enables you to obtain relief if you have symptoms and be able to keep your own teeth clean. The fixed orthotic used for diagnosis is not permanent and cannot be left on your teeth for long periods of time without supervision from Dr. Heit.
If you do not have any symptoms but want to have a 'make over' with cosmetic application of veneers or crowns, then having a comfortable bite with measured, relaxed muscles is an important option to protect the integrity of your dental work as well as preventing the development of symptoms that can occur from dentistry that does not take into consideration the muscles. Also, the cosmetic results of your treatment is enhanced by the proper position of the jawbone within your face as dictated by the relaxed muscles.