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Medical Forum / General / Dentistry / May 2005NTI isn't working--alternatives?
I recently heard about the NTI and had one made, thinking it would really help with my chronic headaches, and it has. I wasn't thinking too much about protecting my teeth until a few months later, when I discovered that I cracked a tooth clenching/grinding. (Should have listened to my wife when she told me she could hear it at night, huh?) So now I have a new crown. The NTI was working great for the headaches, but then it got loose and I took it back to have it adjusted. After that, it started to really hurt one of my lower teeth, and several mornings, the tooth was loose. So I stopped wearing it and went back to my dentist, who was perplexed. The NTI is not uneven on my teeth at all, and my teeth are straight and even, and neither one of us can tell how I'm managing to put all the pressure of my clenching on one tooth--one of the center ones on the bottom. But I am-- and in just two weeks I clenched enough to wear a nice groove in the NTI. So he said that he just didn't think the NTI was going to work for me--that I was finding ways to defeat it and that it would adversly affect my orthodontics. He said that short of shaving a bit off one tooth, there's nothing to be done to fix the NTI (and he said he didn't want to do that, because in all likelihood I'd just shift pressure to the tooth next to it and have the same problem). He would prefer that I stop wearing it and switch to a traditional nightguard. He said that I'm the only patient he's ever seen to do this with an NTI. I haven't committed to a traditional night guard yet, but I'm thinking about it. Do you all have any other ideas? The NTI was helping so much with the headaches that I hate to give it up entirely. Thanks, Will >I haven't committed to a traditional night guard yet, but I'm thinking >about it. Do you all have any other ideas? The NTI was helping so much >with the headaches that I hate to give it up entirely. > >Thanks, >Will The groove can be filled in or a new one made. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com He already smoothed out the groove once--when he made the inital adjustment. This new groove isn't huge--big for the short time I've worn it, but really only good as proof that I'm still grinding away. In my experience, 'traditional bite guards' are pure crap. Don't go there! You may need more (or less) opening with the discluding element. The occlusion on the lower incisors should be even (a *small* adjustment won't hurt anything). If that cannot be achieved, flip it over and make one on the bottom teeth. If it was working, and suddenly is not, it is very likely that it just didn't get back to it's original shape. If you stay with it and experiment a little, you should be able to find comfort again. JME, Fawks > I haven't committed to a traditional night guard yet, but I'm thinking > about it. Do you all have any other ideas? The NTI was helping so much > with the headaches that I hate to give it up entirely. > > Thanks, > Will I had patients on nocturnal NTIs 25 years ago, long before we called them that. Fellow in NY name of Gelb was promoting them for nighttime wear. When you say "mouthguard" I'm assuming your dentist is talking about a conventional, i.e. "stabilization", "Tanner", or "Michigan" splint. I would be inclined to think this would be a good next step for you if repairing/adjusting your NTI doesn't work. My own belief (and believe me when I tell you that splint design is a hot, controversial topic among dentists!) is that they aren't as effective in relieving muscular symptoms as NTIs. But they do, by design, distribute the load over a lot more teeth. And one of the nice things about the "traditional" splint is that you can wear them 24/7. Good Luck Not to be argumentative, but you can wear an NTI 22/7 (take it out to eat). Traditional splints do spread forces, but they also form a perfect clenching platform which will do nothing good for headaches. Experimenting with the dimensions of the NTI should solve the problem. JMO, Fawks > And one of the nice things about the "traditional" splint is that you can > wear them 24/7. > > Good Luck I agree about clenching/stabilization splints - I think they give little relief for these folks. But bruxers are very different critters, and I've had a lot of luck with them - 'course maybe that's just my built-in bias presuming a positive result, Ramfjord was my first occlusion prof. after all. But I have embraced how full of --- he could be, too! Anyway, I think you've inspired me to stop being chicken and try out my next NTI patient who seems to need it on 22 hour wear. Thanks. You can make the daytime device on the lower and/or quite small so as not to interfere with speach. :-) Fawks > I agree about clenching/stabilization splints - I think they give little > relief for these folks. But bruxers are very different critters, and I've [quoted text clipped - 4 lines] > Anyway, I think you've inspired me to stop being chicken and try out my > next NTI patient who seems to need it on 22 hour wear. Thanks. Your dentist needs more experience with the NTI. You might benefit from wearing a lower NTI. Perhaps wearing your upper NTI with a lower slide bar. Perhaps the NTI was too thick. Maybe the DE on the bottom of the NTI is at the wrong angle. Perhaps you have excessive curve to your plane of occlusion and need some careful reshaping of teeth. etc. About one patient in 50 will wear a groove into an NTI once. About one patient in 300 will constantly wear a groove into it. We simply bring the patient back and fill the groove every few months. It takes all of five minutes.  Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... >I recently heard about the NTI and had one made, thinking it would really > help with my chronic headaches, and it has. I wasn't thinking too much [quoted text clipped - 29 lines] > Thanks, > Will How about making opposing NTI's? I'm not kidding. > Your dentist needs more experience with the NTI. > [quoted text clipped - 52 lines] > > Thanks, > > Will A slide bar is a lower NTI with no DE. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > How about making opposing NTI's? I'm not kidding. > [quoted text clipped - 73 lines] >> > Thanks, >> > Will |
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