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Medical Forum / General / Dentistry / June 2005Post-NTI symptom?
Hi all. Been a while since I've posted serious stuff. This is perhaps serious: Lady about 40-ish, had an NTI placed last month or thereabouts. I had to extend the DE anteriorly a few mm because she protrudes like there's no tomorrow. She came back in today saying that when she wakes up in the morning, there is a numbing effect in the mouth, around the upper second molars. This is like as if the mouth were frozen with dental anesthesia in that area. This sensation wears off in 20 min, or so. As usual, there is some 'replacement" of the mandible as the muscles regain normal position, but that is all. I should also add that she _can_ touch her canines to the DE, but with alot of effort. Does anyone have any ideas? Thanks SP  SignatureFinally: take out the TRASHH She is touching somewhere. I say make the DE slightly longer and taller (maybe 2 mm). Maybe make a lower slide bar, or make a lower NTI. Take a set of "good" study models and only articulate with your hands. Rub the models side-to-side, front-to-back and in circular motions. Find the prematurities and mark them. On a spare model, scrape the marked areas, and re-do the movements. If that makes the excursions smoother, transfer to the mouth and repeat. I bet this person has an exaggerated curve of Spee and gets second molar cusp tips to touch when fully protruded. 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. ...................... > Hi all. Been a while since I've posted serious stuff. This is perhaps > serious: [quoted text clipped - 18 lines] > Thanks > SP > She is touching somewhere. > [quoted text clipped - 9 lines] > I bet this person has an exaggerated curve of Spee and gets second molar > cusp tips to touch when fully protruded. But shouldn't she also have numbness on the lower molars. I mean she can't just have the problem in one jaw since the height of the DE might possible only let two spot touch each other. I would also think of muscular probs Or the joint, perhaps she just protrudes more with the slide in place. I myself have hurting teeth (upper and lower jaw, all molars) when I wear the device over night. When I then chew for breakfast it's getting weaker and vanishes over the day. But wearing the DE at night it all starts over again. For my case I presume that my occlusion is only stable when I press together. Discluding the teeth overnight may give them the possibility to move. This is over when I have the occlusion by pressure or chewing in the morning. So that's what my experience is. I am going to place some NTI the next weeks. I am interested about the results I will get. JK SignatureDr. Jochen Kulow |email: jochen.kulowNOSPAM Zahnarzt/Dentist | (at)dentalmail.de |remove NOSPAM |PGP: http://wwwkeys.de.pgp.net |HP: http://www.dr-kulow.de --------------------PGP-Fingerprint------------------- DAA3 468E 10FB 463D AE5C A135 6D6B 9250 7746 6FC7 ------------------------------------------------------ >> She is touching somewhere. >> [quoted text clipped - 9 lines] >> I bet this person has an exaggerated curve of Spee and gets second molar >> cusp tips to touch when fully protruded. ...................................... > But shouldn't she also have numbness on the lower molars. If the lower molars are numb the NTI is not made right. If she finds a place to clench on with the NTI in place, she will have muscular pain and cephalgia. >I mean she can't just have the problem in one jaw since the height of the >DE might possible only let two spot touch each other. Area of complaint is dependent on the latero-protrusive bracing positon. If she can get to it with the NTI in place, she will continue to have pain. Some patients will develop a new bracing posiong with the DE as part of the tripod. > I would also think of muscular probs Or the joint, perhaps she just > protrudes more with the slide in place. Most people protrude more after wearing the NTI for a while. Has to do with muscle spasm going away. Most joint problems are muscular. > I myself have hurting teeth (upper and lower jaw, all molars) when I wear > the device over night. When I then chew for breakfast it's getting weaker > and vanishes over the day. But wearing the DE at night it all starts over > again. I cannot be certain, but would guess that your DE needs to be larger or taller. Does your habitually acquired CO change in the morning? Do you wake with a more distalized CR postiion? You might benefit from a properly done minor equilibration done first thing in the morning after waering the NTI all night long. I plan to have George W_B do a minor equilibration on my molars (next time we are together) as I distalize the condyles after wearing the NTI all night long. Early morning CO is closer to CR. I need to have more of a "long centric" adjusted in. > For my case I presume that my occlusion is only stable when I press > together. Discluding the teeth overnight may give them the possibility to > move. This is over when I have the occlusion by pressure or chewing in the > morning. I can tell we need to discuss prafunction with you Jochen. Teeth are not designed to be together. They are designed to fit comfortably for tiny moments during chewing and swalowing. Teeth should only touch for 3-4 minutes out of 24 hours. The occlusion becomes un-stable when the teeth are together too much. Teeth do not move when they are apart (in the absence of orthodontic appliances). They need some pressure applied on them to move. > So that's what my experience is. I am going to place some NTI the next > weeks. I am interested about the results I will get. Please make sure you understand the principle of the NTI better before doing it on patients. Make one for each of your staff and all your familiy members first. You will get a lot of good feedback from them. The NTI is a great device, which is easy to use, but you want people to get better wearing it, (and you want them to actually wear it). Tell you what, you spend a week in Michigan this summer, I'll get a few other dentists here, and we will all learn from each other. We can show you how to get the most from the NTI. I'll show you why you should forget all the hocus pocus your employer makes you use, and invest in technology that realy works instead. SM 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. ...................... >Tell you what, you spend a week in Michigan this summer, I'll get a few >other dentists here, and we will all learn from each other. We can show you [quoted text clipped - 3 lines] > >SM An interesting offer. But.... don't you think that it's just that one of JK's legs is shorter than the other ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>Tell you what, you spend a week in Michigan this summer, I'll get a few >>other dentists here, and we will all learn from each other. We can show [quoted text clipped - 12 lines] > other ? > -- You know me, I *have* to help if I can. after Jochen Kulow observed: > > I myself have hurting teeth (upper and lower jaw, all molars) when I wear > > the device over night. When I then chew for breakfast it's getting weaker [quoted text clipped - 11 lines] > long. Early morning CO is closer to CR. I need to have more of a "long > centric" adjusted in. Ray Bertolotti does this also with the NTI. His method is that you not take it out AT ALL untill you get to your morning appointment. You have your coffee, and perhaps have a liquid milkshake breakfast over the NTI, but you leave it in. You don't even brush your teeth. When you get there, the dentist takes your NTI out and only lets you close when there is a horse shoe Accufilm placed between the teeth. Then you see where to adjust. SignatureFinally: take out the TRASHH >Ray Bertolotti does this also with the NTI. His method is that you not >take it out AT ALL untill you get to your morning appointment. You have [quoted text clipped - 3 lines] >is a horse shoe Accufilm placed between the teeth. Then you see where to >adjust. Makes them 4:00 PM appointments kinda tough on the patient, eh ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >Ray Bertolotti does this also with the NTI. His method is that you not > >take it out AT ALL untill you get to your morning appointment. You have [quoted text clipped - 10 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com Sure do: but then this type of treatment would be done around 07h30 in the AM. The effects of nocturnal muscular activity would still be there. But then I'm sure you knew that... SP SignatureFinally: take out the TRASHH >> Makes them 4:00 PM appointments kinda tough on the patient, eh ? >> -- >> >> W_B >> Take out the G'RBAGE >Sure do: but then this type of treatment would be done around 07h30 in >the AM. The effects of nocturnal muscular activity would still be there. >But then I'm sure you knew that... >SP Yep, I wuz ribbin' ya. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > She is touching somewhere. > [quoted text clipped - 9 lines] > I bet this person has an exaggerated curve of Spee and gets second molar > cusp tips to touch when fully protruded. The old Horgar Occlusion evaluation trick. Yes, I can do that. I _did_ verify if those molars could touch yesterday when she came in, but it would be better with the models and an evaluation of her occlusion. Thanks SP SignatureFinally: take out the TRASHH Well, then we are getting somewhere. Let us know how it works out. 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. ...................... > >> She is touching somewhere. [quoted text clipped - 18 lines] > Thanks > SP |
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