Friday, December 17, 2010
Anterior night guard vs. maxillary guard?
(Photo shows an NTI Appliance)
Question: I've been wearing the latter for 30+ years but the new dentist Kaiser referred me to for a new guard to a dentist who recommended an anterior guard. He switched from giving patients maxillary guards to anterior ones after attending a seminar from a Frank Spears,DDS, who seems from his website to be an adjunct prof. at U of Wash. and spends a lot of his time giving lectures and selling DVDs.
I've come across articles saying that if you have any joint damage you shouldn't use the anterior appliance, but I only know 30 yr. old xrays showed that I had spurring in one joint and I have a history of pain that has improved in the last 10 years or so to a degree that I'm usually asymptomatic. The new dentist says I'm ok since I have no jaw clicking.
I also read that there's a chance of "eruption" of back teeth in certain circumstances, although the dentist says there's no problem if one only wear it while sleeping. An internet source says there's danger if you wear it more than 8 hours (I sleep 9 hours).
The orthodontist who made my old max. night guard said I should stick with the maxillary type and that anterior ones put too much pressure on the TMJ.
When I told the new dentist what the old one said, he replied that the old one is living in the past century.
Are anterior plates the preferred type now? It seems there is a lot more downside for anterior ones, especially since no one has suggested doing tests to ascertain if I have joint disease in the jaw.
Answer:I just attended a Spear seminar and he did advocate using the anterior bite ramp appliance for patients without any 'joint derangement'. He reported that the literature indicated that it might be more effective in discouraging bruxing. The type that he likes is actually full arch night guard with an anterior bite ramp included. As to posterior eruption, You are unlikely to experience permanent posterior eruption as long as you do not wear it all the time. Certainly 8 or 9 hrs per day won't cause this. You may notice some alteration in your bite in the morning when you wake up, but after 20 minutes or so, your bite will return to normal.
Since the type that Dr Spear recommends covers the entire arch,. it can't possibly allow eruption. Ask you dentist about this.
In my opinion, you can have either type and its OK. I still use the older style night guard and it works. Sometimes patients do report that they are still bruxing with it, but at least it seems to offer some protection to their teeth. Choose which ever style you feel comfortable having and be done with it. Sometimes dentists are caught up in fads, just like anyone. I do believe that either choice is acceptable.