teeth feel fat (or "itchy")"
This is due to the re-establishment of
normal PDL health. Prior to
using the NTI-tss, the patient had
been compacting their teeth within
their sockets on a regular
basis. Explain to the patient
that it is similar to the tingly
sensation one gets after one's "foot
falls asleep" from sitting on it
wrong. As the PDL regains its
normal state, it can be
hypersensitive, creating the sensation
of "fatness". The sensation will
resolve with 2 or 3 days.
jaw joint is sore"
Typically, this occurs when the
Discluding Element has opened the
patient's vertical dimension too far. With the
NTI-tss in place, have the patient
move excursively as far as possible to
both the right and left. The
direction they hesitate going in
(which is uncomfortable) is the
direction they go while asleep.
Since the DE has already created a
degree of opening, it
is also creating an additional
degree of rotation
in excursive movement.
Reduce the height of the DE and have
the patient perform the movement
again. A change in sensation
(decrease in discomfort) confirms the
excess of vertical dimension.
Close the vertical as much as
Excessive vertical upon protrusion
will create, or maintain, joint
can't close my mouth"
"I'm always drooling"
What the patient may really be trying
to say is, "I can't seal my lips
together". The bulk of the
labial wall should be thinned
and blended to a near knife-edge as
possible. Reduce the labial bulk
of the DE if possible. The
primary-clenching patient should be
reminded that their assumption that
lip-seal is necessary is really "the
parafunctional muscular condition
trying to fool you into thinking
that's so". Many of these
patients' clenching habits include a
tight lip-seal and creating a vacuum
within their mouth. When they no
longer can do that, they feel that
something is "wrong", when if fact,
what they have been doing is part of
the parafunctional disorder.
Also, with a new "foreign" object in
their mouth, it is normal for excess
saliva production for a period of
Sculpting the device to make it as
"natural" as possible will help.
too tight on my teeth / I feel
Even though the device may appear to
be fitting as it should, if the
patient senses any discomfort /
disruption, the NTI-tss device becomes
more of an irritant to them than a
muscular suppressant. The device
should feel "like a part of their
teeth", not "like a object stuck in
their mouth". To readapt the
device, submerge it in hot water for
5 seconds and replace onto the
teeth. The tight/pressure
sensation on the patient's teeth
should no longer be apparent.
Let the device set in place for a
few minutes before removing.
lower tooth is sore"
There are three common
scenarios. 1) When using an
Upper Device, the orientation of the
DE to the opposing incisors needs to
be re-established, or; 2)
an incisal corner of an incisor is
contacting the DE in excursive
activity, or; 3) An posterior
contact exists in excursive movement,
thereby allow increased clenching
intensity which traumatizes an
incisor. If while in a centered
clench, the opposing tooth feels
tender or sore, repeat the reline
procedure as in the above
example. Re-orienting the DE
will most likely eliminate the
discomfort (it may not look
perpendicular to the long axis, but
the absence of tenderness or soreness
during clenching is more important
that how it looks). In the event
an incisal corner catches the DE
during excursive activity, attempt so
smooth and round off such
irregularities, creating as little
resistance to the movement as
possible. If a posterior contact
exists, equilibrate the interference.
method to rectify the above is to
provide an opposing device, as
described in the NTI
teeth have moved"
The first assumption a patient usually
makes when becoming aware of a change
in their occlusal scheme is that
individual teeth have moved.
They are somewhat convinced of this
based on their identification of just
one tooth that seems
to have moved. What they are
actually reporting is an occlusal
interference that their musculature
had been adapted to and accommodated
for up until the use of the
NTI-tss. They should be
reassured that without orthodontic
intervention, an individual tooth
cannot move by itself in a matter of
weeks (especially when they perform
normal chewing daily).
Ideally, the interference should be
reduced (equilibrated) while advising
the patient that as their muscular
condition continues to resolve,
another occlusal adjustment may be
still getting headaches"
Although the patient's headaches may
have been reduced, the patient may
change their focus from headache
reduction to headache
elimination. Inquire as to when
they are getting their
headaches. Upon awakening?
Later in the day? Typically, the
patient's morning headaches are
noticeably improved, but they now
focus on the headaches that come on
later in the afternoon. This is
an indication for a daytime
device on the lower teeth. Also,
review the protocol for night time
use, confirming there are no oversights.
For a migrainuer who has shown little
noticeable improvement within the
first two weeks, consider opening