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ASSISTANCE with NTI protocol
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      Upper or Lower?  Flowchart
      Interpreting Patient Responses
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MSDS, Headache Questionaire,
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      TMD, Parafunction, Migraine
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Interpreting Patient Responses

"My 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.


"My 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 possible.   Excessive vertical upon protrusion will create, or maintain, joint strain. 


"I 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 time.
Sculpting the device to make it as "natural" as possible will help.

"It's too tight on my teeth / I feel pressure"
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.   


"My 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.
*The preferred method to rectify the above is to provide an opposing device, as described in the NTI 2.0 protocol..


"My 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 indicated.


"I'm 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 the vertical.