A Device to Prevent Jaw Clenching
2
MARCH 1998 353 THE JOURNAL OF PROSTHETIC DENTISTRY T he evidence that some persons clench their teeth is not difficult to find. Patients may not be aware of it and may even deny that they do it. Clenching will result in a scalloped design inside the mouth on the cheeks and on the lateral and anterior borders of the tongue, which can be easily detected on oral examination (Fig. 1). The wear facets on the teeth that result from clench- ing are distinctive in that they are very small and should not be confused with bruxing facets, which cover a much larger portion of the involved teeth. The scalloping is caused by making a vacuum with the tongue. It can be easily demonstrated that a vacuum is required to clench the teeth. If one is asked to clench the teeth and hold them very firmly together for a few sec- onds with the lips closed, the tongue will usually be found thrust against the palate and anteriorly and laterally against the lingual surfaces of the teeth and thus a vacuum is made with the tongue. If the tongue is held away from the anterior palate so that a vacuum cannot be achieved, the person’s protective reflexes will usually prevent biting hard for more than a few seconds. For a person to con- tinue to clench the teeth, a vacuum must be maintained. It is difficult to completely understand what causes a person to clench. Among the probable causative factors are “tension” or the temperament of the person, and the anxieties or frustrations faced at that time. An uncom- fortable occlusal relationship may also be a causative fac- tor. Whatever the cause, clenching is destructive. It can cause wear, mobility, and sensitivity of the teeth. Several things can be done to prevent the harmful ef- fects of the habit. If a malocclusion is a causative factor, occlusal adjustment may reduce the degree and inten- sity of the clenching. Biofeedback training can result in some muscular relaxation. Properly designed interocclusal splints may reduce muscular activity or damage to the teeth from clenching when being worn. This article describes a procedure for fabricating an intraoral device that will prevent the formation of a vacuum in the oral cavity. Because a vacuum is neces- sary for the patient to clench the teeth for an extended period, its absence will eliminate the patient’s ability to clench the teeth. a Private practice. A device to prevent jaw clenching James Hart Long, Jr., DDS a Daytona Beach, Fla. This article describes a device that is intended to prevent the clenching of the teeth. The principle involved is that to clench the teeth for an extended period, an intraoral vacuum must be formed and maintained. A tube or drinking straw held between the lips extending out of the mouth will prevent a vacuum. The article explains and illustrates how such a device can be made that will exploit this principle. Disadvantages and advantages are discussed. (J Prosthet Dent 1998;79:353-4.) PROCEDURE 1. Obtain some lengths of 1 /16 inch diameter stainless steel wire from a welding supplier and cut a piece to measure approximately 14 cm long. 2. Bend the piece of wire, beginning in its center, to follow the labial contour of the mandibular teeth. 3. At the distal surface of the second premolar, double each end back forward so that these extensions are roughly parallel to each other (Fig. 2). 4. Cut two pieces of a plastic drinking straw 2.5 cm in Fig. 1. Example of scalloping on border of tongue. Fig. 2. Contoured 1 /16 inch wire overlaying 1 mm graph paper to show its size.
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Transcript of A Device to Prevent Jaw Clenching
LONG THE JOURNAL OF PROSTHETIC DENTISTRY
MARCH 1998 353THE JOURNAL OF PROSTHETIC DENTISTRY
The evidence that some persons clench their teethis not difficult to find. Patients may not be aware of itand may even deny that they do it. Clenching will resultin a scalloped design inside the mouth on the cheeksand on the lateral and anterior borders of the tongue,which can be easily detected on oral examination (Fig.1). The wear facets on the teeth that result from clench-ing are distinctive in that they are very small and shouldnot be confused with bruxing facets, which cover a muchlarger portion of the involved teeth.
The scalloping is caused by making a vacuum with thetongue. It can be easily demonstrated that a vacuum isrequired to clench the teeth. If one is asked to clench theteeth and hold them very firmly together for a few sec-onds with the lips closed, the tongue will usually be foundthrust against the palate and anteriorly and laterally againstthe lingual surfaces of the teeth and thus a vacuum ismade with the tongue. If the tongue is held away fromthe anterior palate so that a vacuum cannot be achieved,the person’s protective reflexes will usually prevent bitinghard for more than a few seconds. For a person to con-tinue to clench the teeth, a vacuum must be maintained.
It is difficult to completely understand what causes aperson to clench. Among the probable causative factorsare “tension” or the temperament of the person, and theanxieties or frustrations faced at that time. An uncom-fortable occlusal relationship may also be a causative fac-tor. Whatever the cause, clenching is destructive. It cancause wear, mobility, and sensitivity of the teeth.
Several things can be done to prevent the harmful ef-fects of the habit. If a malocclusion is a causative factor,occlusal adjustment may reduce the degree and inten-sity of the clenching. Biofeedback training can result insome muscular relaxation. Properly designedinterocclusal splints may reduce muscular activity ordamage to the teeth from clenching when being worn.
This article describes a procedure for fabricating anintraoral device that will prevent the formation of avacuum in the oral cavity. Because a vacuum is neces-sary for the patient to clench the teeth for an extendedperiod, its absence will eliminate the patient’s ability toclench the teeth.
aPrivate practice.
A device to prevent jaw clenching
James Hart Long, Jr., DDSa
Daytona Beach, Fla.
This article describes a device that is intended to prevent the clenching of the teeth. The principleinvolved is that to clench the teeth for an extended period, an intraoral vacuum must be formed andmaintained. A tube or drinking straw held between the lips extending out of the mouth will prevent avacuum. The article explains and illustrates how such a device can be made that will exploit thisprinciple. Disadvantages and advantages are discussed. (J Prosthet Dent 1998;79:353-4.)
PROCEDURE
1. Obtain some lengths of 1/16 inch diameter stainlesssteel wire from a welding supplier and cut a piece tomeasure approximately 14 cm long.
2. Bend the piece of wire, beginning in its center, tofollow the labial contour of the mandibular teeth.
3. At the distal surface of the second premolar, doubleeach end back forward so that these extensions areroughly parallel to each other (Fig. 2).
4. Cut two pieces of a plastic drinking straw 2.5 cm in
Fig. 1. Example of scalloping on border of tongue.
Fig. 2. Contoured 1/16 inch wire overlaying 1 mm graph paperto show its size.
THE JOURNAL OF PROSTHETIC DENTISTRY LONG
354 VOLUME 79 NUMBER 3
length. The lumen of the straw can vary in size ac-cording to the patient’s preference.
5. Insert a piece of plastic straw over the end that coverseach of the anterior wire extensions.
6. Place a rubber washer (E/Z Connector Washer,DuBro Products Inc., Wauconda, Ill.) (Fig. 3) overthe end of each of the anterior wire extensions to holdthe straws in place (Fig. 4).
7. Place the device in the patient’s mouth with the wirebetween the lip and mandibular teeth (Figs. 5 and 6).
DISCUSSION
Some minor disadvantages are reported by some patientsbut most will overcome them. Adjustments may be neces-sary to relieve impingement on the soft tissues. During thenight, some air will enter the mouth through the tubes,which is intended and desirable, but it may cause somedryness in the mouth and throat. When the user sleeps facedown, some saliva may leak, the device may dislodge, orthe opening may be blocked by the bedding. The user maybe annoyed by this foreign body in the mouth and mayconsciously or subconsciously remove it during the night.Some patients may fear that they will swallow the device.
The device is intended to be worn when sleeping.
Fig. 3. Package of washers.
Fig. 4. Completed device placed on 1 mm graph paper toshow relative size.
Fig. 5. Device being inserted in mouth.
Fig. 6. Device in place in patient’s mouth.
Patients seem to have little difficulty with the accumu-lation and leakage of saliva during sleep unless they sleepon their face. When one is sitting or standing, saliva mayleak out of the mouth because it is not possible to evacu-ate saliva with a normal swallow without a vacuum.
SUMMARY
This article describes an intraoral device that preventsclenching of the teeth while it is worn. The only nega-tive aspects of this device are that some dryness of themouth may occur and some patients may be anxiousabout the safety of it, fearing that it might be swallowed.The size and shape of the device makes it most unlikelythat it could be swallowed. If the patient wants the ben-efits of the device and will persist in wearing it, he or sheshould get used to it and the mandible will remain re-laxed as long as it is in the mouth.
Reprint requests to:DR. J. HART LONG, JR.320 HARVEY AVE.DAYTONA BEACH, FL 32118
Copyright © 1998 by The Editorial Council of The Journal of Prosthetic Den-tistry.
0022-3913/98/$5.00 + 0. 10/1/87983
