There’s always been something eerie about the hours between bedtime and waking up.
Yet, as a dentist, you’re not concerned about bad dreams or things that go bump at night ‒ you’re worried about what your patients do to their jaws and teeth while catching z’s.
Specifically, we’re referring to clenching and grinding and the adverse impact, both short and long-term, these involuntary actions can have.
While multiple approaches do exist to treat bruxism, this article will focus on NTI (Nociceptive Trigeminal Inhibition) Devices.
You might have heard a whole host of takes on this anti-clenching and anti-grinding tool – and we’re investigating what’s fact and what’s fiction.
NTIs are small, plastic, acrylic-made devices covering only a wearer’s anterior teeth.
Training jaw muscles to relax is the primary objective of an NTI, and it prevents the anterior teeth from touching while the wearer is asleep. So, while wearing an NTI, a patient is physically unable to clench their teeth.
In essence, this function of the NTI takes the wearer’s teeth out of the equation, allowing the jaw to slink into the best possible position. It rests the jaw joint and turns off the muscles, relieving tension and hyperactivity.
Another main purpose of NTI is to block out potential pain from the trigeminal nerve located in the head. A sizeable portion of the mouth and face receives sensations from the trigeminal nerve, and the device works to inhibit it.
Bruxism patients can train their muscles to relax and reverse their habits by using an NTI. Commonly, dental professionals suggest that patients struggling with bruxism-rooted migraines use this device.
It’s also worth noting that patients prescribed NTIs shouldn’t be worried about the movement of their teeth since the device won’t prevent it.
How come such a device can be so valuable?
For one, jaw joints are highly complex due to how our teeth bite together.
Most of your patients’ lower and upper teeth fit like claustrophobic puzzle pieces. Ideally, upper and lower teeth seamlessly combine when the ball of the jaw joint rests correctly in the socket. Realistically, though, many people don’t have that perfect symmetry because the teeth fit (or occlusion) outweighs the ball’s position in the jaw joints’ socket.
Thus, unideal bites might lead to teeth that fit perfectly but yank the ball from the socket.
This disparity between the ideal position of the ball in the socket compared to the preferred position of the teeth overstimulates facial muscles. Headaches and muscle tension follow.
The key difference between the NTI and a nightguard is how an NTI stops teeth from touching but doesn’t halt tooth movement.
Nightguards, also made of hard plastics and acrylics, cover the entirety of a wearer’s teeth, cushioning the teeth from grinding and clenching-related traumas.
Depending on what you decide is best for your patient, nightguards can cover their upper or lower arch.
Instead of preventing grinding and clenching, nightguards act as a protective layer stopping patients from wearing down their enamel. Additionally, these devices stifle tooth movement.
Frequently, patients receive nightguard prescriptions after undergoing orthodontic work.
These devices also fit the bill for patients with mobile teeth needing protection from periodontal disease.
Since nightguards cover everything, they hold a patient’s teeth in the ideal mouth position during sleep, stopping tooth-related movement.
Conversely, nightguards don’t mind if the teeth touch since the added cushioning stops them from moving.
As much as we’re living in the information age, we’re also living in the age of misinformation. Without getting all the facts, naysayers perpetuate myths to the detriment of the general public more than ever.
In the case of dentistry, NTIs have felt the brunt of misinformation. Fortunately, we’re here to correct the narrative surrounding this anti-bruxism device:
There’s a (false) idea that since the posteriors are out of occlusion, an NTI can cause supraeruption, leading to an anterior open bite.
The first sign that the above notion holds little weight is how during 16 hours of the day, patients don’t wear their NTIs. They’ll be talking, swallowing, eating, and clenching during that time.
Moreover, according to industry research, any potential for supraeruption disappears because everyday alveolar stimulation eliminates it.
TMD patients wore an NTI for eight weeks during a peer-reviewed study, resulting in no tooth movement with nightly wear. Further studies found that teeth must be unopposed for anywhere between 24 hours and eight days for any movement to happen.
Another false notion lending credence to the NTI-open bite myth is the forces from the appliance being on the opposing anteriors.
At first, it might seem like there’s merit to the above theory since the bite forces revolve around the opposing anteriors while patients wear NTIs. However, the device leads to a 70% reduction of bite force, decidedly debunking the naysayers.
It’s a common fear for patients that an NTI is so small that they’ll swallow it.
Unfortunately, some practicing dental professionals perpetuate this myth.
While NTIs are small, they’re much larger than a temp crown that a patient might sleep with.
Furthermore, NTIs are custom-crafted to fit your patients’ mouths, ensuring no chance for any swallowing. To that point, it’s wise to get patients to use all potential force when removing the device with their lips or tongue.
A study published in 2011 found that 78,000 NTI deliveries performed by over 500 dentists yielded no swallowing or aspirations of the devices. Radiographic imaging verified these findings.
We’ve now entered the bigfoot territory of our NTI-based myths. You’ve probably heard an industry peer talk about an NTI changing a patient’s bite–and they might genuinely believe it’s the truth.
Yet, once you debunk the myths about the chance for an open bite, you’re also eliminating the possibilities for other bite-related changes (for the most part).
Regardless, it’s wise to bring up this potential side effect and carefully explain it to your patients before having them sign a form of informed consent to receive an NTI.
After all, there are outliers. One study examined 512 dentists who delivered 78,711 NTI devices, and bite changes occurred 1.6% of the time. So, yes, less than two of every 100 cases saw a bite change.
The same research discussed how nearly 97% of respondents stated they’d keep up with their NTI-usage or increase it.
In other words, the advantages of an NTI far eclipse the off-chance of any bite change.
An NTI is an exceptional tool for preventing bruxism since it trains the mouth to stop clenching and grinding. There are many scenarios where this device will prove effective and positively impact a wearer’s quality of life.
Still, the correct solution isn’t a one-size-fits-all type of thing. Successful care is about catering your care to your patient’s specific needs.
Therefore, it might work better for a given patient to use a nightguard instead of an NTI. Either way, you have the expertise and skillset to offer the best advice and care!