One of the common TMJ related problems I hear about from readers of this website—both dentists and patients—is early morning jaw locking. The dentist will, of course, ask enough questions to try to understand the possible reason for this situation.
For example, is the patient wearing a night guard? Patients who wear night guards often complain that symptoms, including jaw clicking and locking are worse in the morning. The locking then goes away after several minutes and a few gently forced openings.
What’s going on here? There are a few possibilities. The usual problem is a night guard that is poorly balanced, with one side hitting much too hard when the person closes. It is not unusual to see one tooth, usually a lower second molar, in heavy contact with the upper night guard. This is a recipe for a night guard spending its nights alone in a dresser drawer.
But what if the dentist, upon careful observation, finds that the night appliance is well-balanced right to left and also has proper anterior-posterior contact. Now, what’s going on.
In this situation, the dentist needs to ask a few more questions: When you wake up, and you’re clicking or locking, which side is affected? How about sleep posture? Stomach sleeper? Side sleeper? Which side?
Often the dentist will find that the patient sleeps on her stomach or side with the head turned to one side with one side of the face or chin supported with her hands, a pillow, or both. Let’s say she supports the right side of her face with her hands or pillow, this forces the mandible to the left—maybe significantly to the left. And which side locks? In this case the left.
Assuming the locking and clicking goes away with a few mouth openings, this describes a Piper stage II disc displacement—the earliest and least serious displacement. See the following link: http://www.piperclinic.com.
Now, if the dentist is dealing with a stage III or IV or even an arthritic situation, I recommend 24 hours per day stabilization: a daytime appliance plus a night appliance with appropriate design.
But for the scenario described above, a night appliance that minimizes or prevents that lateral movement of the jaw is often the difference maker.
The SomnoMed snoring/apnea device can be used in this situation. However, I came up with a simplified, one-piece design that accomplishes the same stabilization.
For the person who displaces to the side due to pressure on the side of the face either from hands or pillows, this design has been the answer, reportedly very comfortable with no morning clicking or locking.
Any dental laboratory that has experience fabricating oral appliances ought to be able to duplicate this design, however, True Function Lab in Southern California is quite experienced in making these. True Function Lab knows it as the Prado Appliance.
For these early morning locking patients, this design may just be the ticket.