Dental Integration Education
Dental Integration of a Postural Restoration-based Physical Therapy Program with a Custom Occlusal Orthotic (Splint)
Purpose of Custom Occlusal Orthotic:
A custom occlusal orthotic or splint formed by your dentist assists in the positioning of your head and neck. One of the most important senses we have in our bodies is how our teeth contact each other (occlusion), and this contact (bite) can have drastic effects on how we position our bodies against gravity. Our brain receives input (i.e. "feel") from our teeth, ligaments of the teeth, mechanical position of the jawbone (mandible), and temporomandibular joints (TMJ), and this input results in how our head, neck, and bite are positioned. These positions can be less than ideal, and receiving a custom occlusal orthotic can assist in having an ideal bite and, therefore, help to maintain a proper resting position of the head, neck, and body (i.e., "neutral") against gravity.
How a Custom Occlusal Orthotic Works:
The orthotic splint is designed by the dentist and therapist to give you uniform molar contact on both sides while your neck is in a neutral state. If there is too much input through the anterior (front) teeth, then this can result in positioning of the head forward, an extended neck posture, and shifting of weight forward onto the balls of the feet, which is not an ideal position for our bodies. Giving proper sensory input to the molars with the splint provides your brain with a consistent, appropriate sense of where your head and neck should be positioned in a neutral state. Having molar contact allows your head to have a reference (i.e., "floor"), and your brain will position the head based on that floor. When that floor is not positioned properly, your head and neck position will be imbalanced. Using the splint, your molar feel will help to create a level floor and, therefore, allow for proper positioning of the head and neck. This will also have a trickle-down effect on the rest of the body to allow you, as the patient, to feel the actual floor through the heels properly.
In addition, the smooth, flat surface of the splint will allow better movement of the mandible, a more optimal bite, and reduce the inaccurate feel from your normal bite without the custom orthotic. This splint has what are called built-in canine guidance ramps, similar to guardrails, on either side to allow for the jaw to come back to a neutral resting position and give your brain a sense of where the jaw is positioned in space when moving the jaw side to side. Molar contact in general is utilized by your brain as a "floor" to rest your head upon. If that "floor" is not in an appropriate position, your head position and neck position may be imbalanced. This posterior sense will be integrated with an appropriate sense of the floor under your heels for further upright integration and postural control. The smooth, flat surface of the splint will also "free up" the mandible and occlusion to reduce both the neurological and mechanical influences of the bite position. The occlusal appliance has built into it canine guidance ramps on either side to give you appropriate references when moving your jaw from side to side. For example, if you move your jaw to the right, your right canine will come in contact with the splint to dis-occlude the teeth on the left and vice-versa. This way, no matter where you position your jaw, you will have a reference point to bring you back to a neutral state or position.
Getting your body, and specifically your neck, in a neutral position at the time of fitting the splint is important and will be monitored by your dentist and/or physical therapist. There are test indicators that allow us as providers to measure neutrality and to make sure your splint is designed correctly. At the time of the bite registration and equilibration of the appliance, the correct position of the neck will be assured by your physical therapist (PT) or dentist, using whatever other tools are needed (shoes, glasses, etc.), to make sure the correct position is calibrated into your appliance.
When to Wear Your Custom Occlusal Orthotic:
It is our professional advice that your custom occlusal orthotic be worn at night indefinitely, with any physical therapy exercises and any physical activity. We also encourage, early on in treatment, you to wear your splint as much as possible during the day to allow for your nervous system to learn a new body position and eventually reduce the need for your splint. Your dentist and physical therapist will guide you on when your splint will be worn and if any other aids, such as glasses, foot orthotics, and shoes, need to be worn with your occlusal orthotic. For those patients who have significant breathing dysfunction or bruxism (i.e., "clenching/grinding of teeth") during sleep, alternative nighttime intervention may be needed, and the splint would be day use only. Typically, we encourage more use of the splint during the daytime even when not doing your activities, and hope that gradually you will need the splint just for night times. Your PT or dentist will assist you with specifics for your use of this appliance including when to wear it, what to do with it, and what else to wear with it (i.e. glasses, shoes, orthotics).
Information on What to Do with the Custom Occlusal Orthotic:
It is recommended that you get a custom occlusal orthotic because your head and neck are not positioned properly in a resting state. This usually presents as tension, pain, and decreased mobility. Other signs and symptoms include improper use of certain muscle groups, over- or underuse of muscles, posture abnormalities, and limitations in movement. Once the splint is in place and adjusted to fit you, the patient, normal daily and recreational activity is encouraged because interference from the old bite does not affect the position. Typically, if you are recommended to have an occlusal appliance fabricated, your neck and head have not been assuming an appropriate rest position, which typically manifests itself as tension and/or lack of mobility. Movement of the jaw, head, and neck independent of each other becomes challenged. This can lead to muscle misuse, overuse, or underuse due to positional and structural limitations. Once the splint is in place and calibrated to ensure head and neck neutral positioning, activity is then encouraged to move the head, neck, and jaw independently of each other without interference from the old bite position or pattern.
At rest, the jaw is typically open with the teeth not touching. The habitual touching of teeth occurs with swallowing, speech, and movement. We would encourage a resting tongue position where the tip of the tongue rests lightly on the hard palate behind the upper front teeth and a small space is present between the upper teeth and the splint. The splint is not intended to be clenched on. If you are noticing persistent clenching, please alert your PT or dentist.
To Do's We Would Encourage with Your Custom Occlusal Orthotic:
It is important to frequently move the jaw to the right and left, sensing the canine "ramp" as the jaw moves from side to side while keeping the tongue resting behind the upper teeth.
For example, as the jaw slides to the right, the right canine should hit the ramp, and as the tooth slides up the ramp, the left teeth should no longer be in contact with the splint. This sense of either the left or right teeth contacting the splint helps us be aware of where the jaw is positioned and where neutral is and engages the musculature of the jaw in a normal manner (as is needed for efficient and normal speech, chewing, and breathing).
Periodically throughout your day, keeping posterior molar contact with the splint, turn your head from side to side in a comfortable range of motion, and swing your arms walking, ensuring your trunk is rotating side to side.
All these instructions and information in this handout will help retrain your body to move in a more "normal" efficient manner with the neutral starting point pre-set by the tools given to you. You will, probably in most cases, also be given other exercises to encourage neck and trunk movement without interference from your teeth.
If you have specific questions, please do not hesitate to contact your dentist or physical therapist.
*For more information on the science of Postural Restoration or the Postural Restoration Institute (PRI) from which the concepts and purpose for this splint are designed and developed, please visit: www.posturalrestoration.com.