T
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PA
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JAMISON SPENCER
CLICKING, POPPING
& POSTERIOR OPEN BITES
Last time I discussed what a
reducing disc displacement
is, and how this may result in
a posterior open bite due to
the fact that the oral appli-
ance will help keep the disc
IN PLACE all night long (or as
long as the patient wears the
appliance). So how do we educate our
patient about this anatomical
issue?
If you missed part one, here
are the links to Dr. Westes-
son’s videos of normal joint
anatomy and disc displace-
ment with reduction: “Mrs. Johnson, you have what
we call a reducing disc dis-
placement. That means that
normally the disc in your TMJ
is OUT of place. When you
open your mouth, the disc
goes INTO place, which you
experience as a click or pop.
When you close your mouth
the disc goes off the condyle
again. Now we are going to
treat you with this oral ap-
pliance for your sleep apnea.
Putting this piece of plastic
between your teeth is going
to make it so the disc in your
TMJ stays in place all night
while you sleep. That’s a
good thing. Here’s the prob-
lem though—when you wake
up you’re going to need to
DISLOCA TE YOUR JAW to get
your back teeth to touch.”
When I explain a reducing
disc displacement to my pa-
tients, which I do EVERY time
I have a patient with clicking,
I say:
At this point the patient will
usually nod their head—as if
they understand (but I know
they don’t). So I’ll say:
“Let me go over that again.
Your disc is out of place now
except for when you open
and it clicks. The oral appli-
ance for your sleep apnea is
going to help keep the disc in
place while you sleep, but in
the morning YOU WILL HAVE
TO DISLOCATE YOUR JAW TO
GET YOUR BACK TEETH TO
TOUCH AGAIN.”
At this point the patient will
usually say, “but what if I
don’t want to dislocate my
jaw.” And I say, “exactly! You
may come to us in the future
and say that you’re more
comfortable with your jaw
“relocated.” If that is the case,
then we may need to work
with our orthodontic col-
leagues or your general den-
tist to help get your teeth in
to a position that allows your
disc position to be more sta-
ble, if possible. BUT, let’s see
how you do just getting back
off the disc every morning,
and clicking throughout the
day like you have for years.
If you tolerate that just fine,
then you shouldn’t need to