Dental Sleep Medicine Insider May 2017 - Page 6

T R PA O W T 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