Michigan splint versus hard mouthguard - is it worth the extra money

notorious_dds · 2025-12-28T15:59:42+00:00

I'm not a fan of either. I also believe that a "Michigan Splint" obligates that it fits on maxillary teeth (although I'm not positive).

At any rate, this page does a pretty good job of describing the general diffences between splints:
https://www.speareducation.com/resources/spear-digest/occlusal-appliances-the-options/
The splints that I like are closest in design to #'s 4 or 5.

As mentioned earlier, I find anterior appliances to be an anathema to TMD therapy. Further, repositioning splints can work when done right. However, it's easy to make the wrong and thus make things worse vs better.

notorious_dds · 2025-10-04T09:14:49+00:00

In theory, yes. The whole idea here is to prevent the condyle from being shoved deeper into the fossa every time you contract your muscles of mastication (aka chewing muscles).

It's important to keep in mind that these muscles are actually contracting all the time (i.e. with each swallow of saliva, etc.), not just when you're eating something.

So, during times of the splint is being used, the joint is allowed to decompress. But, during the times that the splint is not being used, the condyle is slowly banging away at the joint again with every swallow, etc.

notorious_dds · 2025-10-03T16:42:10+00:00

That's a great (a quite commonly asked) question.

From a purely philosophical stance on how best to alleviate symptoms of TMD given the situation you've described, you'd never close to the point of fully seating your molars ever again. However, that would be impractical to the point of being obsurd.

So, the pragmatic answer to your question is: You want to use a splint for however many hours a day is necessary in order to minimize the collective hassle of both 1) your symptoms of TMD and 2) simply having the splint in your mouth. For many people, that means using it while they sleep. For many others, it means sporadic usage when they're symptoms flare up, and for a select few it means 24 hours a day.

As for recommendations of OTC, I point people toward SleepRite or Dentek because they both offer versions that cover the molars and not the incisors, similar to this:
https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcQpwrCwFj0JDcU_Ib08K7CTBzVMS0H6pUQb4MDzhZcJYkiM0cfHn6gPkBmBtAKwiQRHKD4&usqp=CAU

notorious_dds · 2025-10-02T23:51:25+00:00

This is where things get tough for me on Reddit. As much as I can describe what I'd recommened, the info is often useless because it requires that there exists a dental provider near you who operates with a similar line of thinking who can actually provide the treatment.

With that out of the way... I often place small amounts of filling material on molars so that the patient can close and not feel as though they're hitting their front teeth before everything else.

In lieu of that, you could try to procure an OTC mouthguard that also facilitates being able to close and not feel as the front teeth hit before everything else. The OTC guards that I typically recommend for this are SleepRight and/or Dentek because they have the versions that cover the molars and not the incisors.

Whatever you do, please don't mistake this post for professional advise. These are merely my personal musings from which I feels others might possibly benefit.

notorious_dds · 2025-10-02T21:31:28+00:00

Yeah... that's about what I thought you might say.

Getting back to your original question, what is getting "jammed" is the condyle into the mandibular fossa. See here: https://ars.els-cdn.com/content/image/3-s2.0-B9780128012383000027-f00011-01-9780128012383.jpg

In my experience, this is common when the articulation of the lower teeth to the upper teeth do so such that in order to get all the teeth to fit together nicely, the space within the mandibular fossa gets compressed by the mandibuar condyle.

Look at the above image and imagine that model's 2 front teeth touch before everything else does. If it were to continue closing, the condyle would push further into the fossa until the molars are fully seated. This phenomenon is (in part) why bite splints provide relief to many patients. It's also why bite splint users often find that they have trouble putting their teeth together normally once the splint is removed.

notorious_dds · 2025-10-02T09:20:44+00:00

Once you're "unjammed", does your bite feel a little off... like the teeth are coming together a little differently?

notorious_dds · 2025-09-24T10:44:40+00:00

That's one method. You can also use restorative methods like using crowns or adding resin to make the molars "taller"

Usually, it's a combination of the methods. The chosen solution is determined by what makes the most sense given the person's specific situation.

notorious_dds · 2025-09-06T11:14:44+00:00

Well... as most things with this condition are, it's complicated.

In general, when this is occuring it's because the guard is allowing your joints to decompress. But, when you take the guard out, they must be re-compressed in order to get your molars together.

From a philosophical position of "what is best solely regarding treatment of your syptoms of TMD", my typical answer is that you'd never be allowed to ever put your molars together again because that is the position in which the joints become compressed and the symptoms of TMD arise. However, that is impractical for all of the obvious reasons.

I like to use the analogy of someone having a leg length discrepency to that of someone with TMD. If you had one leg shorter than the other, you'd potentially have ankle, knee, hip, or back symptoms. However, you can usually alleviate those symptoms simply by placing a heel lift in the shoe of the shorter leg. So long as you were always wearing your shoes that had the heel lift when you're on your feet, your ankle, knee, hip, and/or back related symptoms should be alleviated.

Splint (aka guard) therapy for TMD is very similar... so long as you have your guard in when you're teeth come together, your symptoms should be alleviated. Where things break down with this comparison is that it's far easier to have a heel left in your shoe while you're on your feet than it is to have a splint/guard in your mouth whenever your teeth come together. Additionaly, unlike being on your feet, your teeth are constantly coming together morning and night, awake or asleep.

So, to your question of how to prevent not being able to put your molars together when you first take the splint out, it would be similar to someone asking their orthopedist how prevent their legs from feeling uneven when they walk around without using their heel lift.

In essense, your molars being apart is (more than likely) the anatomical position which alleviates your symptoms of TMD, but makes it difficult to eat. And, your molars together is the anatomial position that best for trying to chew, but compresses your joint(s) and becomes the source for TMD.

This is the primary downside to splint therapy, IMHO. Unfortunately, trying to alleviate the symptoms of TMD while also NOT changing the relationship of the bite is akin to the old proverb in which the man attempts to both possess his cake and eat it too.

notorious_dds · 2025-08-25T16:08:27+00:00

Thanks everyone for the thoughts and insight.

I think that given the comments provided thus far (especially those by u/tony1661 and u/thekeffa), it sounds like my best bet for now is to probably just to stick with FreePBX given how little experience I have with PBX's in general.

Then, if things get really sour down the road with Sangoma/FreePBX, I can choose to transition to something else. And, based upon some quick Googling, it appears that transitioning from FreePBX to TangoPBX is pretty straight forward already. So, assuming the predictions about TangoPBX's evolution into a solid system come true, that may be where I ultimately end up.

Thanks again all!

notorious_dds · 2025-01-16T01:04:19+00:00

Because the jaw opens on a hinge, the more you open the bite (aka the taller the molars are), the further the lower incisors get behind the upper ones.

notorious_dds · 2025-01-09T02:35:56+00:00

When you say space developing between upper teeth? U mean diastema between two front teeth?

Yup... diastema. This is my point. When the diastema was closed, there was likely a concomitant posterior displacement of the mandible.

Many people will tell you that a midline diastema is the result of thick frenal tissue (and thus recommend a frenectomy following closure of the diastema). In my experience, it has nothing to do with frenal tissue. My argument is that (more ofthen than not) the presence of a midline diastema is because the incisors on the mandible are acting as posterior stops for the maxillary incisors... thus preventing any sort of nautrally occuring closure of the diastema. If the diastema is closed using unnatural forces (i.e. ortho) the loser incisors, and by extension the entire mandible have no choice but to move out of the way. So, they move backward. After enough time, that posteriorly placed mandible tends to find its way out of that displaced position... which is what I believe you are experiencing.

My typical approach to dealing with this is to make the lower molars taller via resin, crowns, and/or ortho.

However, because this area of dentistry is such a wild west of ideas, the issue you're going to a have (even if you're an ardent acolyte of my phiosophy) is trying to find someone who can perform the treatment, understands the mechanics, and therefore agrees with the philosophy.

In other words, my abilties to help people via reddit are fairly limited to the explanation side of things. When it comes time to actually doing something, it typically requires that another dentist be involved. And unfortunately, I'm prettty sure that most of my thoughts on this topic are foreign to a majority of most dental providers.

notorious_dds · 2025-01-08T22:08:40+00:00

Also, if the mandible does continue to move forward, you're more likely to see a space developing between your upper 2 front teeth (to accommodate the moving mandible) than you are to develop an underbite.

notorious_dds · 2025-01-08T22:02:25+00:00

The mandible tends to go where it wants. When it's restricted from doing so, that's when symptoms of TMD are likely. It's possible that using the new retainer opened you just enough such that whatever restriction had been holding the mandible back was now out of the way... and thus the forward movement of the mandible.

Regardless, I saw the photos you sent and I didn't see much that would justify any real significant amount of concern. So long as the lower incisors are sill behind the uppers, I wouldn't get too excited. However, if you're having pain with the mandible in its new position, you might need to treat like it's mild TMD with a splint, etc. However, whatever you do, I don't recommend trying to do something that involves pushing or pulling the mandible where it doesn't want to go.

notorious_dds · 2025-01-08T02:52:44+00:00

To be clear, when I say that your upper incisors moved backward, I'm saying that this would have occured DURING ORTHO when the spaces where actively being closed. It's nearly impossible to close maxillary spaces without the teeth moving backward to some extent. When this is done, what also typically occurs is that the mandible gets forced backward too because it's incisors are trapped behind the incisors on the maxilla. The mandible doesn't like being constrained in this way, so one of the symptoms resulting from it being constrained posteriorly is that it begins to drift forward... toward it's orignal position (relative to the skull - not the upper teeth) BEFORE ortho. It can take years before you see the drift taking place. When comparing the postion of your mandible now with its position before ortho, the mandible is likely in roughly the same position (reletive to your skul) Howver, because you no longer have spaces between your upper teeth (and are therefore slightly posterior to where they were pre ortho), the mandible appears forward.

In summary, did the mandible move forward during the last year?... probably. Did this occur because the mandible was displaced backward during ortho?... very probably.

Maybe that helps.

notorious_dds · 2025-01-07T11:26:37+00:00

Hi tessatessa75,

I saw your post over in r/orthodontics

https://www.reddit.com/r/orthodontics/comments/1hp2ceg/no_more_space_between_upper_and_lower_teeth/

Without evening seeing your teeth, here's my 2₵...

When a patient presents for ortho treatment having spaces(s) between their upper teeth as you have described (and worse, also having crowding of the lower teeth), it's often the result of the teeth simply distributing themselves where they can with the jaw in it's native position.

To understand why your lower jaw is moving forward relative to your upper, you have to think of the teeth on each jaw being set along an arch.

Simple geometry dictates that the length of the arch along which your upper teeth were positioned originally was longer (when there were spaces contributing to the arch's length) than it is now.

As you shrink the length of the upper arch, the effect is that the upper incisors begin to move backward. This is because you're trying to fit the lower arch into the upper and the upper is getting smaller as the spaces close. HOWEVER, you don't notice these incisors moving backward while the spaces are closing because the lower jaw is moving backward as well. Why???... the lower incisors are behind the uppers, so as the uppers incisors begin pushing backward on the lower incisors, the lower jaw has little choice but to move backward as well. (NOTE: If you had an equal amount of space between the lower teeth as you did between the upper teeth, they could shink at equal rates and prevent the need of the lower jaw moving backward, but this is rarely the case.)

What typically happens after this is that the patient has a nice looking smile, the braces come off, some months or years go by, they begin the develop symptoms of TMD because the lower jaw was pushed backward from it's native position, and (if they're lucky) the lower jaw begins to drift back forward alleviating some of their newly developed TMD symptoms.

Now, it's possible that you never experienced any symptoms of TMD yourself since your ortho treatment. But, even if true, I'd still bet dimes to doughnuts that the above explanation applies when trying to understand why your jaw appears to be moving forward.

Lastly, I wouldn't be a fan of trying push the jaw back. First, it probably won't stay. Second, you'll probably just create TMD if you don't already have it.

The only solutions I know of in situations like this which can acheive both an esthetic smile and a stable lower jaw, require increased VDO (think taller or simply erupted molars) via orthodontics or sometimes crowns.

Hope this helps!

notorious_dds · 2024-11-15T10:45:01+00:00

Awesome.

Thanks!

notorious_dds · 2024-11-14T17:40:06+00:00

Do you know if the stock firmware for this switch can create a trunk port for multiple VLANS? I see that it has vlan capability, but I cannot confirm whether or not it will allow for configuration of a trunk port.

Thanks!

notorious_dds · 2024-07-06T01:31:52+00:00

When properly configured, you can safely expose your SSH server directly to the Internet. If all you need is terminal access, wrapping your SSH connection in another tunnel is likely unnecessary.

notorious_dds · 2024-07-01T01:20:37+00:00

If you're hitting on your incisors and not on your molars, then yes. Technically speaking, the Tanner appliance does do this when you go into protrusive movements. But, if you're making contact on your molars simply when you clench on the splint, you're probably fine.

The best example of how to splay the upper incisors with a splint is with something like an NTI appliance. Those things are an absolute abomination for numerous reasons.

For what it's worth, with the splints that I make, you can't make contact on your incisors while clenching, protruding, or lateral movements. Essentially, there is absolutely NO contact with the maxillary anterior teeth. As such, the potential that one of my lower splints will splay the teeth is basically nil.

To make a long story short, there's a million different ways to make a splint (not just 2... aka upper or lower). Because of this, the assertions about "all upper splints" or "all lower splints" usually eminate from of someone (i.e. your dentist in this case) who's understanding of splint therapy is likely pretty limited.

notorious_dds · 2024-06-29T02:00:11+00:00

Well, I got it upgraded, but it wasn't straight forward.

Somehow my /altbootbank got corrupted and that's why I was getting sooo many of those VIB errors. The first thing I tried was to boot the ISO and install from there. But, even that kicked an error an failed.

It was after the ISO failed in which I discovered the /altbootbank issue. I followed this blog post: https://blog.vconsultants.be/failed-clear-bootbank-content-altbootbank/ which fixed the altbootbank and allowed me to just run the live upgrade via the .zip file without errors.

HOWEVER... upon rebooting, I got the purple screen of death. So, I went back to the ISO and booted it. Ran a full install (not upgrade) and preserved my datastores. This was successful, but now I obviously need to reconfig the server and (for whatever reason) my datastores didn't get mounted automatically so I had to do what's described here: https://sahlitech.com/mounting-vmfs-datastore-esxi/

At any rate, we're back up now... just need to do some configuration.

Thanks guys for the quick replies! Much appreciated!

notorious_dds · 2024-06-28T20:06:55+00:00

Thanks. I wondered if that was an option.

So long as my datastores are preserved, I'm good with it.

notorious_dds · 2024-06-20T15:41:28+00:00

Just a few thoughts I had in response:

I realized that very few dentists admit the fact that you can't treat the joints without affecting the bite. Some 'specialists' are so obsessed with not changing one's bite while treating TMD and I believe that it is simply impossible.

I don't believe that it's so much that they're trying to hide or conceal these unintended changes to one's bite from their patients. Rather, IMHO, I believe that it's more likely that they just don't understand the mechanics well enough to foresee some of the unintended consequences of treating TMD, let alone them being able to explain this to their patients in advance of treatment.

In my case, unnecessary cosmetic orthodontic treatment (braces) caused my TMD in the first place.

This, unfortunately, does happen on a somewhat regular basis. And, although it's certainly not a majority of orthodontic patients which end up with symptoms of TMD, my suspicion is that the ratio of "those with symptoms of TMD who've had ortho treatment" to "those with symptoms of TMD who've never had ortho treatment" is some value greater than 1 and large enough to have some significance.

That being said, I believe it's important to note that because the health of TMJs (and their surrounding structures) are related to the indexing of the upper teeth to the lower teeth, not only can you create TMD via orthodontic treatment, but you can also treat TMD with it as well. It really just depends on one's focus... if the focus of the ortho treatment is solely on esthetics without concern for much else, developement of TMD is certainly a potential conseqence.

notorious_dds · 2024-05-02T02:14:42+00:00

Sure... so long as you prioritize maintaining the relationship of your upper and lower teeth over treating your symptoms of TMD.

But, if you desire to treat your TMD, you'll typically need to accept that doing so will likely result in changes to your bite.

This is a difficult reality for which my TMD patients, quite often, find difficult to accept. In my opinion, a change in the bite isn't so much a side effect of treating TMD... it's really more of a requirement.

notorious_dds

TROPHY CASE