Hi Everyone and welcome or welcome back to my YouTube channel! I'm Priya Mistry, the TMJ doc.
Today's video is an update on one of my older videos called "How to Take an Aqualizer Bite".
I had a wonderful dentist named Dr. Mac Lee reach out to me and encourage me to
add an additional step to my method for taking an Aqualizer bite, and with this
additional step Dr. Lee says that we can treat jaw joint noises as well as muscle dysfunction,
headaches, neck pain, ear pain, jaw pain, etc. So this video is largely for dental practitioners,
but if you're not a dentist that you want to watch - feel free! For those of you who don't know me,
I'm a General Dentist with a practice in Portland, Oregon. In my practice, we are dedicated to taking
care of patients with TMJ Disorders. With the method I'll be going over in today's video,
Dr. Lee has told me that he has seen headaches jaw joint noises, ear pain, neck pain, all of those go
down drastically with his patients. Typically the headaches, jaw pain, neck pain, ear pain - those
go down within a month; the jaw joint noises can take longer - three to five months or so.
And so the reason this method works so well for the pain - headaches, neck pain, jaw pain,
ear pain, the myofascial concerns - is because we are treating the muscles with this method.
A lot of that pain that I just talked about is due to dysfunctional muscles of the head,
neck, and jaw and if we're able to put those muscles in their relaxed position,
then good things tend to happen and we see pain go down quite a bit. The reason this works with the
joints is because we're actually decompressing the joints by making an orthotic and we're also
improving the relationship of the condyle to the disc within the joint; so we're putting
them in a more ideal relationship. This gives the disc the ability to remodel over time and adapt
and hopefully stay where it's supposed to stay - instead of getting reduced,
to non-reduced reduced, non-reduced, etc. So that should lead to a decrease in the clicking
and popping over time. Once this AqualIzer bite is obtained, which I'll cover in a moment, I'll cover
that method in just a moment - you will then send the bite and the models of the teeth to the lab.
The first thing you want to put on the lab slip is to ask the lab to mount the models to the
bite you gave them!! This is crucial, this is the key, this is the whole reason we're doing this!
Many labs will hand articulate the models and build an occlusal guard with that and that is NOT
what we want to do for these patients that do have myofascial concerns as well as joint concerns.
I'll even ask my lab to send back the mounted models just to verify that this was done - or I
used to do that at the beginning, I don't really need to do that anymore as I've established a
really good relationship with them. If you have a good relationship with your lab and you can trust
them to do that, that's great! Next you're going to ask the lab to make a lower occlusal guard
with bite indexes all the way around it that are two millimeters deep - so that's quite deep. It's
very obvious where the upper teeth should be indexed and fitting into that occlusal guard.
You want to make those bite indexes all the way around. You want them pretty light canine
to canine, and you want them to have almost no contact for the upper posterior teeth - the buccal
cusps of those - the lingual cusps you definitely want contact. The buccal cusps not so much.
The reason for that is if all four of the molar cusps or the buccal cusps of the premolars are
hitting against the occlusal guard, it gives the patient more to ledge against, to grasp against,
and to grind their teeth against - so sometimes when they find something to ledge against,
it can actually temporarily worsen symptoms. So definitely you want to keep those buccal contacts
pretty light or non-existent in the back and very light in the front with the incisal contacts.
These bite indexes will guide the upper teeth where to rest and it will then put the mandible in
the position that we measured with the Aqualizer bite. When the mandible is in that position, it's
a position where the muscles are relaxed and the joints are decompressed and things get a chance
to just rest and hopefully heal. The reason for a lower occlusal guard or orthotic or splint - as
opposed to an upper one - is because it promotes proper tongue posture. The tongue should be up
against the roof of the mouth with the light suction. An upper guard can prevent this. Another
reason for a lower guard is I've just found that patients find them more comfortable overall. Our
teeth fit together like a hat box and so this lower arch is typically smaller for most of us,
and so if you're wearing something that's a little bit smaller, a little bit lower profile, it can be
easier to get used to. As I show you this method for taking an Aqualizer bite, I'm going to switch
to voice over because I'm going to come out pretty muffled if I try to do it with my mask on.
I will be working with my lovely, sweet patient - Alex. Hi everyone! Welcome back! All right - so
the first thing that we want to do is have the patient bite in centric occlusion and make note
of where the midlines are. I typically want to keep the midline the same and not alter the right
or left position, because this can strain the joints. Just knowing if the midlines are matched
up or if the mandibular midline is a little off to the right or the left, etc; just knowing where
that is and keeping that midline relationship the same is important, unless there's a good reason to
change it. I like to use the medium volume Aqualizer because it has three millimeters
of vertical dimension and that's usually enough to make a good orthotic. To place it in, you take
the Aqualizer out and bend it into an arch shape with the two little water pads facing each other.
Then you place it in the patient's mouth and be very careful to gently maneuver their upper
lip over that band, and ask them to rest their teeth gently against the water pads.
The Aqualizer website says it takes five minutes, but I do 10 minutes usually to get the muscles
nice and deprogrammed so they float to their happy place. Once the 10 minutes are over, we
will record the bite. Us dental practitioners will decide the A-P, the anterior- posterior position,
and the way that we do this is ask our patients to count from 66 to 76 slowly with the Aqualizer in
their mouth - this is the key! It may be kind of awkward for the patient to talk with an Aqualizer,
but what you're looking for is determining where the jaw "wants to be". Counting from 66 to 76
allows us to see where the jaw positions itself and oftentimes if the patient has wear facets,
they will line up as the patient counts. It's helpful to have an assistant watching from the
opposite side at a 30 degree angle to the patient as well. Two sets of eyes are always better than
one you and your assistant will start to recognize a position that the jaw goes to as the patient
slowly counts. Once you feel as though you found a consistent place and/or the where facets line up,
ask the patient to freeze. Then, making sure your patient is as upright as possible,
place the blue bite registration in the anterior portion where the Aqualizer pads are not resting
between the teeth. Let this set. Then remove all of it - the Aqualizer and the anterior jig.
What you're going to do is then place the anterior jig back in
and make sure that the patient lines their lower teeth up - so you can line the upper
teeth and have them find where the lower teeth line up into. Then you're going to fill in the
posteriors on the right and left. Be sure to stitch the set and unset material together.
Let that set and then, my friends, you have your Aqualizer bite! That will help to treat
the muscles, the joints, and the ligaments. Exciting stuff! So there you have it you guys!
A couple notes - with Alex we did not see much anterior movement of her jaw when she counted
from 66 to 76. She does not have any myofascial concerns, she does not have any joint problems,
and she has a very ideal occlusion, a full set of teeth. So she is not our typical TMJD patient.
When you take this bite on a TMJ patient, you're going to find that a lot of people jut their jaw
forward as they count from 66 to 76. And I did ask Alex to do that just to kind of give you guys an
idea that it is going to come forward. Even when I count, you can see my jaw comes forward. 66,
67, 68, 69, 70. I can't count that well with my jaw back. I'm bringing it forward. I had my four
premolars extracted and retraction orthodontia, so I didn't get the forward face growth that
probably would have been a little bit more ideal for me. So that's why my jaw is jutting forwards.
The position of the jaw when we count from 66 to 76 is sort of telling us where things should be.
In an ideal world, where the relationship of the maxilla to the mandible should be. I myself use
a different and more precise method in my TMJ practice. I don't use the Aqualizer bite often
and the method that I use requires a lot of expensive equipment, that's totally worth it,
but this is a simple and easy thing you guys can implement into your practices to help more
patients! This method likely won't work on a locked jaw and if you're not getting the results
that you expect to see after a period of time, be sure to send your patients to a TMJ doctor in your
area. This is not a fix all by any means; it's just a method that you can implement that will
likely help a lot of people. So that's really it, my friends! If you liked what you heard, if you
learned something, click "Like" below, SUBSCRIBE to my channel. As always, feel free to reach out
with questions, comments. I'm happy to answer them and remember - you can never have TMI about TMJ!