By Rachel Teel Wall, RDH, BS
Did you know that, according to a press release issued by the ADA, 95% of Americans experience bruxism at some point in their lives? I'm thinking that, out of those 95%, some of those Americans (if you practice in the United States) have to be your patients. As hygienists, are we noticing the subtle signs of bruxism to educate and enroll our patients to own their tooth-grinding habit and its consequences?
Sometimes it takes the fracture of a tooth or severe wear that presents cosmetic concerns for patients to take this recommendation seriously. Other times, it takes us utilizing intra-oral cameras, patient education videos, or bite analysis tools. Sometimes a simple mirror works wonders to show the patients how their grinding habits are creating intricate wear patterns that they can actually see.
The bottom line is to get each patient into a protective appliance before major damage occurs.
The following is a 10-step practical hygiene application guide that is simple and fast for Dental Concepts' BruxGuard.™ BruxGuard is a time-saving and cost-effective treatment option used to prevent damage from tooth grinding and for immediate relief of bruxing-induced TMJ disorders.
The bonus is that I have made hundreds of BruxGuards and this guide includes a few "Insider Tips" that will ensure the best final product. Remember, practice makes perfect. The more guards you make, the better the results!
Insider Tip: It is wise to create a BruxGuard fabrication kit and store all necessary materials together in one place.
What's in a fabrication Kit?
1.) BruxGuard kits in various sizes
2.) Impression trays, one of each size
3.) Wooden spoon or cotton pliers
4.) Minute timer
5.) Boiler pot
6.) Bowl for cooling/setting water
7.) Surgical scissors
8.) Latex gloves
Step 1: Determine Proper Size -- BruxGuard comes in three sizes; small, medium, and large. In the beginning, it is helpful to use standard impression trays to determine the proper size guard. Most dental assistants and hygienists are able to glance at a patient's mouth and tell immediately which size impression tray will fit. After making a few BruxGuards, the same technique is possible.
Insider Tip: You may use standard impression trays to determine the proper size guard. A size 1 tray is comparable to a Small BruxGuard. Size 2 tray = Medium, Size 3 tray = Large.
Step 2: Examine the Guard Form -- Look closely at the guard before beginning the fabrication. Notice there is a trough that runs through the central portion of the guard. Also notice the ridge that extends along the inner and outer edge of the guard form. Along the outer ridge, there is a small notch in the center. This notch will align with the maxillary central incisors. The teeth will fit into the trough and the ridge will become the malleable material that will be formed around the teeth and the palate to create a custom fit.
Insider Tip: Review fitting instructions and examine the guard form before beginning the fabrication process.
Step 3: Educate the Patient -- Give the patient a step-by-step explanation of how the guard is to be fabricated. Let them know their part in the process. Make the patient aware that the guard will be warm when it is placed in their mouth and that you will need to work quickly to take full advantage of the working time.
Insider Tip: Give each patient clear instruction on how they can assist you in making the best BruxGuard possible.
Step 4: Boil the BruxGuard -- The next step is to heat the guard. This allows the thermoplastic liner material to become malleable so it can be formed around the teeth and palate. Fill the heating appliance about half full with tap water. Turn the pot on high and bring water to a rolling boil. Allow guard to remain in the boiling water for 55 seconds. It is important not to let the guard form touch the sides of the plastic pot. Use cotton pliers to keep the guard in the center of the boiler pot and to remove the guard from the water. After 55 seconds in the boiling water, remove the guard.
Insider Tip: The water will boil faster if the lid is kept on the pot. Be careful when removing the lid.
Insider Tip: Heating the guard must take place in the same operatory is which the patient is seated. This ensures maximum working time.
Insider Tip: After heating the guard, the operator has only one to two minutes of working time to complete the fabrication of the biteguard.
Insider Tip: The guard must remain in the boiling water for 55 seconds.
Step 5: Cool the BruxGuard -- Immediately drop the guard into a bowl of water or rinse under running water. This step cools the guard to reduce the temperature of the guard before placing in the patient's mouth.
Insider Tip: Use luke warm water to cool the guard. Using cold
water greatly reduces working time.
Insider Tip: For best results use latex gloves when fitting the guard.
Step 6: Place in Patient's Mouth -- Place the heated guard in the patient's mouth. Have patient bite with upper anterior teeth inside the trough but just behind the outer ridge. Align the maxillary anterior teeth with the notch in the center of the ridge. Placing the teeth inside the ridge allows enough material to mold around the teeth to create a snug fit. If the arch is wider than normal, the sides of the guard can easily be pulled apart to match the width of the maxillary arch. After the guard is placed, quickly have the patient bite down.
Insider Tip: Have the patient bite on the outer edge of the trough. This ensures a snug fit without creating bulk at the front of the guard.
Step 7: Forming the Ideal Fit-Outer Surfaces -- Immediately after patient bites down, use fingers to firmly push the clear material against the facial surfaces of the teeth and up toward the gums on both sides of the arch. Begin pushing around the molars and work toward the front of the mouth. During this step, the patient should be biting down and sucking in using their tongue to push the soft material on the lingual surface up toward the palate.
Insider Tip: As the patient is biting, have them use their tongue to push the soft material up toward the palate.
Step 8: Forming an Ideal Fit-Inner Surfaces -- Now have the patient open their mouth. Using your thumbs and forefingers, firmly pull the material from behind the front teeth and push into the roof of the mouth and back toward the soft palate. Do this around the entire arch. Next, pinch the material around the entire arch with fingers. Have the patient bite and hold the BruxGuard in place after you do this for five seconds.
Insider Tip: It is important to firmly press the soft material up and back across the palate with fingers. This ensures retention of the guard when it is worn.
Step 9: Removal & "Setting" of BruxGuard -- Instruct the patient to bite down firmly once again for a second or two. Remove the BruxGuard from patient's mouth and place in a bowl of very cold water for 30 seconds to set the guard. This allows the thermoplastics to harden and retain the exact impression of the mouth and teeth.
Step 10: Test for Fit -- Show the patient their new BruxGuard. Have the patient place the BruxGuard back in their mouth and close their mouth comfortably. When made properly, the guard should remain on the patient's upper arch when they open and close their mouth. The dentist may check the biting surface of the guard with articulating paper. The hard surface may be adjusted to create the desired occlusal pattern.
Insider Tip: Rinse the guard before placing in mouth. The moisture will aid in retention of the guard.
Insider Tip: Each BruxGuard may be customized. The hard biting surface maybe adjusted with an acrylic bur. The soft liner may be easily trimmed with scissors.
Following these instructions will help you easily create a customize biteguard. BruxGuard provides an effective solution for bruxing and clenching. There are no messy impressions or models to trim and no waiting. The process from start to finish takes 10 minutes or less and the patient leaves the office with his or her BruxGuard in hand-- Immediate relief from grinding and an end to tooth destruction!
Rachel Teel Wall, RDH, BS, is an active clinician, speaker, writer, and consultant. During her 14 years as a hygienist, she has enjoyed positions in periodontic and cosmetic practices as well as teaching, consulting, and research. As founder of Inspired Hygiene, Rachel serves as a hygiene consultant whose goal is to inspire dental teams to reach an outstanding level of patient care and performance. For more information you may contact Rachel at [email protected].
