NTI-tss -- Informed Consent -- Care of device
Please initial each item as you read and understand it. Please feel free to ask us if you have any questions.
___ Wear the appliance(s) while sleeping or daytime napping, and for the first couple of weeks, during stressful daytime occasions.
___ Never wear an NTI appliance while eating. . (Doing so may be painful and possibly damaging to the opposing teeth). Discontinue all gum chewing even when not wearing the NTI. Depending on your diagnosed condition, you may need to avoid chewing hard or rubbery foods for some time. Note: use your container when you take out your NTI and don’t wrap it in a napkin. There can be a fee for lost appliances. ___ Avoid sleeping on your stomach. Sleeping on your stomach forces your head to be turned to the side, which may allow significant muscle strain and headache perpetuation. ___ Bring your NTI with you to all future dental appointments.
NTI use should temporarily be discontinued (and adjusted by your doctor):
___ if it is uncomfortable, too tight or binding, too loose (can easily be removed with minimal tongue or lip movement), or damaged. ___ if, when wearing the NTI, your back teeth or canine (eye) teeth can somehow touch each other in various jaw positions. ___if you notice that your teeth are no longer coming together as they did prior to NTI use. This is an indication that your jaw is re-aligning. Although this is usually a good sign and occurs as symptoms have resolved (or are resolving), the improving alignment of the jaw may be undesirable without some type of modifications to the teeth (either via reshaping the surfaces of some of the teeth, or via orthodontics). Therefore, if this is either undesirable or impractical, you and your provider may elect to discontinue NTI use and seek an alternate therapy. Patient understands that:
___ The NTI suppresses the intensity of muscle dysfunctions and is not an orthodontic appliance which can move teeth. Daily chewing (without wearing the NTI) will maintain each tooth's original position. Those familiar with any type of removable custom mouthpiece realize that a mouthpiece may fit poorly if it has not been worn for an extended period. This is due to the constant slight adjustments teeth make to the forces around them.
___ Jaw-joint noises (clicking) may not necessarily be indicative of disease or damage, but of an adaptation to previous injury. The NTI may allow the degree of "loudness" to decrease or resolve completely. Or sounds could increase (as you jaw’s range of motion increases). Your
dentist will recommend diagnostic tests for specific jaw joint disorders.
___ Complete resolution of your symptoms may not occur immediately (the nighttime jaw muscle hyperactivity “searches” for new ways to perpetuate the symptoms it’s been causing). Typically, the jaw's range of motion improves. Symptoms may change over time and must be reported to your dentist. Sometimes your dentist must modify the device as the condition adapts and attempts to "defeat" the NTI.
___ Reducing jaw muscle tension (clenching intensity) may allow the jaw joints to realign to their most ideal orientation (if they weren’t in that position to begin with), thereby allowing the
jaw to close in its best and most natural path, which may be different from what the patient
originally started with. This is considered a “diagnostic event”, and while it is not a common occurrence, it presents as symptoms are relieved, demonstrating that your jaw-joints had not been in their ideal positions. There is no test to determine in advance if the jaw-joints are in their ideal positions prior to the initiation of therapy.
___ One example of an improvement in jaw relationship results in the farthest back molars contacting before the other teeth do, while the front incisor teeth may not contact as well as they did before (or in rare cases, may not be able to touch each other at all). In this event, your dentist may recommend modifying your teeth to achieve the most efficient closure (or "bite"). This may be done by varying combinations of shaping the teeth, adding to them by fillings or caps or even moving them by orthodontics (braces).
___ Historically in dentistry, a "full coverage" mouthpiece had been provided for intense clenching and grinding activity. These appliances all of the upper (or lower) teeth and are intended to deflect, absorb, or modify the forces generated by muscle clenching or tooth grinding. Unfortunately, these appliances can also allow for the intensity of muscle forces to increase, by simply providing a more efficient surface to bite on. The NTI appliance is specifically designed to suppress muscle bad habits.
___Upon removing the device in the morning, brush it gently with a soft toothbrush and cool water. (Do not put it in the dishwasher or microwave!) You do not need to soak the device during the day, but can pour a “splash” of hydrogen peroxide on it upon placing it in its container. Once in a while you may have to soak it for a half hour in diluted white vinegar if crusty deposits are starting to develop. Soak, then brush. Note: the plastic portion of the NTI many change color with time. This will not affect the function of the appliance.
___Keep the appliance away from pets. They love to chew on them too.
Signature of patient or guardian date
Dentist signature date