When is an Anterior Bite Splint is Right for You?
By Ann McCulloch | Reviewed by Dr. Brad Eli
Not all oral appliances are just for teeth! Anterior Bite Splints are short-term mouthguards that help with jaw sprain/strain (JAMSS) and headaches.
Numerous medical mouthguards are on the market, making comparing mouthguard types and splint options confusing. Your typical mouthguard centers on “teeth”; but did you know that some mouthguards are designed specifically for medical applications?
Table of Contents
- What’s an Anterior Bite Plane Splint?
- What Do Anterior Bite Plane Splints Look Like?
- Where is an Anterior Bite Plane Splint Placed?
- How Does an Anterior Bite Plane Splint Work?
- How do I Use an Anterior Bite Plane Splint?
- What Medical Conditions Benefit from Using ABP Splints?
- How is an Anterior Bite Plane Splint Different from an Occlusal Guard?
- ABP Significantly Reduces Jaw Muscle Hyperactivity
- Dental uses of an Anterior Bite Plane Splint
- Conclusion: How and When to Use an ABP Splint
This article features one of the most powerful medical mouthguard designs, the Anterior Bite Plane (ABP) splint. The ABP design is appropriate for short-term and immediate treatment of jaw injuries, TMJ disorder flair-ups, and a number of headache conditions, including migraines and tension headaches. While dentists have used them for years, it’s now easier to obtain these splints. People can purchase them as a self-directed intervention for acute injuries, face pain, and headaches.
We’ll start by answering common questions about ABP design. You’ll also learn how and when it might be right for you!
What’s an Anterior Bite Plane Splint?
The anterior bite plane splint (ABP splint) is also know as an “anterior deprogrammer”. True to its name, is an anterior placed splint that doesn’t cover the back molars. This achieves one of the principal objectives of the design; to keep the back teeth out of “occlusion”, meaning they can’t come together.
When the posterior teeth are prevented from contacting each other, the large muscles that drive jaw motion suddenly relax. This relaxation is called “deprogramming”. This helps muscles that are neurologically trained to clench and “deprogram” them so that they relax.
What Do Anterior Bite Plane Splints Look Like?
The ABP splint is flat on one side and comfortably conforms to the teeth on the other. This “flat plane” design distributes the force of the jaw muscles across all the anterior teeth. This helps reduce pressure on the temporomandibular joint (TMJ).
ABP splints are designed to be hard on one side. The stable and firm surface of an ABP creates a hard stop for teeth that causes reflex relaxation. It works similarly to the way your jaw naturally stops when you bite on something hard, like an olive pit.
Hardness is also important because if the mouthguard is even slightly flexible, the tendency of the jaw will be to chew on it (this is called parafunctional behavior). This means that if the OTC mouthguard is made of clear boil-and-bite materiathat is chewy, it may actually increase jaw clenching, not decrease it.
Where is an Anterior Bite Plane Splint Placed?
ABP splint design can span:
- The bicuspids (including your canine and premolar teeth).
- Just cover the incisors (the front four teeth).
- In extreme cases, just cover the two central incisors. Examples of this last splint are the Nociceptive Trigeminal Inhibitor (NTI)and the Best-Bite Discluder.
An NTI is great at stopping clenching, but it’s so small, there have been some reports of people choking on it at night1. The main takeaway is that ABS splints can cover any teeth but the molars (the back two teeth, or if you still have wisdom teeth, the back three).
How Does an Anterior Bite Plane Splint Work?
The ABP splint is also considered “permissive”, so the jaw can slide freely along the horizontal axis, allowing muscles to release, relax and heal. Over a few days or weeks, a permissive splint will allow the masticatory muscles and ligaments supporting the jaw joints to relax. This allows the position of the jaw bone (the mandible) to sit in its most natural position in the jaw joint socket.
|Distinctive Features of ABP Splints|
|Mechanism of Action:||Relaxes and “deprograms” jaw muscles by preventing posterior teeth contact.|
|Tooth Coverage:||Anterior teeth only; no molar coverage.|
|Flat plane:||Distributes jaw forces evenly across teeth.|
|Permissive:||Allows jaw to slide freely in the horizontal plane, further relaxing muscles.|
|Non-compressible:||Hardness triggers reflex relaxation and prevents parafunctional behavior.|
How do I Use an Anterior Bite Plane Splint?
A quick overview for using Anterior Bite Plane Splints includes:
- Acknowledge that they are meant for immediate, short-term use.
- Identify the best time to wear them for your condition.
- Don’t delay treatment.
First, recognize that ABP splint use is for short-term applications only. The teeth are remarkable in their ability to move around in the jaw. Consider the miraculous effect that invisible aligners have on the teeth after a short period of time. If a person were to wear an ABP splint around-the-clock for several weeks, there’s a theoretical risk that the posterior teeth would start to protrude out. The technical term is to “erupt”, because of the lack of posterior contact.
Next, for some medical applications of ABP splints, the clinical plan is to wear them at night. That’s because this is when most clenching, grinding, and parafunctional behavior takes place. Another reason it is recommended for nighttime wear is that ideally during the day a person’s focus should be on keeping the teeth apart and holding the tongue on the roof of the mouth. This focus also helps to deprogram or retrain the brain to have a natural jaw resting position. On the other hand, in cases of jaw injury, the ABP splint can be worn during the day to act as a protective device, like a sling for an injured shoulder.
Finally, perhaps the most important thing to know about an ABP splint is that the sooner you use it after your initial injury or onset of symptoms, the better. When jaw pain or muscle tension is not addressed, the pain signals start to persist in the brain. This occurs even after the original injury or flair-up is resolved. It is called “central sensitization”, meaning that your entire nervous system around the jaw, head, neck, and shoulders becomes vulnerable to long-term pain and hyperreactivity in the case of reinjury. There is a premium on speed to treatment; this process of central sensitization can happen in as little as 1-2 weeks. To summarize, immediate treatment for TMJ injuries results in faster healing and recovery and prevents chronic pain issues.
Since we know that speed to treatment is important, conversely, how to quickly get ABP splint matters. Many sports injuries occur on weekends. Finding a TMJ dentist with available appointments can be challenging. Fortunately, simple ABP splints are readily obtainable for direct use. They may be provided by any healthcare provider, without required dental equipment or training.
This is a significant development, given the importance of timely medical care to avoid the escalation of chronic pain. Orofacial Therapeutics seeks to increase awareness of the function and uses of ABP splints. Public knowledge of how and when to use them reduces jaw dysfunction.
What Medical Conditions Benefit from Using ABP Splints?
There are several medical applications for ABP splints. The three of most common are:
- JAMSS injuries.
- TMJ-related orofacial pain.
As mentioned above, the ABP splint is useful after JAMSS injuries. These injuries can be roughly characterized by the direction of traumatic force to the jaw. If it’s a direct blow to the chin, the force of the blow is transmitted through the jaw to the joint space. The joint space is richly innervated with sensory tissues. When a traumatic blow occurs, it not only activates pain signals but an inflammatory response. This nerve inflammation causes muscle guarding and bracing in the jaw complex, which then irritates the joint even more. Using an ABP splint for frontal blows to the jaw will prevent the jaw from clenching and further irritating the joint space nerves.
Lateral blows to the jaw can cause irregular stretching of the jaw muscles. Guarding reflexes in the muscles then causes spasms and contraction.
Prolonged jaw muscle guarding causes:
- Muscle fatigue.
- Tissue hypoxia.
- Additional local tissue inflammation.
Using the ABP splint in these cases provides rest to these fatigued muscles. It also calms the bracing reflex, much like a sling for a shoulder injury.
2. TMD Flare-ups
Another important medical application for the ABS splint is for those with chronic TMJ disorders (TMDs). It’s the nature of TMDs to have periods of “flare-up”. This is when new TMJ pain symptoms appear or when old symptoms suddenly get worse. From a treatment point of view, flare-ups should be viewed as if they were new injuries.
Common triggers of TMD flare-ups include:
- Increased stress or anxiety.
- Dental visits.
- Eating hard or chewy foods.
- Biting something hard, like your pencil, or using your teeth as openers.
Once a TMD flare-up is triggered, the cycle of jaw muscle tension and guarding begins. It’s important to quickly treat the TMJ just like you would any other injured joint. While conservative measures such as ice packs and analgesics often assist, the most useful tool is the immediate use of an ABP splint.
Finally, like TMDs, chronic headaches tend to be periodic in nature. Regardless of what triggers your headache, nearly all headaches eventually result in a clenching or guarding reflex. This muscle tension itself then becomes an instigating and perpetuating factor.
The technical term for this is “pain amplification”. Short-term use of an ABP splint will instantly relax these tense jaw muscles, allowing for other headache factors to subside. In these cases, only a couple of days of splint use can make a huge difference in overall symptoms.
|Anterior Bite Plane Splints are Effectively Used For:|
|Medical Condition||ABP Splint Benefits|
|JAMSS||Interrupts the cycle of reflex guarding and clenching.|
|TMD flare-ups||Interrupts the cycle of reflex guarding and clenching.|
|TMJ-related headaches||Prevents “pain amplification” from jaw muscle tension.|
ABP Significantly Reduces Jaw Muscle Hyperactivity
A March 4, 2022, study using an anterior bite plane called the Nociceptive Trigeminal Inhibition (NTI) compared it to a placebo oral device. Author Andrew M. Blumenfeld, reports on the use of the ABP to inhibit jaw muscle hyperactivity in the Adjunctive treatment of chronic migraine using an oral dental device: overview and results of a randomized placebo-controlled crossover study article. It contributed significantly to an improvement in reported HIT-6 Scores (Headache Impact Test).
We learn that “68% of refractory chronic migraine sufferers using the NTI as measured by sequential HIT 6 scores had at least a one-category improvement (severe to substantial, or substantial to some, or some to none) compared to 12% when using a placebo device.” Blumenfeld also talks about how 36% of jaw pain patients using the NTI device reported a two-category improvement in their HIT-6 score, versus 0% when using placebo.
The improvement in HIT-6 scores produced by the NTI device, suggests that patients with Chronic Migraine may have intense nocturnal jaw clenching as a contributing factor to their headache related disability. An NTI device is one method of assessing whether jaw-clenching is a contributing factor to ongoing migraine.
How is an Anterior Bite Plane Splint Different from an Occlusal Guard?
An Anterior Bite Plane situates your upper and lower jaw in a specific position that is meant to relax and heal craniofacial muscles. Mouthguards are often used by dentists under the name “Occlusal Guard”. They typically use them to protect the enamel in your teeth from wear or breakage from clenching or grinding. An Anterior Bite Plane Splint is functionally different in that it is designed to help you avoid stress, muscle spasms, and fatigue in the main jaw opening muscles (lateral pterygoid). Additionally, it avoids issues with you main closing muscles (the masseter, internal pterygoid and temporalis).
It is a fantastic tool for treating TMJ dysfunction and pain in the immediate, short-term until symptoms resolve, or a longer-term treatment option is determined by a healthcare provider. Occlusal guards are typically “full coverage” oral appliances that cover all teeth and are approved for wear on a longer-term basis.
The ABP splint is a powerful tool whose utility is medical and dental. They are designed for short-term use to either protect an injured jaw joint or to deactivate jaw muscle tension in conditions such as TMD flare-ups and chronic headaches.
Dental uses of an Anterior Bite Plane Splint
The ABP design keeps the upper and lower teeth “out of occlusion” and this is a helpful aid for a wide range of dental procedures. Dentists use ABP splints for their comprehensive oral examinations because relaxing the jaw muscles and “deprogramming” muscle holding patterns helps a dentist determine how the teeth should fit together, especially if there are any planned changes, such as placement of new crowns or veneers or dental implants.
Using an ABP for several days or weeks helps relax jaw muscles after a long dental procedure and helps prevent the patient from inadvertently biting down hard on a tooth or gums that have been operated on. The growing field of Cosmetic Dentistry uses the ABP splint in treatment planning when the patient presents with “worn” teeth due to clenching and grinding over years.
In this case, an ABP splint is a diagnostic tool and an educational aid for the patient. These are just some of the many uses of ABP splints, and the materials and fabrication methods of ABP splints vary.
I’ve had many patients with acute jaw pain from injury and strain after dental visits, tooth extractions, sports injuries and other traumas to the jaw. Patients want and need immediate help to prevent developing persistent jaw pain and temporomandibular (TMJ) disorders. To begin healing, I place a same day anterior bite plane and provide immediate self-care to protect the muscles and joints, relax the jaw, and encourage quick healing. I believe all dentists and other health professional should learn use these simple appliances for acute jaw joint and muscle sprain and strain.” – Dr. James Fricton, Pain Specialist and Professor Emeritus at University of Minnesota
Conclusion: How and When to Use an ABP Splint
Learn more by reading our S.A.F.E Protocol Instructions. These splints are readily available to the public, but because of the overwhelming number of mouthguard types on the market, their design and utility are still not yet widely understood. This brief introduction provides guidance for individuals seeking fast-acting relief from head, neck, and jaw pain in conditions where jaw muscle tension is a key contributor.
Ann McCulloch, MBA is co-founder and president of Orofacial Therapeutics, this site, and oversees the company’s expanding portfolio of resources and tools for jaw and headache pain diagnosis and treatment. Her chronic jaw pain issues continue to inspire her to investigate the needs and challenges of patients suffering from orofacial pain.
Dr. Brad Eli, DMD, MS is a graduate of UCLA’s post-doctoral Orofacial Pain program. Dr. Eli has also been on the educational staff at university hospitals, pain centers, and the clinical staff of Southern California hospitals