What is a Dental Deprogrammer?

What is a Dental Deprogrammer?

What is a Dental Deprogrammer? Can it Adjust your Bite?

By Ann McCulloch

Deprogrammers are short-term oral splints used in dentistry to “deprogram” muscle memory in your jaw muscles.

The term “dental deprogrammer” originated in dental concepts focused on neuromuscular reprogramming and how the masticatory muscles function when you chew, swallow, talk, yawn and make facial expressions. A deprogrammer can release habitual, subconscious tension in the jaw muscles. In this sense, anterior deprogrammers are more about muscles and less about your teeth.

The purpose of this article is to explain several reasons why your dentist may have given you an anterior bite plane device to wear for a short period of time.

Table of Contents

The intent of wearing a deprogrammer at night when you sleep is to relax the muscles responsible for opening and closing your jaw. Sometimes habitual muscle routines cause harmful effects. For example, “text neck”, which is a term used to describe the shortening of neck muscles over time from looking down at a cell phone. The same is true with habitual jaw tension and tight muscles that can occur with stress, poor jaw posture, or bruxism.

What Can Trigger Jaw Alignment Shifts?

The following oral habits can result in an alignment shift of your upper and lower jaw:

  • Chewing gum.
  • Chewing food on one side.
  • Propping up your jaw with one hand.
  • Playing a wind instrument.
  • Even certain facial expressions.
  • Clenching teeth.
  • Awake or sleep bruxism.

Bruxism is the medical term for habitual clenching, grinding, or thrusting of the jaw. Prior to the introduction of deprogrammers, some dentists tried to relax jaw muscles with bimanual manipulation (akin to massage and physical therapy.) Now with anterior deprogrammers, they can rapidly and effectively relax the jaw muscles with the use of an oral splint.

Why Does Jaw Alignment Matter?

The relationship between the upper and lower jaw can be out of alignment even in the absence of painful symptoms and still inhibit normal functioning. In these situations, however, when a dentist is planning to replace crowns or add new veneers, it is still important for the dentist to carefully plan how they might make any adjustments to the bite. Dentists who are trained in occlusal planning (how the upper and lower teeth fit together at rest and when chewing) will give their patients a deprogrammer to wear for a few days so that the jaw muscles will relax and return to a natural and optimal alignment of the jaws.

Before working on a patient’s teeth, dentists trained in occlusion want to investigate physiologically whether the jaw joint is in a “stable condylar position”. In lay terms, they investigate if the “ball fits the socket” of the jaw joint. (think ball and socket of other joints.) Relaxation of the jaw muscles makes it easier to analyze the placement and height of the new crowns (or new veneers, implants, and other procedures). Recording bite records that will help the dentist plan for optimal occlusal relationships.

What is Occlusal Harmony?

Occlusal dysfunction is the opposite of occlusal harmony.

Occlusal harmony is a view of occlusion that considers both the muscles of mastication (chewing), the positioning of the jawbone and skull, and the occlusal relationship of the teeth themselves into account. Meaning, it’s a global view of occlusion rather than a narrow view that focuses on interdental contact.

For instance, the masticatory muscles can be a critical aspect of proper occlusion. When the bite is significantly altered, muscle activity can take time to return to a baseline level of functioning. If there’s abnormal spasming in the masticatory muscles, the proper bite relationship will not be established. Occlusal splints can be used in these cases to prevent occlusal disharmony.

The position between the jawbone and skull is also important for establishing occlusal harmony. Centric relation is the normal and natural position of the mandibular condyle (the ball) in relation to the glenoid fossa of the temporal bone (the socket) [1]. Achieving centric relations is an important part of establishing occlusal harmony. Anterior bite plane splints are often used to find centric relation because they inactivate the muscles of mastication, allowing the relaxed jaw to fit in the joint space with ease.

Occlusal harmony describes how upper and lower teeth fit together in a way that is both comfortable to the patient and familiar. Some people hold their lower jaw in an unnatural position or chew predominantly on one side. These are examples of habits that accumulate over time and “muscle memory” can make it difficult to retrain the brain to make changes. By using a deprogrammer to remove muscle memory (which can take days or weeks of wearing the anterior bite plane) a dentist can help the patient find a natural position that will facilitate an optimal fit for the new dental elements.

Many dental conditions cannot be properly treated without performing an analysis of the patient’s jaw muscles and joints. This includes evaluating worn teeth and also a condition called an “open bite”. Open bite is where the upper and lower teeth don’t come together enough to chew food. Having an open bite can occur on one side of the jaw or involves the anterior (front) teeth. The dysfunctional result of an “open bite” is referred to as occlusal disharmony.

Dentists have many treatment options to address occlusal disharmony. They can use orthodontics to increase the height of one or more teeth using composites, crowns, veneers, or implants. Yet no matter the treatment, it’s best to plan the treatment around the natural resting place of the jaw and to find this, a “dental deprogrammer” is usually needed.

What is Managing Bite Force?

When your posterior (back) teeth bite down hard on a bagel or piece of steak, your teeth bite down hard with maximum bite force compared to chewing pasta. A deprogrammer typically inhibits the posterior teeth from coming together. This relaxes bite force and stabilizes the jaw joint. With this unloading, the joint becomes “seated” in its natural position. In technical terms, the mandibular condyles of the TMJs are seated in the glenoid fossa.

A good example of when bite force management is necessary is in the acute period after jaw and muscle sprain/strain. In this kind of jaw injury, there’s a clenching reflex that’s meant to be protective. Over time, however, this bracing and clenching can cause significant occlusal disharmony or chronic pain. An anterior deprogrammer in this case relaxes the jaw muscles and deprograms them from their tense, guarded state. This reduction in clenching can also reduce inflammation in the joints.

Dr. James Fricton explains that “Acute sprain/strains can occur at any joint and muscle group. Sprain/strains can vary from 1st degree (slight muscle or ligamentous tear with mild pain and functional limitation) to 2nd degree (partial muscle or ligament tear with blood clot formation, moderate pain, and functional impairment) and 3rd degree (total separation of the muscle or ligament with severe pain, loss of function and stability). Signs and symptoms of each include progressively increasing pain, tenderness, swelling, limited range of motion, and functional loss”. [2]

Degrees of Acute Jaw Joint and Muscle Strain/Sprain
  1st Degree 2nd Degree 3rd Degree
Injury Slight muscle or ligamentous strain and subclinical fibral tearing. Partial muscle or ligament tear with blood clot formation and bruising. Total separation of the muscle or ligament with visible morphologic change.
Pain Mild Moderate Severe
Limitation Slight functional limitation Moderate functional impairment Loss of function and stability

Dental Deprogrammers Can be a Powerful Joint Pressure Inhibitor

Dentist will use an anterior bite plane when bite force management is necessary to reduce further injury. For instance, if a blow to the mandible causes a fracture of the temporal bone or anterior ear canal, a deprogrammer will act as a powerful inhibitor of any pressure on the joint, acting like an orthopedic splint.

Dentists may share with you information about the deprogrammer and how it helps to manage or distribute the bite force. This is a reference to equal distribution of the torque and pressure of the jaw muscles and ligaments and overall, less compression of the articular discs in each of the jaw joints.

Additional Diagnostic Uses of a Dental Deprogrammer

Often a dentist will use an anterior bite plane to reduce clenching habits. An ABP is also important to diagnostically determine if a patient with jaw pain can experience symptom relief from inhibiting the clenching behavior.

A dental deprogrammer is also useful for:

  • Evaluating the stability of a patient’s bite.
  • Locating a patient’s optimal jaw position.
  • To distinguish between types of abnormal occlusal attrition.
  • Aids in making the patient’s bite easier to manage.
  • Can be used as a trial oral device to see if it helps with headache management.

Given there are many similiar dental terms, let’s answer another question.

What are Oral Functional Appliances?

An oral functional appliance is a device used in dentistry to adjust occlusion by harnessing the natural forces of jaw muscles activation or bone growth. Oral functional appliances are typically used when the relationship between the jaw and midface or the width of the palate are the source of malocclusion. Sports dentistry providers can assist athletes seeking help for an injured jaw.

This is different from typical oral appliances, such as retainers or clear aligners. They focus on dentoalveolar relationships, or the relationships between the position of the teeth in the jawbone.

A typical application of oral functional devices is to correct a recessed jaw and deep bite, a condition known as Class II occlusion. There are several deprogrammer designs that address this purpose. For instance, mandibular advancement devices slowly push the jaw forward [3]. The anterior bite plane splint can also be used for this purpose by “raising” the bite (a type of mouth guard).

More rarely, oral functional appliances can be used to adjust masticatory muscles activity, as opposed to effect change in occlusion. This is typically a temporary application, such as finding centric relation (the natural position of the jaw) or temporary relief from clenching. Again, the anterior bite plane splint can be used in this case, it strongly inhibits masticatory muscle activation.

Dental Deprogrammers can Lead to Positive Jaw Neuromuscular Changes

Dentists use dental deprogrammers primarily to establish occlusal harmony. They achieve this by accomplishing near-complete inhibition of jaw muscle clenching. This powerful effect also allows it to be used for therapeutic purposes that go beyond occlusion, such as with bite force management in cases of jaw trauma. Finally, anterior deprogrammers act as diagnostic tools to evaluate temporomandibular joint disorders and related headaches.

Functional appliances should be regarded not as simple devices that treat Class II malocclusion through skeletal and dental correction alone, but as exercise devices that lead to neuromuscular changes by facilitating muscle adaptation and activating various brain regions.

Functional jaw orthopedics provides not only dental and skeletal corrections, but is also said to bring about morphological changes by training the patient in a new mode of function by actively engaging the central nervous system via stimulation of nerve receptors in the teeth, periodontium, muscles, and joints while the appliance is in the mouth.” – Evaluation of temporomandibular joint, masticatory muscle, and brain cortex activity in patients treated by removable functional appliances: a prospective fMRI study, NIH, 2019

SUMMARY: A Dental Deprogrammer is a Therapeutic and Diagnostic Tool

This is a diagnostic tool to rule out whether the patient’s symptoms are muscle-related or dysfunction in the jaw joints. A dental deprogrammer reduces muscle tension, headaches and excess wear on a person’s teeth by relaxing the jaw. People can more about our brands that support neuromuscular reprogramming and dentists can benefit from our our JAMSS Protocol Instructions.

Read our Blog to Learn More About Jaw Pain Management

Author bio

AAnn McCullochAnn 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.

 

References

[1] “Dimensional and Positional Associations between the Mandibular Condyle and Glenoid Fossa: A Three-dimensional Cone-beam Computed Tomography-based Study,” by A. A. Almashraqi, https://pubmed.ncbi.nlm.nih.gov/33686026/, pp. 1075–1083, Oct. 2020

[2] “Jaw Joint and Muscle Strain/Sprain Treatment Technique” by Brad Eli, DMD, MS; James Fricton DDS, MS, https://www.oralhealthgroup.com/features/jaw-joint-muscle-strainsprain-treatment-technique/, July 2016

[3] “Does mandibular advancement with clear aligners have the same skeletal and dentoalveolar effects as traditional functional appliances?,” by Y. Wu et al., https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-023-02709-5, Feb. 2023