Very Clinical: A Love/Hate Relationship with Night Guards

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[00:01:52] This is a production of the Very Dental Podcast Network. Welcome to the Very Clinical Podcast. In about the time it takes to do an MO on three, we will entertain and amaze you with tips and tricks on regular daily dentistry. Here's Kevin and Zach.

[00:02:22] Clinical Hacks listeners, welcome back to another episode of the Clinical Hacks. I am Zach Miners from Kansas City, home of the Super Bowl champion Kansas City Chiefs. And the crowd goes wild. With me, I've got Kevin Fryer from Cleveland, whose team did not make the Super Bowl. What's up, Kevin? Never has. Yeah. Congrats, Zach. Yeah.

[00:02:52] On the Super Bowl. That's great, great stuff. And we've also got Carolina Jones over here. Mac, what's going on, man? Mac, who has no team. Yeah. You're more of a college sports guy at the core, right? I am. Yeah, definitely. Is North Carolina going to make any football national championship games in your lifetime? You know, when I was a freshman at college, I thought there might be a chance, but things went downhill significantly after that.

[00:03:18] And the future is looking a little brighter for us, but I'm not saving any money for those national championship tickets yet. Hey, did you ever go to a Final Four when they were in the basketball part of it? This is funny because I was talking about this with my girls just the other day. I never did, but I was in school for the 2005 championship. Okay. Who was on that team? Who was on that team? Well, let me see. I'm looking at the newspaper right here.

[00:03:50] Rashad McCants. Yeah. Jeez, I've forgotten so many of these guys. Shawn May, Ray Felton. Ray Felton. I remember that guy. Oh, gosh, I can't remember this guy's name. I'm looking right at his picture. CJ Hooker was a little guy from my hometown who's one of the walk-ons. Okay. So not one of their big time pros? No, I mean, it was a solid team. Yeah. Jawad Williams may have actually been on there. He was a Cavalier for a while. I can't remember if he graduated the year before that or not.

[00:04:21] But no, I was on Franklin Street, which is like the college town street there. Mm-hmm. And for that championship and was there in a bar, had a great spot overlooking the street as the crowd poured into the street after the game. And yeah, I would take that environment over actually being at the game any day. Cool. Very cool. Well, we are recording this. I just got back from Miami yesterday. I was there for the Super Bowl, attended my very first Super Bowl. Awesome experience.

[00:04:47] If your team ever makes it, I highly, highly encourage it. But so tomorrow, we're recording this on, let's see, what's today? The 4th, February 4th? The 4th. Tomorrow is the parade, hometown parade for the team. So also pumped about that one. So awesome, awesome run for the Chiefs. Very excited. Very excited. All right. We're all happy for you. Thank you, man. Well, if you don't care about sports, that was a completely useless few minutes for you.

[00:05:17] And you're probably wanting us to get to the real topic today. So, uh... Hey, Zach. I got a quick question for you. Yeah, go for it, man. Did you take your night guard to the Super Bowl with you? It's funny. You should ask. I did take my night guard to the Super Bowl with me because I was with a buddy and I did not want him to hear me grind and snore and all that stuff. So, yes. And so, by the way, this is a listener by demand episode.

[00:05:44] Uh, someone asked us to talk about bike guards and night guards and here we are. We're doing it. Taking requests weekly. Taking requests. Uh, so, we have got a pro night guard, uh, team and a kind of a anti-night guard team. So, we'll start, we'll start with the pros. Uh, Kevin Fryer, tell us, um, what night guards are like in the 3D dental world. All right. So, um, we're really doing sort of two modes of treatment.

[00:06:13] Uh, for our patients that we suspect have, uh, the need for a night guard, we're going to give them a home sleep test first. If they're a sleep apnea type person, we're going to make them, uh, a sleep appliance. That's going to be their night guard. If they're not, then my go-to is making them an NTI. It's like, tell us for the, maybe the newer dentists, uh, that didn't get that kind of training in school.

[00:06:43] Define an NTI for us. You're going to make me say it. Uh, it's, uh, nociceptive trigeminal inhibitor. I think that's right. That's a Jim Boyd, uh, deal from dentaltown days. Nice. Um, I don't know about you guys, but to me, uh, TMJ, TMD was a mystery in dental school.

[00:07:05] We got competing philosophies that to me felt like dogma or religion and nothing really made sense. Um, I remember early on in practice, I would make a full arch night guard and most of those patients would get better after I gave it to them for the first week or two. Um, and then symptoms would come back or just didn't work or whatever.

[00:07:30] And I just attributed that to sticking a piece of plastic in someone's mouth and things sort of change. Um, from dentaltown days, Jim Boyd was big on there and I attended one of his lectures and it, it just made sense to me. Um, you know, to give an anterior discluding device and, you know, that's my go-to night guard for most people.

[00:07:57] I'd say 90% of the people who aren't, uh, being treated for sleep apnea and just, uh, deprogramming the muscles and that, and that sort of thing works for a lot of people. If it doesn't work, then they get a referral. That's, that's sort of how it goes. So the NTI, is that similar-ish to like a Lucia jig type? Okay. And are you making them in house or do you, someone make them for you?

[00:08:22] I send them to, uh, Keller lab or whatever it's called now and DX or something like that. Um, that's, uh, I used to make them in house and they all look like crap after a year and I just, it just didn't work out really well. So, uh, the ones that our lab made last a lot longer and look better and are more durable for the patient. Are they coming from scans or are they coming from stone models? All right. Good question.

[00:08:50] I've only made one from a scan and I made that for, uh, my wife and it didn't fit at all. Okay. And, uh, I attribute that to it being too accurate. It was way too tight. So, and I've talked to other CEREC users that have had a similar problem for that particular type of appliance. It doesn't make sense to me.

[00:09:13] Uh, and I, it's something that I'd need to find more out about because we'd scan for Invisalign all the time and those fit great, but for whatever reason it didn't fit. So that is one thing that we actually use PVS for. Oh, PVS. Okay. So you, you send in the impression then, or do you send in a model? Yep. Send them an impression. You send them the impression. Do you use like a, one of the cheaper PVS is like a, like a silchnat type of thing, or do you just use your, um, like, uh, extrude. Use extrude. Yeah.

[00:09:43] Extrude in a triple tray. And we have a sort of a recipe dialed into the lab. I want to made the same way. Uh, we, we make them canine to canine. Okay. Uh, it's for more retention. That was, uh, uh, find out the hard way mistake. Uh, so they fit better cause you have more teeth to latch onto. Okay.

[00:10:06] And, um, just a quick triple tray with, uh, extrude our normal, normal PVS and off to the lab and we get it back in about two weeks. So we're probably making one or two of those a week. Okay. Okay. That many today. Okay. Yeah. Okay. Do you do more of those than you do sleep appliances then? Hmm. Or is it pretty close? It's getting, it's getting to be, uh, 50, 50. Okay. That my protocols changed since, you know, learning more about sleep apnea. Yeah.

[00:10:36] Um, what, what is a, what is a lab bill and a patient bill on like an NTI type of appliance in, in Ohio? Yeah. I think that the lab bills around 150, 160. I think we're charging 500 or 550, something like that. Okay. And it's really not a lot of my chair time. So the system takes the impression and they deliver it. And I talked to the patient and walk out of the room. Are they tough to sell in, in, in for you?

[00:11:06] I think, I think we, we identify, identify those patients fairly well. Um, it's even easier after they've had a sleep test to say, Hey, great. You don't have sleep apnea, but you do have these TMJ symptoms or you have, um, you know, this tooth wear that we're concerned about. So here's another alternative to help you out.

[00:11:27] And, um, since numerous team members wear them nightly, uh, we've got the testimonial from them. So that, that works out well. I think, uh, one, two, three, maybe four of my team. Where's an NTI at night is NTI. Like, is that all you got? Is that like, you know, if, if there's a bite thing, it's that.

[00:11:52] So like the only, or sleep, obviously I know the sleep part, but like, is that the only time I deviate from that is if someone comes in with a full night guard from previous converting them to something else. That's a mistake. Just like, you know, a lot of things people just get used to what they have. So I will just duplicate what they have.

[00:12:13] If, if that's the case, like if, if they came from somewhere else, another dentist or moved into town or whatever, and said, Hey, I want to, uh, my night guard broke or whatever. I will, I'll make them what they had and they'll be happy. All right. Thanks. Cool. All right. All right. Now, Mac, uh, when we were kind of doing some pre notes for the show, uh, we were talking about bite guards and Mac was like, I don't know. I don't make too many night guards. I don't have much to say.

[00:12:43] And I was like, well, okay, Mac, well, tell me more. And then all of a sudden about seven to nine things came out of why night guards aren't a big part of Mac's office. So I'm going to just going to let, I'm just going to sit back and let you guys, uh, listen to Mac's, uh, uh, mantra, his top nine haterade on night guards. Go for it. So this is, I'm going to unleash my tirade here on you. Please. I've got exactly 10 reasons not to do night guards now. It grew.

[00:13:13] 10 reasons now. Well, this keeps growing by the end of the show. It'll be 15. So absolutely. All right. Mac Jones word count unleash. But first of all, I mean, I think night guards can be a very good thing. Um, and I think there are definitely a place for them and their patients that, that do need one and benefit from one. However, in my practice, I'm fortunate to be able to select out things where patients predictably get better. And I found in my hands, night guards are not necessarily one of those things.

[00:13:43] Um, so here are my top 10 reasons. And we have any, like any music we can play or drum. Are we going to start with 10? Is this a countdown? Yes. Right. Number 10. That was a mistake. I just made the dog spark. Number 10 patients pitching about the cost. Yep. Which is not exclusive to night guards, but I don't know. It seems to be a hot bushing hot button issue for patients. X number dollars for a piece of plastic, man.

[00:14:12] How many times do you hear that? Yep. So number nine, I have to charge a lot to make a profit. Um, so I started out using a lot of less expensive labs for these, not really putting a lot of thought into them. And the more I really learned about occlusion and about what the night guard should be doing. Yeah. I just found myself just spending, seeing amount of time just in these things to actually get anterior disclusion.

[00:14:37] And, uh, basically switch labs, uh, great lakes, worth a pretty well-known lab. They do a digital splint there where you can basically send in a stone model or an impression and they do a digital scan of that. And those things fit amazingly well. The occlusion is 99% dialed in usually, but I think lab fee on those is like 280 bucks. It's up there. Uh, okay. So you factor that in your time, the time you spent talking to the patient about it. Time spent adjusting, um, patient.

[00:15:07] Is that a, is that a PBS, PBS impression to send it to this lab as well? Usually yes. I found I got the best result from that using a heavy body and light body combination there. Okay. Um, so of course your costs can go up there as well. Yep. Um, so we bill out, I think around 875 for that. Okay. And really when I factor all that in, I don't really feel that great about making a couple hundred dollars on that. I mean, it just, I don't know. It doesn't seem to be that beneficial to me. Okay.

[00:15:32] Um, number eight, um, they only protect patients when they sleep. And I felt there's a lot of people out there walking around with, you know, dysfunctional occlusion where every time they're eating something, chewing gum, they're doing most of the damage then. And nighttime is such a small slice of that. So is the night guard even really doing them good if they're not wearing it all day and who's going to wear it all day? Uh, number seven insurance and coding variability. Do you guys run into this a lot?

[00:16:03] Um, there is a code we get, I think, you know, we check for coverage and if, if it's covered, great. If not, then patients responsible for it. That's, that's, that's what I've run into. It's either, it's kind of, it either is or it isn't. And it seems like more often it's not. Yeah. So there's like a code for an occlusal guard and there's a separate code for like, uh, orthotic splint. Some insurances pay one way. Some insurances defer that I think the orthotic splint to medical. Um, so if you build medical, that's great. We don't.

[00:16:33] Um, so I don't know. That's just one of those things where we've never really been able to be that consistent with it and give patients like a real great answer on that. And that may be a failing on our part and our staff's part, but, um, that's just one of the issues we've run into. The patient's getting pissed off when insurance doesn't do what we say insurance was going to do. Um, number six, it doesn't fit well after my new crown. So what I hate, put a patient in night guard, spend 900 bucks on it.

[00:17:03] They get a crown or even a patient that comes in with existing night guard. You do a crown on them. It also doesn't fit. And they never realize it the day you deliver the crown. Yeah, it's they get home, put it in. Some doesn't feel right. And then you're burning a whole nother appointment. You're grinding acrylic. Um, hoping that you get it right. Now you may end up making the night guard too loose at that point. And they complain about that. Um, that's where the CEREC shines. I can just duplicate their teeth. Yeah.

[00:17:31] Um, great point and a great, uh, plus for a CEREC for sure. Hey, it's Kate, the dental assistant, and it's time to get very clinical in this episode's very clinical corner. Are you ready, Dr. Mead? I'm ready. I want to ask your advice on storage. Sure thing. What's the question? So my team is always looking in multiple places for the same or similar materials. And I feel like no one knows exactly where anything is. Do other practices struggle with this too? Yes, many practices do.

[00:17:58] And I'll be honest, legacy errors are to blame for this current state of quote unquote organization in dental practices. So tell me what you mean by legacy errors. A legacy error is when somebody starts a process or a system with no scientific background or research or education. They just make the decision and then train their successors on the way that they want things to happen and then what works for that one person. So that sounds like it could cause problems over the long run.

[00:18:23] It can, especially when the person that sets the system leaves and then the next person comes in and then makes changes. And now we're creating more confusion because where it was isn't where it was the last time. How do you change that or how can you prevent it? Create standard operating procedures and then define spaces for the procedure specific materials and then the general disposables as well. So give me an example of that. Procedure specific materials are the ones that you need to actually perform your procedure.

[00:18:49] For example, bonding agents, cement, sutures, gutta percha, often they're expensive and expirable. And those should be stored in a central location where their quantities and expiration dates can be monitored closely. What about the general disposables? Those are the items that we need for pretty much every single patient. PPEs, barriers and cotton products are to name a few. And those should be stored in a separate room or closet due to their bulky packaging and quantities. And we don't want to waste valuable space and central sterilization on those items.

[00:19:18] So two storage spaces for dental materials beats the 15 places that we have them. Absolutely. Listeners, if you want to avoid legacy errors and have a timeless organizational system, check out the show notes on where to start. So number five, and we kind of sort of already touched on this one, but this is a little bit different. I bought a $900 piece of plastic that doesn't help. Yeah. Yeah. You're refunding that. You've got all the money in the lab bill tied up your time.

[00:19:47] Do you make them another design at no cost? Do you refer them like Kevin does and give them their money back? Yeah. So that, I mean, certainly have run into that and that that's my pitch to them. If it doesn't work, it's a piece of plastic. I haven't done anything irreversible to you. I'll take it back and, you know, refund you and you're getting a referral. So valid, valid point. Number four. And Kevin, you touched on this already. It's not like my old Dennis made.

[00:20:17] I want you to make one just like Dr. So-and-so made me. Mm-hmm. And I ran into that early on when I bought my practice, made a night guard for a lady. She had this terrible design. It was soft on the inside. It was all cracked. It was terrible. Really had no anterior disclusion. She was complaining of jaw pain. Um, so I made her one with an anterior bite splint, uh, anterior discluder and delivered it.

[00:20:44] Um, she came back in like two days later when the old Dennis was there covering for me one day. And he told her it was quote unquote too thick and that it needed to be remade. Ah, understand what it was supposed to be doing. And she could never get it through her head at that point. And I had her in time after time, just say, Hey, I need you to try this. It's going to work. And eventually just, I think that patient left the practice. Cause we just did not see eye to eye on that.

[00:21:13] And, um, you know, just one of those things I like to avoid in my practice. There you go. Um, so working down the list, number three, it's too thick. Oh, sorry. This is actually the wrong list. Oh, let's skip right. Right down to number two, um, treating all this TMJD stuff. Um, it attracts crazy patients. Yeah.

[00:21:41] It's a bit of, but there's a lot of crazy ones that I just kind of like to avoid bringing them in. Um, number one, my dog ate my new night guard. Dot, dot, dot. I don't have to pay for the price for a new one. Do I? Yeah. Yeah. Well, we, we preempt that at the beginning. Cause they smell like their owner or food. Yeah. I don't know. Yeah. We, we always tell them if you have any pets, keep it away.

[00:22:10] And you know, it's up to them. I mean, you know, I don't, I don't have any problem charging them full fee to make another one. Cause their dog was too stupid to eat it. Good for you. So again, these are all reasons, not necessarily that night guards are bad. I think night guards can be a great thing. This is just the 10 reasons I do not do a lot of night guards in my practice. I really, I really need a patient to sell me on the fact that they need a night guard.

[00:22:35] So are you essentially only making night guards for someone that either like had one and there's wore out or they got a new crown or something like that, or someone who came, came from somewhere else and had an existing one. And again, again, something happens and it doesn't work anymore, but they want it, that type of a thing. Yeah. So, I mean, based on what I tell patients, you know, if they come in, their chief complaint is jaw pain. They, they're really at the point they want to do something about that.

[00:23:05] I say, you know, this is what we can do. It's 900 bucks works for most patients, but at the end of the day, it is trial and error. There's no test I can do to see if this particular design is going to make you better. If you're okay, spending $900 for something that may not work. We can make that for you. It's no problem. Um, most patients in my practice kind of balk at that and say, well, no, thanks.

[00:23:29] It's not bothering me that bad. You know, um, my other go-to is a patient that comes in and says I'm grinding my teeth and I'm, I'm worried about my teeth grinding down. And I know I'm doing it at night. And then I'm happy just to make a flat plane splint just to, and I tell them it's not going to do anything for jaw pain. It's just going to keep you from wearing your teeth. You can be wearing this instead. And those are the two areas to me where I found the most success, um, treating patients with night guards.

[00:23:57] Okay. So you have then two styles that you make, you have a flat plane one, and then you have an, an anterior loaded splint that you make. Yeah. So, um, okay. This is an interesting little tidbit I got from Jeff Rouse, like way back in the day before anybody knew who he was before he was all into the sleep. Um, but he cited a study where he said, if you had a flat plane and you have four points of occlusion, um, the canines and the second molars.

[00:24:25] That basically cures everything that the anterior discluders and everything else does. And I have made some of those in the past and done okay with them. Um, but like Kevin said, I really liked that anterior bite ramp. I like for them to disclude there. Um, but if they just simply want something to keep them from grinding their teeth, you know, flat plane is going to accomplish that. Right on. Well, Mac, that list was intense, man. I don't know how I can, how we can all, what do you, do you have a response? I want to see how many more I can come up with while we're sitting here.

[00:24:56] Yeah. Well, I mean, a lot of those are valid. There's sort of, uh, things that we've got to maybe, uh, send golly the patient over. But I mean, I think that it's not a huge part of our practice and I don't really want to attract crazy people, but you know, we certainly get some of them in, um, thinking of someone particularly today.

[00:25:22] But, uh, you know, it's, uh, it's a, it's something that I think we can help people with. It's just a little bit different than a lot of the other things we do. It takes more time. I probably massaging the patient's personality. There's a lot of dancing involved for the patient with this stuff. I said that again, dancing involved in, um, kind of helping the patient along and, and get them to think the right thing. Sort of.

[00:25:53] Do you guys, either one of you like, um, almost like throw in some type of a night guard when you're doing maybe a larger interior case for someone that you don't, you want them to wear something. So they don't bust up like a veneer case or a bonding case, or a, maybe a larger bridge or something like that. Is ever, does that ever enter into the equation? Like protecting what you did at all? Is that a thing for you guys? I've definitely done that in the past.

[00:26:22] If I was concerned, for sure. How about you, Matt? I may have at some point, we don't do a ton of really big cosmetic cases anyway. Um, but it kind of goes back to one of my reasons here is, you know, I mean, is it even a nocturnal thing that we're protecting against or is it just a dysfunctional occlusion? You know? And, uh, like I said, if they're not going to wear it all day, it's not necessarily going to protect that. Okay.

[00:26:48] So I'm way in a different ballpark than either, either one of you guys on, on these, on these bike guards. Um, I'll, I'll tell you what I'm doing, but I will tell you that I have, I have a terrible time selling, selling these things and I'm charging less than, than both of you guys for, for one, I've got, I've got three, three guards. I make, I used to only have two. Now I've got, now I've got a third one.

[00:27:12] Um, I've got the flat pain, plain bite splint and, uh, I make them myself. Oh, we take the alliginates. We pour them up, system mounts them. I make them something. I usually knock out like over lunch hour. And we actually reduce the fee for those from like, I don't know, 400 or 450 down to like in the threes just to try to get more people to say yes to them. Still doesn't work. It's still a $300 piece of plastic that they don't want.

[00:27:39] Uh, so, uh, I guess this just all goes back to, I'm a terrible salesman when it comes to these things, which is, it defines a lot of things for my career. I think I must need that Svengali course or something like that. But, uh, uh, I, uh, so I have the flat plane splint after I took the spear demystifying occlusion course. I added in like the, the anterior bite, uh, anterior, uh, split for the clenchers.

[00:28:06] That's more, uh, it was more for like the clenchers and pain of things. Those seem to be working pretty well. We actually charge less, uh, for those than the, than the, uh, the full plane bite splints. Um, those, those seem to people that are having a little bit of discomfort seem to buy those a little bit more readily. So those, again, I'm making those just with a, uh, like an 040 suck down. And then I add the, uh, add the acrylic up in the front on a mounted model. They're pretty easy to make. It's pretty fast. Um, then we have a third one.

[00:28:35] We have like a, I don't know if I believe you that I'm grinding my teeth splint. We just make an Essex, like just an 040 Essex suck down splint for just take an upper model and just put that in someone's mouth. And it solves the, it's too thick. Um, the comment that Mac made and it, it is, it is a big problem, big problem here in Kansas city for sure. Uh, and it like, if they're a legit grinder, they'll blow through that thing and then they might believe.

[00:29:05] So it kind of, it'll, it may be, uh, it converts them into a, a, a, the thicker 080 type of splint later on. But there's a lot of people that just wear that thing and they're very happy with it because it's easy to wear. It's comfortable and it does protect their teeth if they're not really like, you know, mowing them down. So I've got that as kind of my, like a real introductory type of, of bite guard.

[00:29:29] And I know there's no real science to back that up other than, um, uh, I see people seem to like them and it seems to at least like show them if they've got a worse problem for sure. Cause like I said, they will blow through them if they got it, they got an issue. So that's where I'm at with bite guards. It's all, I, I try to keep them affordable and I wish more people said yes to them. Cause I see anytime I see a lot of wear is, you know, you ask them to go through the questions, you know, is try to figure out if it's a sleep thing. Try to figure out if it's a nail biting thing.

[00:29:58] Try to figure out if it's acid erosion, all the, you know, try to get it. A lot of them are grinders. And, um, uh, I probably need to put more people into sleep tests cause a lot of it's probably a lot more of it's probably that, but I'm not quite there yet. So I've, I've got these other guards in the meantime. So what are your guys go to, does this happen in your practice? Someone comes in with acute TMJ pain? Yes. Um, what, what do you do for them?

[00:30:31] Um, I have some of those aqualizers around. Do you, have you guys heard of the aqualizer? I have some of those around to, to give out. Those are like a poster disclusion type of a splint. And they seem to help, you know, some, some people out. Um, sometimes I'll try to get a splint since I make the splints in house. I can usually get one turned around for someone, especially in an emergency situation within a day or so.

[00:31:00] So sometimes I'll, I'll just make a splint lick it, you know, lickety split for someone. Um, look at his splint. Look at his splint. Yeah. Yeah. But I don't know. Those suck. Yeah. Because, um, so that's, that's the worst. Cause you know, usually, I don't know. I have a hard time with those. So if you got a better solution, I don't know. I struggle with those, those acute situations actually. One thing I've done for a few patients is, um, if you have the little Lucia jigs in your office, which I use those to take our bike registration.

[00:31:30] I need to, if we're making a night guard. I need to, I need to add that in. That's what that's been on my list of things to do is add the Lucia jigs. Line one of those and just send them home with that and just tell them, you know, to wear that as much as they can for a few days. Always nervous about them sleeping with that though. And aspirating that. But so far so good. They never came back. They either died or got better. It's two ways to solve the pain. Winning. How about you, Kevin? Acute pain.

[00:31:59] Uh, usually that's, uh, uh, I got to dance around some things. Usually I'll get them on some anti-inflammatories and make them an NTI and just got to wait two weeks. And, you know, usually like patient today, things weren't much better. I delivered the NTI today. We'll see what happens after a couple of days. But, um, uh, usually if we can get them on some anti-inflammatories, at least gets it good enough so that they can function.

[00:32:28] But it's, it's a problem, but not having an immediate solution to that is a problem. I'm sure there's other answers for that, but, um, I, you know, making the, the, the homemade NTI just didn't work out well for us. I think Max onto a good idea there with having the, the loose shoe jig idea. I mean, they're really nice to keep around. They're pretty inexpensive. I mean, yeah, that's, that's a good one, Mac. Yeah, sure.

[00:32:56] Uh, that's, I guess that's the only benefit to making my, my splints myself is that I can definitely get someone turned around into something really fast. If need be, it seems like if you ask someone who's in that kind of pain to wait a couple of weeks. Yeah. You know, they're, they're, they're pissed. I've always done it just in a bite registration material. Um, I don't really work with a lot of acrylic, but I mean, if you have that in your lab, I mean, you could probably adhere to that and that would be something a little bit more substantial. Okay. Yeah.

[00:33:22] I mean, I, that's what I would probably use is like a, you know, like a snap, uh, type of acrylic, but I could see where a heavy, uh, blue mousse style thing would, would work pretty good too. For, especially if, especially if it's designed for a shorter term, uh, shorter term use. But, um, you guys advise those people to do the three, three, uh, ibuprofen, one Tylenol every eight hours type of thing, every six to eight hours. I always, uh, use the analogy of a sports injury.

[00:33:51] Like if you, you know, ran too much and sprained your knee or something like that, let's get some anti-inflammatories in there and, and try to calm, calm the muscles and, and the joint down. So do you guys ever do either like tell them to do like heat pads on their cheek or do you never do muscle relaxers or anything like that? Any, any of that for you guys? I have done some mild muscle relaxers in the past. Um, but really it's been a long time since I've subscribed that. What have you written? Um, you remember an old one called carbamol.

[00:34:21] Um, Oh, it was called, um, I can't remember the trade name for it, but there are a flex reels and other ones that I've written before. Um, sclaxon, I think is what that is. Um, but yeah, it's been a while. How about you, Kevin? Any, any, uh, I haven't, I haven't done that for 20 years. Okay. It's not something I really want to get into or mess around with.

[00:34:46] I also just tell people to limit opening and, uh, you know, kind of tell them it's like, like Kevin said, a sports injury, like you strained it. Don't keep straining it. Don't you go, um, right. Don't go out and get a giant substand. Soft, soft diet, cut things up with a knife and a fork, little bitty bites, take it easy. Soft diet, um, lips together, teeth apart for sure. Some common sense things there. If you hurt your knee playing basketball, you wouldn't go play basketball again. Sure. For a while.

[00:35:14] Those people are always annoyed that they don't heal as fast as they think they should. You know, they think that it's something that should get better immediately. And the sports analogy thing is a good one. Cause no one would expect a sprained knee to get better in 48 hours or something like that, you know? So that's a good one. Back to my list. I've kind of thought of another one here. Oh, this, but on this list, I mean, have you noticed, you know, if you have a, TMJ patient you're treating that it's like, you have this conversation over and over in hygiene.

[00:35:41] Like you're always talking about the joints and just how it's not as good as they expect it to be. And they just never seem to be that really satisfied patient. Yes. I guess I just have some sort of a wall put up. I, I empathize on the outside, on the inside, I'm far away, but. Yeah. I mean, for sure that happens. Do you guys, I assume you guys are in big enough cities that there's some kind of a TMJ

[00:36:11] guru in town for that you can refer to. You don't, Mac. I see you shaking your head. For the longest time, we had no one. And that was always the tricky thing is like, you know, like Kevin said, try this, doesn't work. We'll refer you. We had nobody. We had a prosthodontist, you know, 45 minutes away and he didn't really like to do this stuff. Um, just in the last year, there is a lady who is somehow affiliated with the local dental school. It's relatively new here.

[00:36:38] Um, that has kind of limited this practice in a, it's actually in a medical office, um, where she's treating TMJ stuff. And every chance I get, I will send a patient there in a heartbeat and also triages out how serious the patient is about treatment. And, uh, you know, and I tell them, say, Hey, I can make this $900 piece of plastic trial and error. This person may be able to kind of dial things in and more predictably put you in a design

[00:37:04] that's going to make it better and give them the choice. All right. So, all right, Mac, I, I gotta ask like, um, I mean, I have, like I said, I have a hard enough time selling my $350 pieces of plastic to the point where I'm only doing maybe a, you know, a night guard a month or something like that. How many $900 pieces of plastic it's getting to, uh, make it a year. I could not tell you the last one I made. I mean, I'd say there you go, maybe 10 a year.

[00:37:32] If even that many, that's all, that's more than you. I, that's more than I thought you were going to say it's, it's been a while. So, okay. But I mean, very good. Well, case in point, the specialist that I go to, I even have patients go there, be evaluated and come back and say, well, it was gonna be $1,300 for this split. Right. I decided not to do it. Like, sure. Everyone seems to end up doing some kind of an OTC thing. I mean, your problem can't be my problem. They want the Walgreens thing. Right. Yep. Yep.

[00:38:01] Well, um, listeners, uh, this was not a definitive TMJ course by any means. If you are, if you want some real information on that, go, go to the spear demystifying occlusion course. And, uh, I went and I'm not demystified yet, but at least, uh, I got a, I realized what I was doing wrong. So there's at least that. So anyway, but that's what three regular ass dentists do with bite guards in their, in

[00:38:31] their offices or all over the map. Some people make our own, some send them to labs. You do you on night guards and, or you can listen to Mac and talk people out of them. Not doing it. That's me. I'm doing me. There you go. Uh, all right. Well, thank you guys. Uh, we will catch you next week. And so for Kevin Fryer for Mac Jones, this is Zach Miners and see ya. See ya.