Instructions
Instructions for Relieving Bruxism Symptoms and Facial Jaw Pain with the Aqualizer® Bite Splint
First Appointment
Diagnose & Relieve Pain of the Head, Neck, and Upper Back
Remove Aqualizer® from package and insert. No preparation of the bite splint is necessary. Note: Instruct patient not to take medication for facial jaw pain the day of the appointment. Accurate diagnosis requires that bruxism symptoms be present. Rule out organic pathology and confirm adequate posterior occlusal support.
Instruct the patient to keep the fluid pads between the posterior teeth. The patient should relax and rest their teeth against the fluid pads when swallowing. It is not desirable to clench. Ask the patient to be aware of any change in sensation anywhere in the head, neck, shoulders, and upper back. Monitor the patient’s symptoms in your reception area every five to ten minutes for 30 to 60 minutes.
Physiologic Changes
Simple insertion of the Aqualizer® bite splint creates a muscle-dominant functionally generated occlusion instantly. This occurs because the Aqualizer® facilitates muscle-dominated mandibular repositioning while it equalizes, axializes, balances, distributes, and makes simultaneous all occlusal forces.
- 1) The Aqualizer®’s smooth, flexible surface permits the teeth to easily slide across it. The flexible fluid pads, positioned between the upper and lower occlusal surfaces, eliminate all tooth-to-tooth contact. Proprioceptive guidance is neutralized as the dominant factor in functional mandibular placement. For the first time, the muscles are not forced into position by the way the teeth fit together; they fit everywhere. The muscles respond instantly by moving the mandible into its most comfortable, least accommodated position. Generally within the first minutes, this occlusal-muscle harmony eliminates occlusally triggered facial jaw pain and muscle spasm. Chronic (as opposed to episodic) sufferers generally experience slower results.
- 2) The Aqualizer®’s fluid system responds dynamically, continuously re-equilibrating and balancing bilaterally as the mandible shifts to the position most comfortable for the muscles to function. The Aqualizer® is taking full advantage of Pascal’s Law of Hydrodynamics. According to this law, an enclosed fluid system, such as the Aqualizer®, perfectly distributes force in every direction. Ideally, occlusal forces are perfectly axial and equal. The therapist accomplishes this by simply inserting the Aqualizer® bite splint.
If Patient’s Facial Jaw Pain Improves (During the first visit)
Pain relief confirms the diagnosis – pain is triggered or exacerbated by the occlusion. This facial jaw pain relief is a clear demonstration to both the doctor and the patient of the benefits that can be obtained by Aqualizer® guided occlusal therapy. Relief of pain usually occurs within five to ten minutes after insertion of the Aqualizer®, particularly in the episodic sufferer.
If Patient Does Not Improve (During the first visit)
Instruct the patient to wear the Aqualizer® continuously for the next 48 hours, except when eating or brushing teeth. At the end of this period, re-examine the patient. If the patient’s bruxism improves after wearing the bite splint, occlusal treatment is indicated. If the patient’s symptoms do not improve significantly, they are most likely not occlusal in origin and occlusal treatment alone is unlikely to be successful. Knowing in advance that occlusal therapy cannot succeed is immensely helpful.
Basic Bruxism Treatment Options (Use only if symptoms improve)
Treatment Option One
Temporary Bite Splint for Pain Control
Relieve acute facial jaw pain by dispensing the Aqualizer® to be worn for no more than eight hours per 24-hour period. For most patients, this is sufficient. If necessary, the Aqualizer® can be worn almost full time for the initial day or two. If a more permanent solution is required, choose Treatment Option Two or Three. Have the patient wear the Aqualizer® when there is muscle pain in the jaw, head, neck, shoulders, headache, or when they feel pain starting to come on. Wear the Aqualizer® twice as long as it takes for pain relief or a minimum of 20 minutes, then remove the Aqualizer® until symptoms begin reappearing.
The Aqualizer® is not indicated for patients with severe bruxism, unless used as a biofeedback device to break their parafunctional oral habit of clenching / grinding. If Aqualizers® are destroyed within hours or one or two nights, the patient is a parafunctional bruxer / clencher. The Aqualizer® is not tough enough for them. Go to treatment choice two.
The Aqualizer® is a waterbed system to rest the jaw. Patients should not continually bite with pressure on the Aqualizer®, rather, the teeth should rest in a relaxed way so that the chewing muscles relax. If you bite too strongly on the Aqualizer® you may break it. If this happens, the distilled water will run out and the Aqualizer® will be unusable. Wear the Aqualizer® for as few hours as necessary to relieve discomfort, either while sleeping or during daytime periods of stress or facial jaw pain.
Anti Bruxism Bio Feedback Instruction for Patients
Insert the Aqualizer® and have the patient close their mouth with mild biting force, while asking them if it feels different to close with the Aqualizer® in. Almost all will tell you it does. Tell them to try to remember the different feel and position of their jaw while clenching on the Aqualizer®. Have the patient give themselves the auto suggestion that, whenever they feel themselves clenching, as above, even when they are sleeping, STOP IT! Just relax while swallowing into the support of the water system. Most patients report longer use life of the Aqualizer® using bio feedback and autosuggestion to reduce damaging nighttime activity.
Treatment Option Two
Take an Aqualizer® Bite Registration, then make a Bite Splint
Aqualizer® Muscular Directed Bite Registration Technique
1. Insert an Aqualizer® into the mouth, allowing the muscles to bring the mandible to its natural most comfortable position, (great in combination with T.E.N.S.). As a general rule the more severe and chronic the symptoms, the longer the period of Aqualizer® therapeutic wear before the bite registration is taken. For those with mild or episodic bruxism, just ten minutes of wear will be sufficient, but chronic sufferers may need to wear the Aqualizer® for a day or two to relieve facial jaw pain.
2. Next set the final VDO (vertical dimension of occlusion). Aqualizers® are available in 2mm, 4mm, and 6mm VDOs. To increase VDO for the bite registration, add base plate wax under the water beds.
3. Instruct the patient to bite down naturally with the Aqualizer® still in place, while injecting silicone across the anterior from cuspid to cuspid.
4. Remove the Aqualizer® with the anterior bite still in place. Inject registration material between the occlusal surfaces of the left and right posterior teeth. Instruct the patient to close carefully into the previously established anterior bite. This creates a one piece full arch bite registration.
5. Assemble the patient’s dental casts accurately into the bite registration. Send this assembly to your lab or mount the combined casts/registration assembly on your articulator.
Treatment Option Three
Aqualizer® Guided Equilibration of Bite Splints (all types)
Have the patient wear the new bite splint simultaneously with an Aqualizer® over it for a few minutes. The Aqualizer® automatically eliminates the distorting influence of the occlusion, harmonizing muscles, bite, and body. Remove the Aqualizer® and insert articulating paper, instructing the patient not to touch their teeth together or swallow until the paper is in place. Have the patient close naturally just once. The contact points are the displacing prematurities. You may also choose to use the Tekscan T-Scan® system to determine malocclusion. Equilibrate the disclosed contacts and repeat the process until you are satisfied.
Aqualizer® Guided Equilibration of Teeth, Crowns, Bridges, Implants, and Fillings
Have the patient wear an Aqualizer® for a few minutes over the occlusion to be adjusted. (teeth, crowns, bridges, implants, etc.). The Aqualizer® automatically eliminates the distorting influence of the occlusion on the functional position of the jaw, harmonizing muscles, bite, and body. Remove the Aqualizer® and insert articulating paper, instructing the patient not to touch their teeth together or swallow until the paper is in place. Have the patient close naturally just once. The contact points are the displacing prematurities. Equilibrate the disclosed contacts and repeat the process until you are satisfied.
Aqualizer® Size Selection
All models of the Aqualizer® are available in three different vertical dimensions: “Low,” “Medium,” and “High.” The vertical dimension (thickness) is controlled by the amount of fluid in the Aqualizer®.
Medium volume Aqualizers® are used by most (90 percent)
Low volume Aqualizers® are for patients with inadequate freeway space (or those sensitive to anything in their mouths) who may find the minimal vertical dimension more comfortable.
High volume Aqualizers® are used when a patient has excessive freeway space or needs a greater vertical dimension to fill the space between the upper and lower occlusal surfaces.
Aqualizer® Model Selection
Aqualizer® Ultra: The Ultra is a new improved version of the Aqualizer® designed for increased gum comfort and improved retention. It is used for average size mouths. Our best seller.
Aqualizer® Mini: The Mini is the new improved Ultra shape with smaller pads and arch size. It is used for kids and small adult mouths.
If you are a health care professional who would like to incorporate the Aqualizer® bite splint into your practice, please contact us directly at 1-800-HELP-TMD (1-800-435-7863)or (928) 442-0038. Individual consumers suffering from bruxism-related facial jaw pain should contact Dental Depot (www.dentaldepot.com).
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