The ultimate case acceptance tool you should be utilizing in the office is appliance therapy. The benefits of this approach can be seen in many different patients, from TMD and restorative to orthodontic patients with muscle-based or joint-based pain.
The primary goal is to increase patient awareness and ownership. Though there is a clinical side to appliance therapy, here I will be focusing on the importance of the behavioral side. (Learn about different appliances in the Ultimate Occlusion Series!)

One way that you can develop a patient’s interest in appliance therapy is to demonstrate the potential benefits they can experience. Patients with pain from issues such as muscle tension, chronic headaches, or broken teeth can first experience the benefits of an appliance with an anterior deprogrammer (lucia jig) in the office. (Learn diagnostic red flags in the Occlusion Series.) Your focus should be on creating a positive relationship between the patient and the idea of appliance therapy. A couple methods for doing this are:

1. Explain the findings of the muscle and joint exam.
2. Explain the relationship between these findings and their pain.
3. Describe an anterior-only device and its uses.
4. Invite them to check in with their pain, whether it be headaches or facial muscle tension/tightness.
5. Fabricate the deprogrammer.
6. While they wait, have them relax, read, or play on their cell phone.

When you utilize these steps, you might find something that has amazed me in my own practice: Patients can be incredibly perceptive.

If you emphasize the patient’s impression of differences from using an anterior-only device, you enable them to come to their own understanding of the value of appliance therapy.

Most patient’s can perceive a difference, even slight and connect their muscle activity with the device.

But what do you do if the patient felt no difference or worse? (Learn to treatment plan any case in our Advanced Treatment Planning Workshop.)

Take this as a learning opportunity. You’ve now eliminated one potential problem (the issue is not related to their occlusion or parafunction). It could also be possible that the pain’s chronicity requires more time to sense a difference or that a different appliance would be more effective.

Continue your learning with Dr. Brady about the use of appliance therapy in Part 2: When patients experience joint based pain, Part 3: Using an appliance as a learning tool for both patient and dentist and Part 4: Equilibration.

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