Cue GrindRelief PRO, a custom chairside device we can present to patients in minutes to help provide instantaneous relief (Figure 1).
This is a thermoplastic device that can be fitted onto the upper or lower teeth. It covers only the front 6 to 8 teeth, making patient adherence more likely because it will be more comfortable to use without messy impressions. There also are no high lab costs. The device’s small, comfortable size will immediately reduce muscle activity for your patient (Figure 2).
The learning curve for practitioners is minimal, with the satisfaction of providing a custom-fitted appliance for your patient. The creation of this device is easy. Simply take warm water, possibly from a mug you have microwaved for 90 to 120 seconds, immerse the device until it is submerged shell side down, and wait until the plastic goes from white to translucent (Figure 3).
The trick is to fold the material into the shell prior to seating it onto the teeth to ensure all the material is molded around the dentition (Figure 4).
My preference is to deliver the device to the mandibular dentition, but this can mean there are undercuts to be aware of (Figure 5).
Gently seat the device using mild pressure and be sure to use the central power bar as a reference for centering on the teeth (Figure 6).
You will find that you must border mold the thermoplastic material into the shell. This will also help smooth the material and prevent it from having sharp edges that need adjusting at the end (Figure 7).
Next, have the patient bite down gently to ensure seating is secure, after which you should unseat the device to ensure it is not locked into any undercuts or between the teeth. Reseat the device until it sets and the thermoplastic has returned to its original white color (Figure 8).
If you are creating the device for the upper teeth, you may need to contour the central power bar to conform to the shape of the palate or the frenulum, but the steps will remain the same.
Different conservative treatments—namely soft diet, warm compresses, behavioral therapy along with lifestyle changes, oral appliances, drugs (anti-inflammatories and muscle relaxants), injection of botulinum toxin, and low-level laser therapy—can also be used for treatment long term, but an immediate solution is required. GrindRelief PRO provides instantaneous relief necessary for assessing the need for additional treatment.
GrindRelief PRO is a chairside device that can provide patients relief from bruxism in minutes.
The device is manufactured with a moldable thermoplastic. Its small size reduces patient muscle activity.
For a custom fit, GrindRelief PRO is submerged in warm water.
The material should be folded into the shell prior to seating to ensure it is molded around all of the dentition.
If delivering to the mandibular dentition, be aware of undercuts.
Apply gentle pressure when seating the device.
Anticipate having to border mold the material into the shell to ensure there are no sharp edges.
Additional value comes with telling your patient this is something that insurance will cover or will come at very low cost, especially if it is an unexpected expenditure during that visit while they consider the other cost burdens of rehabilitative restorative treatment. The appeal from this could be the viral marketing practice builder you never saw coming.
The Catapult Education evaluators were each given 10 GrindRelief PRO devices to distribute to their patients, giving us ample opportunity to evaluate and understand the nuances of the device. The providers all personally manipulated the device and did not leave it to other office personnel. Most used microwave ovens; some used water baths to warm the water but would advise caution because of the extreme heat. It was felt that the product did have a small learning curve and that practicing once before starting to work with the device on patients was advisable. Nearly 90% of the evaluators were able to get the right fit on the first try. Additionally, 89% of the reviewers commented that the tutorial video and user instructions were helpful.
One thing to note about the thermoplastic, once it is fully transparent, is to ensure you manipulate it with moistened gloves because it can pull and create strings along with sharp edges when it catches on instruments. Evaluators found that the fit of the product was acceptable on the maxillary and mandibular dentition—50% delivered it on each arch—but the limiting factor would be patient comfort to ensure adherence and to avoid placement on existing crowns and dentures.
Most practitioners indicated they would invest in some additional presentation items like a delivery case and cleaning agents along with the device to ensure the patient takes proper care of their mouth guard. Although material is provided for a vacuum-formed splint on the opposing arch, 100% of the evaluators felt it was not necessary to do so. The patient education brochures provided with the product are thorough and nicely laid out and were preferred over a wall poster to give a nice personal touch to a patient’s welcome folio of information.
In one scenario, a middle-aged patient presents to the office with a chief complaint of a large, painful sore on the side of his tongue. In addition, he does not sleep well and has razor-sharp cusps on his premolars with most of the occlusal anatomy ground away. He is an accountant who works long hours and late nights and is under stress now that many are dealing with small-business loans as a result of the pandemic. There is a high likelihood that telling this patient to drink warm soup and to get more sleep each night to avoid stress will not happen in the near future. With the ongoing pandemic, he may not get into a sleep study to deal with his chronic sleep apnea issues right away either.
In another scenario, we have a young student who presents with shoulder and upper back pain, jaw tightness, and a sense of constant fatigue. He is in college, working a job to make ends meet, and his mother recently died of cancer. There is a high likelihood that therapy and antidepressants are not going to be the immediate cure for his clenching and bruxing.
In another scenario, a middle-aged IT consultant presents with pain on a few endodontically treated teeth. After some discussion, we uncover that he clenches in the daytime while working on the computer and now has a few endodontically treated teeth that are starting to ache again. Upon checking radiographs and occlusion, we find there is great balance, but the clenching and grinding are causing discomfort. Asking this patient to stop working so much and administering medications for his clenching habit are probably not going to be the resolution because the stressor is a part of his lifestyle.
In all these situations, my patients felt immediate relief and improvement of other symptoms like radiating pain and poor sleep. In the Catapult evaluation, it was noted that 90% of the patients reported relief within a week, reaffirming the effectiveness of the device. Although these results are not guaranteed, I find comfort in knowing my patients didn’t use a DIY remedy and that an immediate relief device was available for treatment. I like knowing my patients will be able to carry it along easily and be adherent in using it because of its size. I highly recommend having this on hand at your practice to keep up with evolving lifestyles requiring immediate gratification, and over 90% of the evaluators said they would recommend this to their colleagues.