The NTI Nightguard: Everything You Need to Know
The world of nightguards is a confusing one. There seem to be countless designs and brands, custom-made and generic forms. Even if we rule out generic over-the-counter guards, the possibilities are still almost endless! The reason for the wide range of options is the complex nature of the entire jaw system.
The jaw joints are the most complicated joints in the human body because they are ball-in-socket joints in which the ball actually comes out of the socket in normal function. When you factor in the influence of the facial muscles (that open and close the jaws) and the way teeth bite together, it makes quick diagnosis and treatment anything but simple.
Who Needs a Nightguard?
A nightguard is typically the first line of treatment for patients suffering from the effects of bruxism and/or TMD. Let’s explain those terms first.
Bruxism is the scientific term that encompasses both clenching and grinding of the upper and lower teeth with heavy forces. This can occur at any time, but it is most common during sleep. TMD stands for TemporoMandibular Dysfunction or Disorder, and it refers to a problem with the jaw joints or TMJs (TemporoMandibular Joints). TMD means there is a problem within the joint, like a slipped disc or arthritis.
Bruxism may occur on its own or in conjunction with TMD, and vice versa. Many people clench or grind their teeth without having any problems in the jaw joints. Some people have severe problems in the joints without the clenching or grinding habit. Frequently, these two conditions occur together.
Though these two conditions are different, they often benefit from the same general treatment of wearing a nightguard. Nightguards serve several important functions, including protection of the teeth, reduction of muscle force, and decompression of the jaw joints.
What is an NTI?
An NTI is a specific type of nightguard. Its initials stand for Nociceptive Trigeminal Inhibition. Those big words mean that the guard’s purpose is to block the sensation of pain from a specific nerve in the head, the trigeminal nerve. The trigeminal nerve provides sensation to a large portion of the face and all of the mouth. This nightguard’s goal is to stop pain, especially headaches, by inhibiting this nerve.
The trademark version of this appliance is NTI-tss, which adds Tension Suppression System. The appliance is marketed as a remedy for migraines and tension headaches that are associated with bruxism.
How Does an NTI Work?
An NTI is a small, custom-made appliance that fits over a few of the front teeth. NTIs may fit over the upper or lower teeth, and they have a small ramp that guides the movements of the jaw. Dentists classify the NTI as an anterior deprogrammer because it fits on the anterior (front) teeth and deprograms the jaw joint.
As we mentioned earlier, the jaw joints are the most complicated joints in the body. One of the complicating factors is the way the teeth bite together. In general, most people have upper and lower teeth that fit together in a very tight, puzzle-piece bite. In a perfect jaw system, the upper and lower teeth would fit together comfortably when the ball of the jaw joint is in its proper position in the socket.
Unfortunately, most of us are not perfect. The puzzle-piece fit of the teeth (what dentists refer to as occlusion) takes precedence over the position of the ball in the socket of the jaw joints. Therefore, a “bad bite” could fit the teeth perfectly together while pulling the ball out of the socket.
When there is a disparity between these two positions (where the teeth want to be versus the appropriate position of the ball in the socket), the facial muscles become overactive, leading to muscle tension and headaches.
An anterior deprogrammer, like the NTI, removes the teeth from the equation so that the jaw joint can settle into its ideal position with the ball firmly in the socket when the joint is at rest. By taking the teeth out of the equations and letting the jaw joint rest, you can actually “turn off” the muscles. This relieves muscle hyperactivity and tension. That is the goal of an NTI.
Who Should Use an NTI?
An NTI is a wonderful treatment for patients who need temporary relief from the facial pain and headaches caused by bruxism. It is important for a dentist to verify that the condition of bruxism is occurring prior to the use of an NTI. If the headaches have a cause outside of the facial muscles, this treatment will not help.It is a simple task for your dentist to confirm whether you are clenching or grinding your teeth. The heavy forces of bruxism leave pretty obvious evidence inside the mouth that your dentist can easily spot during an oral evaluation.
Another prerequisite for treatment of headaches and the pain of bruxism with an NTI is two healthy jaw joints. The health of the TMJs is a little more difficult to discern without advanced imaging and complicated testing.
Many dentists actually use the NTI as a tool for the diagnosis of the source of complex facial pain.
• If an NTI produces an almost immediate relief of pain, then the problem is likely originating in the muscles of mastication (the muscles that open and close the jaws).
• If wearing the NTI actually increases the pain, this implies that the source of the pain is inside one or both of the jaw joints.
Who Should Not Use an NTI?
Because of the risks of wearing an NTI, which we cover later in this article, you should NOT wear an NTI if you do not plan to remain under your dentist’s supervision. A dentist must oversee any patients wearing an NTI to monitor the health of the jaw joints and intercept problems before they occur.
Patients with degenerative arthritis in the jaw joints are not a candidate for treatment with an NTI. Neither are patients with a displaced, or slipped, disc in one or both of the jaw joints. Wearing an NTI or any type of anterior deprogrammer can aggravate the symptoms of TMD.
It is important for patients with untreated obstructive sleep apnea (OSA) to avoid the use of an NTI. Because the NTI allows the lower jaw to rest and position itself in a more retruded position, this can exacerbate sleep apnea by shrinking the size of the airway behind the lower jaw.
What are the Advantages of Wearing an NTI?
The NTI appliance carries many advantages that make it an attractive option for patients suffering from migraines, muscle tension headaches or other effects of bruxism.
• Compact size – The NTI is the smallest type of nightguard available. As opposed to most full-arch appliances, it is the width of four to six teeth and about a centimeter in height. Its small size means it is unlikely to stimulate any feelings of claustrophobia.
• Quick relief – When you use the NTI appliance for the right situations, it can provide almost immediate relief of the pain and muscle tension caused by heavy muscle forces.
• Appropriate for both daytime and nighttime use – The small size and unobtrusive nature of the NTI make it useful during the day for those who experience habitual clenching or grinding as they work, perform chores, exercise, commute, etc…
• No stimulation of gag reflex – As the NTI only covers front teeth, it does not touch the soft tissues near the back of the mouth that lead to gagging. Patients with very sensitive gag reflexes may be unable to tolerate full arch appliances.
• Fewer speech effects – Its position over the lower front teeth causes fewer lisps and other speech impediments when wearing the NTI.
• Protection of the teeth – Because it effectively separates the upper and lower teeth, the NTI appliance protects the teeth from the damage that occurs during bruxism. This includes cracked teeth, flattening or shortening of the teeth, and gum recession.
• Helpful tool for diagnosis of TMD – We explained this in the previous section. Wearing an NTI can help your dentist determine the underlying problem causing the pain you are experiencing.
What are the Risks of Wearing an NTI?
After reading through the previous section on the advantages of an NTI, you may be convinced that it sounds just about perfect. We hate to burst that bubble, but it is essential that you understand the risks associated with long-term NTI usage.
• Aggravation of TMD symptoms – When a patient has problems within the jaw joint(s), the positioning of the ball in the socket affected by an NTI can cause those problems to worsen. For example, if a TMJ has a slipped disc, NTI wear can actually push the disc further out of the joint. This is good news and bad news. The good news is that the worsened symptoms will cause you to stop wearing the appliance. The bad news is that the damage could be irreversible.
Due to the above risk, you should never wear an NTI without a dentist’s prescription and direct supervision.
• Serious bite changes – Many people find so much relief from headaches and facial pain that they wear the NTI religiously. By covering only a few of the teeth for many hours each day, the NTI appliance actually allows a serious change in the bite to occur. The NTI separates the upper and lower teeth, but it only provides a barrier on the front teeth. This leaves an air gap between the upper and lower back teeth. Over time, these back teeth will drift together, while the front teeth remain separated by the barrier of the appliance. This causes an orthodontic condition called an open anterior bite. It takes time for this to happen, so wearing an NTI is fine as long as it is only temporary.
Due to the above risk, you should never wear an NTI for more than three months.
What is the Most Important Thing to Know about NTI?
The most important thing to understand is that an NTI appliance is a valuable tool in the treatment of facial pain and headaches as long as it is used temporarily and under a dentist’s supervision.
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