Volume 7 • 2020 • Issue 5

1 2 3a 3b 4a 4b patient, I will sometimes drop some Lidocaine in the area right before the Hyaluronic acid. In other cases, I use a steroid with local anesthetic. Appliance Therapy I will often provide patients with a stabilization appliance (Fig. 2) or an anterior repositioning appliance (Fig. 3a and 3b) and ask them to ice their jaw three or four times per day. Appliances are 2 mm to 3 mm thick and can be maxillary or mandibular. In this image (Fig. 2) , it has a flat plane and balanced contacts at maximum intercuspation and should have balanced contacts in maximum closing. Studies show that it doesn’t matter whether you do an upper or lower appliance. An anterior repositioning appliance (Fig. 3a and 3b) is often used for patients with acute disc displacement with reduction. This helps to get them off their disc and to pull the jaw forward much like a sleep apnea appliance. Patients will typically wear appliances at night and should avoid wearing them during the day. Many people prefer to wear their appliance during the day because it offers symptom relief. In these cases, it’s important to tell patients that this can increase their chance of bite change and that daytime wear should be restricted to one hour a day only. The anterior repositioning appliance has a little ramp that will pull the lower jaw forward to help the disc reduce when patients are taking a bite. After four to six weeks, when the patient is a little less symptomatic, I will grind that ramp off and turn it into a stabilization appliance (Fig. 4a and 4b) . Hinge Exercise for Symptomatic Clicking Joints Sometimes a clicking joint can be the result of a stick-slip phenomenon where there’s just not enough lubrication in the jaw. In this case, patients need to do a hinge exercise where they tether their tongue to the roof of their mouth, like they’re saying the letter “N” and then they open. Tethering the tongue will prevent the click. This helps keep the joint lubricated and will often reduce the number of clicks. To see the full case report by Dr. Shackleton, visit CDA Oasis: wp.me/p2Lv6A- 6RE Figures S upporting Y our P ractice 28 | 2020 | Issue 5