By Rachel Teel Wall, RDH BS
The following instructions will help you easily create a customized biteguard. When using BruxGuard www.bruxguard.com, there are no messy impressions or models to trim and no waiting. The process from start to finish takes 10 minutes or less, and the patient leaves the office with his or her BruxGuard in hand. Immediate relief from grinding and an end to tooth destruction!
If you need a review of grinding and bruxing for the hygienist-please review- "The Clues Behind Bruxism" and click on www.rdhmag.com.
Fabrication Kit
* BruxGuard kits in various sizes
* Impression trays-one of each size
* Wooden spoon or cotton pliers
* Minute timer
* Boiler pot
* Bowl for cooling/setting water
* Surgical scissors
* Latex gloves
Step 1: Determine Proper Size
BruxGuard comes in three sizes -- small, medium, and large. In the beginning, it is helpful to use standard impression trays to determine the proper size guard. Most dental assistants and hygienists are able to glance at a patient's mouth and tell immediately which size impression tray will fit. After making a few BruxGuards, the same technique is possible.
Step 2: Examine the Guard Form
Look closely at the guard before beginning the fabrication. Notice there is a trough that runs through the central portion of the guard. Also notice the ridge that extends along the inner and outer edge of the guard form. Along the outer ridge, there is a small notch in the center. This notch will align with the maxillary central incisors. The teeth will fit into the trough and the ridge will become the malleable material that will be formed around the teeth and the palate to create a custom fit.
Step 3: Educate the Patient
Give the patient a step-by-step explanation of how the guard is to be fabricated. Let them know their part in the process. Make the patient aware that the guard will be warm when it is placed in their mouth and that you will need to work quickly to take full advantage of the working time.
Step 4: Boil the BruxGuard
The next step is to heat the guard. This allows the thermoplastic liner material to become malleable so it can be formed around the teeth and palate. Fill the heating appliance about half full with tap water. Turn the pot on high and bring water to a rolling boil. Allow guard to remain in the boiling water for 55 seconds. It is important not to let the guard form touch the sides of the plastic pot. Use cotton pliers to keep the guard in the center of the boiler pot and to remove the guard from the water. After 55 seconds in the boiling water, remove the guard.
Step 5: Cool the BruxGuard
Immediately drop the guard into a bowl of water or rinse under running water. This step cools the guard to reduce the temperature of the guard before placing in the patient's mouth.
Step 6: Place in Patient's Mouth
Place the heated guard in the patient's mouth. Have patient bite with upper anterior teeth inside the trough but just behind the outer ridge. Align the maxillary anterior teeth with the notch in the center of the ridge. Placing the teeth inside the ridge allows enough material to mold around the teeth to create a snug fit. If the arch is wider than normal, the sides of the guard can easily be pulled apart to match the width of the maxillary arch.
After the guard is placed, quickly have the patient bite down.
Step 7: Forming the Ideal Fit-Outer Surfaces
Immediately after patient bites down, use fingers to firmly push the clear material against the facial surfaces of the teeth and up toward the gums on both sides of the arch. Begin pushing around the molars and work toward the front of the mouth. During this step, the patient should be biting down and sucking in using their tongue to push the soft material on the lingual surface up toward the palate.
Step 8: Forming an Ideal Fit-Inner Surfaces
Now have the patient open their mouth. Using your thumbs and forefingers, firmly pull the material from behind the front teeth and push into the roof of the mouth and back toward the soft palate. Do this around the entire arch. Next, pinch the material around the entire arch with fingers. Have the patient bite and hold the BruxGuard in place after you do this for five seconds.
Step 9: Removal & "Setting" of BruxGuard
Instruct the patient to bite down firmly once again for a second or two. Remove the BruxGuard from patient's mouth and place in a bowl of very cold water for 30 seconds to set the guard. This allows the thermoplastics to harden and retain the exact impression of the mouth and teeth.
Step 10: Test for Fit
Show the patient their new BruxGuard. Have the patient place the BruxGuard back in their mouth and close their mouth comfortably. When made properly, the guard should remain on the patient's upper arch when they open and close their mouth. The dentist may check the biting surface of the guard with articulating paper. The hard surface may be adjusted to create the desired occlusal pattern.
Rachel Teel Wall, RDH, BS, is an active clinician, speaker, writer, and consultant. During her 14 years as a hygienist, she has enjoyed positions in periodontic and cosmetic practices as well as teaching, consulting, and research. As founder of Inspired Hygiene, Rachel serves as a hygiene consultant whose goal is to inspire dental teams to reach an outstanding level of patient care and performance. For more information you may contact Rachel at [email protected].
