Who's this?

What does "NTI" stand for?
Nociceptive (relating to the perception of things that could be harmful); Trigeminal (the nerve that controls the major
muscle of mastication; Inhibition

Doesn't  the NTI-tss cause posterior supra-eruptions of the teeth or anterior intrusion?
No.  Since the patient cannot wear the NTI-tss device while chewing food, the posterior alveolar structures receive regular stimulation every day, therefore, there is no opportunity for a functional adaptation of the occlusal scheme, that is supra-eruption of the teeth.. Research shows that alveolar bone requires at least 8 days of  lack of stimulation before bone growth at the apex (supra-eruption) can initiate.  As for anterior intrusion, the lack of continuous apical force does not provide adequate opportunity to intrude an incisor.  However, Changes in the jaw relationship can be observed within 8 days (which is identified as an change in the occlusal scheme), and is a result of the normalization of the musculature.
(More on supraeruption, or lack thereof)

Isn’t it too small and easily dislodged?
No, the NTI device is retro-fitted over un-prepared teeth with cold-cure acrylic.  The practitioner must relieve the internals to provide for a snap-in fit, without strain or pressure on the teeth. The patient must make a dedicated effort to remove the device.  If the patient is able to remove the device without using their hands, then it should be re-lined or/and made to fit additional lateral teeth for added retention.

Isn't the NTI-tss only indicated for clenching patients?
No. The NTI-tss is indicated for all types of TMDs.  The only way *any* musculature of the head and neck can contract with significant intensity is to have either canine or posterior teeth (or both) in occlusion.  It is the occluding of these teeth which allows the musculature to exert strain on the alveolar structures, TM joint(s), and sphenoid bone (pterygoid plates).  Without  the occluding of these teeth (i.e., "rest position"), these structures stand the best chance for healing and remodeling.  Therefore, the NTI-tss is ideal for all types of TMDs and MPDs.

Is there a patient with whom the NTI-tss clearly would not be effective?
Assuming the patient has the adequate dentition to support the NTI-tss matrix, the NTI-tss will be effective in the presence of muscular parafunction.  A lack of effect can be used as a diagnostic rule-out method (assuming protocol was followed with no oversights)

Are there age restrictions for treatment with NTI-tss?
While every dentist has certainly heard parents complain of a very young child who grinds their teeth while sleeping, the
Standard NTI-tss device is best suited for permanent teeth.  However, for children without permanent teeth who are symptomatic resulting from muscular parafunction, a  custom NTI-tss type device can be fabricated.

How long should a patient expect the NTI-tss device to last?
The duration of the NTI-tss device is dependent on the intensity of the patient's grinding, not clenching. If a patient is an intense grinder, over time they may develop a divot in the Discluding Element of the NTI-tss. This situation would simply require periodic filling and smoothing of the divot.

Does insurance cover the cost?
Usually dental or medical insurance plans will help pay for the service, but all plans are different. The same insurance codes for mouthpieces, splints, and TMD devices all apply to the NTI-tss. FDA 510(k) approval for the prevention of medically diagnosed migraine pain and publication in a peer reviewed journal aids in obtaining medical insurance coverage. Coverage should be discussed with patients, with respect to their individual insurance plans.  See: Insurance Billing

What if the patient complains of pain in the lower anterior teeth?
See: Interpreting Patient Responses
One example: If after a brief wearing period, the patient complains of pain in the opposing incisors, the Discluding Element (DE) is either not in a tolerable orientation to the long axis of the opposing incisors, or a posterior contact in an excursive position is allowing for re-establishment of clenching intensity, thereby traumatizing the lower incisor.  Adjusting  the orientation DE (by altering the DE or relining the matrix) or reducing the posterior cusp interference will readily reduce the strain.

How soon should the patient expect to see the presenting symptoms subside?
Subsiding symptoms are directly related to the degree and longevity of each individual's condition. However, it is not unusual for some patients to report significant relief overnight; others usually within a month.

Most Frequently Asked Patient Questions/Concerns

I'll swallow it.
Ask patient to try to remove the appliance without using their hand.
If patient can get it out, then the inside of the matrix needs a slight reline
Matrix should "snap out" when released with a finger

My teeth will supra-erupt . . . because they do not touch in the back
The device can not worn while eating;
Teeth can not supra-erupt since the teeth are stimulated by eating (the NTI-tss matrix is NOT worn during/while eating)
Periodontal ligament that surrounds the root and holds the tooth in place - if this ligament is stimulated (exercised) it will  continue holding the teeth in correct position.

Who's that picture of?
That's Dr. Boyd's wife, circa 1992.  She was the first migraine patient (other than Dr. Boyd) to use the NTI.
The photo was taken soon after her migraines had resolved.  Legend has it, the better she felt, the more
she considered marrying Dr. Boyd.   ;-)