CATEGORY AUSTRALASIAN DENTIST 89 LINICAL and qualitative criteria (Darveniza 2022). Bio-designing such a dynamic occlusion into the splint helped discourage patient’s reaching and hyperextending (De Coster, Van den Berghe; et al. 2005) past their comfortable safe ligamentous positions and compromising disc stability and muscle health. Full counselling has been instrumental in motivating patients to discontinue undesirable oro-facial habits and modify self-harming behaviour. Full counselling of TMD patients to prevent further destructive occluso-mandibular habits from continuing to stretch TMJ ligaments and displace discs has been an integral component of formal occlusal splint therapy. The ‘Fully Protective Occlusal Splint’ with ‘Formal Occlusal Splint Therapy’ (Darveniza 2022) has evolved since 1984 and continues to deliver for the author, with the aid of ‘Full Counselling’, the required arsenal for conservative management of TMDs. This continuation of occlusal therapy onwards to occlusal equilibration and finally anterior/molar guidance has been termed ‘Full Occlusal Therapy’ and where indicated has additionally improved patient outcomes. The statistical analyses following ‘Full Occlusal Therapy’ performed on 200 TMD patients will be reported in a future paper. For now, suffice to say, that in this analysis formal fully protective occlusal splint therapy patients displayed a 71% improvement, then 91% improvement with occlusal equilibration and, finally 96% improvement following anterior/molar guidance. Conclusions The protocol of ‘Full Counselling’ to modify self-destructivehabits injurious to the teeth, TMJ’s and the muscles of mastication, head and neck has been elaborated. Instructions pertinent for a patient, dental assistant and a dentist delivering a splint have been enunciated. The elements of ‘Sleep Posture Analysis’ for TMD patients was presented. The integration of a ‘Full Counselling’ protocol during ‘Formal Fully Protective Occlusal Splint Therapy’ and ‘Full Occlusal Therapy’ continues to be essential in the conservative management of TMDs. Acknowledgments I am grateful to Carl Warner, professional photographer, for all his audio-visual contributions in this paper. I would like to thank John Atkins, Honorary Research Fellow in philosophy at the University of Queensland, for the editorial help he afforded me in writing this paper. I would like to thank John Rogers, statistician, for the digital help he afforded me in writing this paper and for the statistical analyses performed over the years. u Darveniza Michael BDSc MDSc PhD FRACDS Prosthodontist, 42 Uralba Street, Lismore, New South Wales, Australia, 2480. Correspondence and bibliography: mdarvo@hotmail.com References Alpern MC, Wharton MC. The role of arthroscopy in the management of temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83:163-166. Colquitt T. The sleep-wear syndrome. J Prosthet Dent. 1987;57(1):33-41. Darveniza M. Full occlusal protection-Theory and practice of occlusal therapy. Australian Dental Journal. 2001;46(2):70-79. Darveniza M. Part 1: ‘Full Counselling’ during ‘Full Occlusal Therapy’ with case studies for habit modification, sleep posture analysis and instructions for delivering a splint to manage TMDs. Australasian DENTIST No 97 MAR-APR ed. Black Rock, Victoria: Great Australian Publishing 2023. p. 98-102. Darveniza M. Part 1: Preliminary investigation of 200 TMD patients using ‘Fully Protective Occlusal Splints’ with ‘Formal Occlusal Splint Therapy’. Australasian DENTIST No 92 MAR-APR ed. Black Rock, Victoria: Great Australian Publishing; 2022. p. 70-72. Darveniza M. Part 2: Preliminary Investigation of 200 TMD patients using ‘Fully Protective Occlusal Splints’ with ‘Formal Occlusal Splint Therapy’. Australasian DENTIST No 93 MAY-JUN ed. Black Rock, Victoria: Great Australian Publishing 2022. p. 86-88. Darveniza M. Part 3: Preliminary investigation of 200 TMD patients using ‘Fully Protective Occlusal Splints’ with ‘Formal Occlusal Splint Therapy’. Australasian DENTIST No 94 AUG-SEP ed. Black Rock, Victoria: Great Australian Publishing 2022 p. 94-98. Darveniza M, Chapman P. A jaw excerciser for fibrous ankylosis of the temoromandibular joint. Australian Dental Journal. 1985;30(6):418-422. De Coster PJ, Van den Berghe L, Martens LC. Generalized Joint Hypermobility and Temporomandibular Disorders: Inherited Connective Tissue Disease as a Model with Maximum Expression. Journal of Orofacial Pain. 2005;19(1):47-57. Okeson J. Joint Intracapsular Disorders: Diagnostic and Nonsurgical Management Considerations. Dent Clin N Am 2007;51:85-103. Poveda-Roda R, Bagan JV, Sanchis J. Temporomandibular disorders. A casecontrol study. Med Oral Patol Oral Cir Bucal. 2012;17(5):794-800. Ramfjord S, Ash M. Occlusion. 2nd ed. WB Saunders Co; 1971. p 243-409 Shore N. Educational program for patients with temporomandibular joint dysfunction (ligaments). J Prosthet Dent. 1970;23(6):691-695. Zeldow LL. Treating clenching and bruxing by habit change. The Journal of the American Dental Association. 1976;93:31-33. Table 2. ‘Full Counselling’ for oro-facial and occluso-mandibular habits, and adjunctive therapies during ‘Formal Fully Protective Occlusal Splint Therapy’. ‘TO DO’ LIST 1. Keep lips together (where lip length allows) and teeth apart between about 1 to 15mm in the hinging arc to rest the lower jaw. 2. Keep the tongue towards the floor of mouth where possible, like a stingray does on the floor of the ocean. 3. Use electric heat pads where possible, and other heat pads, and hot showers on the head, face, and neck. 4. Use muscle relaxation medication at low doses, e.g., for a maximum of 2 nights per week, if indicated. 5. Limit large yawns to prevent wide opening e.g., place one or two knuckles between incisors. 6. Sleep Posture Analysis according to Darveniza since 1992: 6.1 Sleep with left hand flat under pillow when lying on right side and vice versa. This supports lower jaw, neck and point of shoulder. Place the other hand towards the same knee. If both arms cross over each other this can be avoided by extending the pillow hand towards the back of the pillow. 6.2 When sleeping on the side, lie on a slightly cocked shoulder which should be located under the pillow. 6.3 In general, when first going to sleep on the side the knees should be located close to each other. 7. Eat on the side with the MOST TMJ pain. 8. Maintain optimal body posture, particularly head and neck, and sacroiliac joints, back and lower abdominal muscles 9. Use a knife to cut large foods – example apples. ‘NOT TO DO’ LIST 1. No jaw exercises and instead adopt all forms of face pampering. 2. Do not place tongue on roof of mouth or press against teeth. 3. Avoid placing hands on face or jaw. 4. No hard, large size or repetitive fatiguing foods, e.g., nuts (particularly almonds and brazil), large carrots, ice and chewing gum. 5. No holding objects in mouth, e.g., pens and tickets. 6. No extreme yawning or extreme laughing. 7. No extreme lip posturing movements e.g., licking lips, lip scrunching or lipstick eating. 8. No pressing, clenching, or grinding teeth or jaw wagging or wriggling sideways. 9. No chiropractic or osteopathic jaw or cranial bone manipulation. 10. Do not allow fans or air conditioners to aim directly at the face. 11. Do not perform any form of wide mouth opening and try to limit mouth opening to the circumference of the first three fingers at the first knuckles. 12. Do not sleep on front as the weight of your skull will transfer onto your lower jaw and into the TMJ’s 13. Do not place fist or hand on top of pillow whilst sleeping. Do not form a fist during sleep or fist your neck. 14. When sleeping on the side do not lie on a sloping shoulder as in a ‘postman’ like shoulder. 15. Do not move lower jaw to left, right or forward except for functional needs e.g., talking and eating.
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