Three New Approaches to NTI Safety

by Gregory Grindmore and Greta Clenchem

I'm Gregory and I'd like to talk about NTIs. Not because I'm smart. I'm not. I'm dumb as a rock and so is Greta. But not the same rock. She's as dumb as her rock and I'm as dumb as my rock. Why, I'm so dumb, I'm built upside down: my nose runs and my feet smell. And she's so dumb that when a homeless guy came up to her panhandling money last week, saying he hadn't had a bite for a week, she bit him! I'm so dumb that when I was asked to play first base in a baseball game my friends were playing, I went over to the appropriate spot on the ball field and curled up on the ground, trying to look as square and flat as possible. And she's so dumb that when she hears a Christmas Santa laughing "Ho, Ho, Ho," she thinks he's a pimp counting his ladies.

As further proof of just how dumb I am, see:

  1. How to Swim in Air part 1
  2. How to Swim in Air part 2
  3. How to Swim in Air part 3
  4. See a and b and c.

Okay, now where was I? Oh yeah, NTIs. Greta and I both got NTIs for the first time a couple of months ago. They really work cool! We both clench less, and do so with less force, and the grinding has mostly stopped, and my TMJ is a lot better. They're lots better than night guards and regular splints at night, although I wear a regular dental splint in the daytime. Greta wears nothing. I mean on her teeth! She doesnít walk around naked. She's not that dumb! Okay, I lied. She is that dumb. But she still doesnít do it . . . not often, anyway. Except in public.

Anyway, according to Big Chief Gottabigun: "NTI good. Clenching and grinding bad. Ugh." And he's right. The guyís got a point. A big one. A big point, that is.

However, there's more to all this than meets the tooth. The form in which they're selling NTIs leaves something to be desired:

  1. They're too tight at first.
  2. They are a potential choking hazardóI nearly choked on mine.
  3. Even though various web sites attempt to confuse us into believing that if you get it fitted properly, there will be neither discomfort nor hazard, that logic quickly breaks down under closer examination.

The Problem with the "Proper Fit" Argument

Here are the facts, as experienced by me and reported via various online comments of NTI wearers:

  1. If itís loose enough to be truly comfy, itís loose enough to be dangerous.
  2. People tend to remove them in their sleep when they're too tight, at which time they could end up swallowing them, losing them, stepping on them on the floor on their way to the john in the dark and hurting their feet, slipping on them and breaking a hip or leg or neck, or hurting their NTIs.
  3. A osteopathic doctor has told us that since NTIs are very tight when originally fitted, this will cause cranial strainóan osteopathic condition that can lead to headaches or worse.
  4. NTIs will always tend to loosen over time, and this will make them feel better, which will in turn tend to make the wearer NOT run to the dentist for an adjustment, which is the recommended response. As a result, most NTIs will end up as dangerous.
  5. Sellers of NTIs assure us NTIs are safe as long as users keep them tight and frequently adjusted. The implication is that, as I, Gregory, already found out: Once they loosen up (enough to be comfortable), they are NOT safe. The NTI makers cover their tails by saying they're safe when used as directed, but the directions end up contrary to human nature: never use them if they feel good! So the directions are unlikely to be adequately followed, so the NTIs are eventually going to become hazardous.
  6. The assumption that people will not choke on them since the gag reflex will be stimulated by an NTI in the back of the mouth sounds like a really good argument at first blush. However, lots of people choke on items every yearóitís not just babies choking on toys and plastic bags. These people are awake and aware at the time, but they choke on the food or toy or bone anyway. Itís much worse when you're on your back and sleeping, since itís a position that encourages the swallowing of items, and you're anything but alert to the dangeróyou're vulnerable. Thatís why babies choke from their faces being against plastic mattress covers while asleep though the same babies if awake would have reacted to the air cutoff promptly.
  7. In addition, even if the gag reflex argument was correct, which it is not, it doesnít change the fact that starting to choke on something and then coughing it out of the mouth is an extremely unpleasant experience that gets adrenaline pumping and the heart pounding (I ought to know), and wrecks the rest of oneís nightís sleep. Can this possibly be the way this product is supposed to performóscare the user half to death to keep him safe?
  8. One big reason this is a dangerous product is that itís so tight itís hard to insert at first, which will leads users to not seat it all the way, even though they think they did it right since it was very hard to get in. So it will easily dislodge lateróas I found out the hard way.
  9. Finally, the NTIs are designed so that they fit nicely over front teeth (upper or lower) if they're in exactly the right place, horizontally, but if theyíre 1/16th of an inch too far to either side they may seem to have been properly inserted to the user even though theyíre not really clicked into place, so they will be likely to come off in oneís sleep.
  10. Given these 9 points, how can anyone seriously suggest that NTIs, as currently designed, will be "safe" or always reasonably comfortable for the average user? Poppycock! This claim defies logic, it defies experience, and it defies human nature.

In addition to all the above, proper adjustment concerns of another sort are likely to hit you another way as well. Greta and I quickly found out that they seem to come from the lab with lots of extra material on their nubs, and it is up to the patient to go back to the dentist for another type of adjustment that highlights the old saying that more is not always better. There is lots of excess material on the tongue side of the NTI and many tongues are going to get very sore underneath or on top in a few days, like Gretaís and mine did. Ouch! Some patients may wear the device less or not at all as a result. But, there's good news for tongue pain sufferers: dentists are happy to grind down the inner nub until it no longer bothers the patient.

The reason this excess material exists is that some people with an under bite and a lower teeth NTI or an over bite and an upper teeth NTI are going to end up needing it to keep teeth from "falling off the ledge"ówhich means the teeth come together as opposed to the NTI doing what itís supposed to: keep back teeth from touching. Either upper front teeth or lower front teeth end up behind or in front of the NTI rather than being kept separated by the NTIówhich is the NTIís main purpose. However, there's more material than most patients need, and this excess material has a fair likelihood of giving the patient a sore tongue: the underside, for lower NTIs, and the topside, for upper NTIs. See the diagram (which also shows where to have a #60 hole drilled [#60 is drill bit size, diameter 0.0400"]ómore on that later) below for the details of alleviating this tongue pain.

Better than an NTI

Youíve read, here, about a host of problems for NTIs. So why wear them? Because they work really well and are safeóAS LONG AS YOU MODIFY THEM SLIGHTLY TO CREATE THIS SAFENESS. Youíve seen one way to modify them for comfort, which most dentists expect to have to do. But the safety issues seem to make the hazards of NTIs unavoidable and hopeless to avoid. Woe is me, woe is me!

But, alas, all is not lost! Gregory Grindmore and Greta Clenchem to the rescue! Read on:

NTI technology needs to be combined with other technology for many reasons.

NTIs, as they are currently dispensed, are dangerous. Users even take them in and out at first (because they are so uncomfortable) just to loosen them up, which makes them immediately dangerous because when they get loose they can, and sometimes do, fall off in the mouth. "Normal" use requires trips back to the dentist to tighten them up, but users resist doing this because they don't want to go back to the original discomfort they experienced when they were first fitted, and these frequent trips to the dentist are expensiveóso thereís much resistance.

NTIs are coming off during sleep and threatening the lives of their users. At online forums users "joke" and try to reassure each other about the loose NTI and the choking danger. They talk about taking it out during the night (unconsciously), pushing it out with their tongues, or finding it on the pillow or bed, or worse, finding it loose in their mouth, and being freaked out about the choking risk. Itís merely a matter of time before the first choking fatality.

Happily, this danger can be avoided! There are three ways. Greta now uses one of them at night (approach 2) and I, Gregory, use another one (approach 1). And dentists will love approach 3 since, once invented (yes, that is a challenge I'm issuing to you teeth-yankers), it will eliminate all risks (choking, death, lawsuits, etc.) and be very expensive to make (you can just see the dentistsí eyes lighting up with dollar signs as they read this), but users will like it since, in addition to being 100% safe, it will eliminate the need for most adjustments once the fitting, and the teeth, have stabilized, and they wonít need to fit tight or uncomfortably on the front teeth. Users will like not having the 100 pound test monofilament fishing line hanging out their mouths that approaches 1 and 2 utilize. (That sounds bad or dangerous at first, but itís quite the opposite: itís easy to adjust it so this smooth line is comfortable just by subtle necklace or ball position movements, and it gives you great peace of mind because it makes you safeóunless you bollix up the modifications.)

The NTI is a great invention (thanks, James P. Boyd!) but an incomplete invention. It needs to be permanently connected to a mouth guard, a splint, a soft and very light "ball and chain," or a loose elastic necklaceóloose enough so that it cannot choke the user.

The three new NTI approaches, with diagrams or pictures, are:

  1. Ball and Chain (used nightly and happily by Gregory Grindmore). This involves a 3" very light, but solid, squishy foam rubber ball, 24" of 100 pound test monofilament fishing line, and the NTI.

    The ball and NTI are hooked together via the fishing line. A 0.0400" hole (bit size #60) is drilled in the NTI (slowly so you donít melt the NTI material, so I believe a Dremel drill is too fastóI had to use a small power drill which let me go slowly). Drill the hole (see drilling tips!) in the inner nub of the NTI, horizontally. A small pointed hobbyist file is stuck through the ball, which is actually one of those squishy hand exercise balls for strengthening hand muscles which you can do while watching TV so you donít cram your face with pastries. But donít stab the ball until youíve Scotch-taped the end of the line to itóyou'll be pulling the line through the ball.

    Pull the line through the ball until 9 1/2" is not yet pulled through. Now turn the file around and stab the ball again ĺ" from where the line exited the ball on your first stabóthis is the return trip. Once the file is through again, you'll have to get some scissors and cut it where it exits the ball for the second time, but you need to squish the 3" ball so itís only 2" thick and cut it at the exit point, so that when you unsquish the ball, the cut end of the line is about 1" buried inside the ball where it cannot scratch anyone. Now stick the other line end through the hole in the NTI. If it won't go, itís either plastic burrs around the hole or you cut the line with a dull scissors that flattened the line a bit. The line end needs to be round in order to fit the hole.

    Once the line is through, slide the NTI on the line until it touches the ball. Now get a match and light it and hold it mostly to the side but also an inch beneath the line end. Donít get too close or touch the flame to the lineóyouíre only trying to melt the end into a teeny ball. Once the melting happens, push the melted line-end ball into the side of something flat to flatten it a bit.

    Once it cools, slide the NTI back so its hole touches the end of the line. There should be about 9" between the NTI and the ball. You're done! If the NTI comes loose in the night, it won't fall to the back of the throat and scare you half to death, and even if it did (impossible?), there's no way you'll end up swallowing it with that line attached, unless you blew the line tip melting process. Rest easy, folks!






  2. Necklace (used nightly and happily by Greta Clenchem). This involves 23" of flat 3/8" elastic, 12" of 100 pound test monofilament fishing line, and the NTI.The two ends of the elastic are overlapped 1" and sewn together into a necklace with a 22" circumference. The necklace and NTI are hooked together via the fishing line. A 0.0400" hole (see drilling tips!) (bit size #60) is drilled in the NTI (slowly so you donít melt the NTI material, so I believe a Dremel drill is too fastóI had to use a small power drill which let me go slowly). Drill the hole in the inner nub of the NTI, horizontally.

    With a pair of pliers, stick a thick needle or brad nail through the middle of the elastic where it overlaps. Now use a needle-nose pliers, taking a short grip, to jam the end of the line through the hole in the elastic. It helps if you first cut off the tip of the line, using a slanted 45-degree cut, with an Exacto or one-sided razor blade (2-sided razor blades are way too dangerous to use to cut anything but whiskers). Push the line several inches through the elastic.

    Now get a match and light it and hold it mostly to the side but also an inch beneath the line end which you hold out in front of you with your other hand. Donít get too close or touch the flame to the lineóyouíre only trying to melt the end into a teeny ball. Once the melting happens, push the melted line-end ball into the side of something flat to flatten it a bit.

    Once it cools, slide the necklace back so its hole touches the end of the line. Now stick the other line end through the hole in the NTI. If it won't go, itís either plastic burrs around the hole or you cut the line with a dull scissors that flattened the line a bit. The line end needs to be round in order to fit the hole.

    Once the line is through, slide the NTI on the line until it touches the necklace. Now get a match and light it and hold it mostly to the side but also an inch beneath the line end which you hold out in front of you with your other hand. Donít get too close or touch the flame to the lineóyouíre only trying to melt the end into a teeny ball. Once the melting happens, push the melted line-end ball into the side of something flat to flatten it a bit.

    Once it cools, slide the NTI back so its hole touches the end of the line. There should be about 11 1/2" between the NTI and the necklace. You're done! If the NTI comes loose in the night, it won't fall to the back of the throat and scare you half to death, and even if it did (impossible?), there's no way you'll end up swallowing it with that line attached, unless you blew the line tip melting process. Rest easy, folks!




3. Splint-NTI Combo (not worn by anyone until someone makes one). They make mouth splints for the lower back teeth and NTIs for the lower front teeth, so take the two items and combine them and you have a splint-NTI combo. I assume the best way to get the job done is to get a patientís teeth molds taken like you normally would for a lower mouth splint, but then also get the mold done for the lower NTI, and utilize both molds in creating this splint-NTI combo.

Advantages:

  • The NTI can safely be loose around the enclosed front teeth so it doesn't cause tooth and cranial discomfort and stress.
  • An NTI as an integral part of a nighttime mouth guard or splint will not fall to the back of the throat and endanger the wearer, or make him worry about choking, but if no one will make this configuration for you, use the ball and chain or necklace method of staying safe.
  • It will not need much, if any, adjusting or tightening once stabilized.
  • It will be COMFORTABLE since it doesnít need to be very tight in order to prevent it from being a choking hazard.
  • It will be secure, reassuring, and nonthreatening.
  • It will not hurt the hands, fingers, and muscles of those with arthritis or fibromyalgia or carpal tunnel or hand injuries when they're inserting or removing it, like the current NTI does. (It helps to wrap a washcloth around the NTI when extracting it with your hand, and try to pry from below, for bottom NTIs, and from above, for top NTIs.)

The NTI is Good for Helping Many of the People with the Following Problems

The use of the NTI is important to people with:

  • TMJ
  • ear ringing
  • ear hissing
  • itching ears
  • unexplained fleeting headache-like pains
  • face/scalp/ear pain
  • sore, oversensitive teeth/toothaches that come and go
  • migraines/headaches
  • sore jaw muscles, talking/chewing worsens this
  • teeth grinding

Drool

On a final note, NTI users have noticed they tend to drool in their sleep. What can be done about this? Sometimes, you just have to accept the wisdom of the old adage:

Spit happens.



Drilling tips

If you donít know how to drill delicate things, let someone drill the NTI that knows what s/he is doing, like a dentist, a jeweler, or very skilled small model builder used to drilling tiny holes in things like model train locomotives.

  1. Start the hole so the drill bit is exactly perpendicular to a plane tangent to the drill hole mark, and once you're in about 1/20th of an inch, stop and realign your drill angle so it will come out exactly at the right place on the far side of the nub. Ignore this, and the drill will likely try to ride along the side of the NTI, gouging a big scar in its side rather than making a neat hole. Drill slowly and carefully, which will help prevent errors as well as melting.
  2. Donít put the drill bit in the chuck so deep you can't see what you're doing, or so shallow that the bit bends and breaks, or bends and goes crooked, or bends and rides along the surface.
  3. Use a vice with lots of padding (rubber or soft cloth) stuffed around the NTI but donít over-tighten as you may compress the teeth slot or gouge the plastic.
  4. Assume youíll get the NTIís nubs ground down, so have the hole close to the nub root rather than near the nub edge.




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