Update on my NTI device for TMJ discomfort

A few months ago, I wrote about how I had been fitted for an NTI device, a retainer-like contraption that fits over your teeth and helps prevent you from clenching your teeth while sleeping.  The device also helps with grinding, though I am more of a clencher—sometimes I don’t realize how terribly tight my jaw is until I go to yawn and hear a series of snap, crackle, pops.

My neurologist and my dentist both think that my TMJ pain mainly stems from my clenching, and the TMJ tightness and pain combine to form a rather persistent and recurring migraine trigger for me.  Sometimes I hear stories about how bad other people’s TMJ is and I dismiss my own case, thinking I maybe overreacted by dropping $150 on an NTI device.  That belief was rapidly dismissed at my last neurology appointment, when my doctor put her fingertips on my jaw and asked me to open and close my mouth widely.  You should’ve seen her face—“empathy” just begins to describe her response as she winced and said, “Ouch!” as she felt and heard my jaw popping dramatically.  “So that’s kind of bad, right?” I asked, half-joking.  “That’s pretty significant,” she said. “I’ll check in with you next time and we’ll see how the NTI device is working—I hope that improves.”

Well, it’s been nearly six months since I’ve worn the device almost nightly—I’m proud to say that I’ve skipped only seven nights or so over that time frame, which is a pretty good track record for me.  The days I woke up after not having worn it, I can definitely feel a difference in the setting of my jaw and the pain I feel when I open my mouth for the first few times in the morning.

But it’s not all together helpful, I don’t think.  Though the device prevents my upper and lower rows of teeth from touching, I’m still waking up with my jaw clenched. It’s just that, instead of clenching down hard so my molars are grinding together, my jaw is forcefully clenching the plastic device.  When I was eleven, I had braces put on and didn’t have them removed until nearly three years later—my overbite, mainly a result of being a thumb-sucker until a rather late age, took awhile to fix.  I still have a slight overbite, and I have wondered in the last couple of months or so if it’s actually gotten worse since I got the NTI device.  Since the manufacturer had to use a mold of my lower teeth instead of the upper teeth (which is the usual technique), my incisors crash down hard on the lip of the retainer in the middle of the night, making it feel as if they are getting pushed outward.  In a couple of weeks, I have a checkup at the dentist and will bring the NTI device and my reports from the field and see if she thinks I should keep wearing it.  Lord knows I am not going to jack up my overbite and risk having to get braces ever again!

My migraine frequency has been pretty bad in the last many months, but I’ve mostly connected this bad spell with other factors in my life and don’t think it’s a fair time to really decide if the device is helping or hindering my migraine treatment. I’m going to check in with my dentist and neurologist (I have appointments with each this month) and stay the course.

Several of you commented on my initial article about trying the NTI device, but I wonder if others of you have any feedback on the device’s ability (or lack thereof) to help you cease clenching/grinding behaviors or its effect (or lack thereof) on your migraine patterns. Thanks in advance for the comments! 

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (20)
  • Sunny
    2 years ago

    I realize this is an older post, but I wanted to share my experience with an otc mouthguard that supposedly works like the nti (ie preventing the front teeth from touching). It seemed to stop the clenching of my teeth – but… it made my jaw feel worse the next day and actually triggered a horrible migraine. I only used it one night and am afraid to try it again.

    I have actually gone for 3 months without a migraine (after years of monthly, and then weekly ones) by using a biofeedback headband (I posted about it on this site earlier).
    The headband uses sensors to detect muscle movement, and if it picks up clenching movement, it emits a tone that you subconsciously hear in your sleep and you condition yourself to stop clenching when you hear the tone. If you don’t stop clenching, the tone gets louder to wake you up.

    The biofeedback headband works fine, and it actually stopped the migraines for 3 months. While using the headband, I got my clenching way down (from a high of 83 clenches in one night to an average of 2-5 per night) But I was still getting woken up once or twice each night, and thought that a mouthguard (used in conjunction with the headband) might help.

    So I went to sleep wearing both the headband and the mouthguard. I actually slept fine, and the headband indicated that I did not clench while wearing the mouthguard, but like I said, with the mouthguard I woke up with terrible jaw pain, which then triggered a migraine (aaarrggh). The mouthguard seemed to push my jaw forward, which is what caused the pain.

    So… I’m just going back to the biofeedback headband – better to get woken up once a night than to get a migraine.

  • Joanna Bodner moderator
    2 years ago

    Hi there Sunny! This is fantastic to hear what a dramatic decrease you have been experiencing. I am thrilled to hear the biofeedback headband is effective! This was so great of you to share your experience! Keep us posted and great hearing from you. -Joanna (Migraine.com Team)

  • Lauren
    3 years ago

    What type of doctor do you see for an NTI device and did insurance cover it?

  • Joanna Bodner moderator
    3 years ago

    Hi Lauren,
    I’d recommend speaking to your dentist regarding an NTI device to get you started & to point you in the right direction. Insurance coverage varies by plan, so unfortunately you would have to check with your provider. In the meantime, here is another article you may find helpful to review: https://migraine.com/blog/trying-the-nti-device-for-tmj-pain-and-prevention/.
    Good luck and thank you for being part of our community!
    Take care,
    Joanna (Migraine.com Team)

  • megalith00
    3 years ago

    I was fitted for an NTI by my dentist and wore it for about 2-3 years. It helped my migraines initially, but then they started to get worse. I already had TMJ prior to the NTI so I went to see a TMJ specialist. He was not happy when I told him I had been wearing an NTI device as he said they are only meant to be worn short term. Worn long term they actually cause damage to the TMJ because it puts the jaw into an unnatural position. He sent me for an MRI (which was so painful, as I had to lay there and bite on something to keep my jaw open). The results were worse than I expected. The discs on each side of my jaw are in bad shape, with one side being described on the report as “macerated.” The TMJ specialist compared this to hamburger meat. No amount of botox will get rid of the pain which is causing my migraines, and aside from a regular plastic mouth guard to protect my teeth, I will need surgery (which is also no guarantee). So, all this being said, I strongly, strongly, strongly, recommend you stop using your NTI ASAP and just get fitted for a regular mouth guard. The NTI does more harm than good.

  • 3 years ago

    I am on my 5th custom made bite guard. I wear it to protect my teeth as it does not help with the TMJ really. My TMJ is caused by misaligned jaw joints that can be corrected only by breaking both and wiring the mouth shut at least 6 weeks. So surgery and no guarantee that I wouldn’t clench and grind during sleep even with such a dramatic surgery. So, will continue using bite guards. You will eventually bute through the appliance and simply wear it out. Paid over $700 for each of the first two and just over $200 for the one a year ago. Worth wearing to save surfaces of your teeth. And, I don’t suffer severe bites on the inside of mouth when eating whicg frequently happens when the guard is not used each night.

  • elizabethnixon
    3 years ago

    I’ve been using an NTI device for years. It does not stop the clenching, even my dentist told me this. It does help to protect the teeth from the damaging effects of clenching. I have broken two NTIs due to my clenching, and had to have several adjustments (smoothing out the surface to take out the trench I’d created).

    I stopped wearing my NTI about three months ago because the depth of the trench I made actually worsens my TMJ discomfort because now my upper teeth are essentially locked in. I never noticed a difference in my migraines with the NTI.

  • Julianne
    3 years ago

    As others have said, the NTI doesn’t stop you from clenching so it doesn’t solve the problem. To do that, you need to truly make a change to the way your jaw is sitting.

    I’ve recently started going to a dentist that deals with a lot of TMJ patients. He highly suggests getting an orthodontic orthotic. This helps you hold your jaw in a better position and over time your muscles will retrain themselves to keep your jaw in a “normal” position. I don’t have mine yet but I’ve visited with several people who have tried these and they say they are amazing and really do work. With the NTI device, I haven’t heard a single person say it did much of anything or their headaches.

  • 3 years ago

    Please share if you get the “otho appliance” how it’s worn and what it’s called. I’m on my 5th bite guard. None prevent grinding, but do protect surface of teeth. I’ve often thought if I had an appliance of some sort that prevents the jaw from locking down, would have fewer migraines in the night.

  • Therese
    3 years ago

    I have the orthotic. I go to a Migraine Treatment Center. They combine this with cool laser, Micro II device (similar to a TENZ unit, but lower intensity), and an Alpha Stim unit for home use. A dentist then uses a scan to measure the amount of pressure each tooth receives when you bite down. He then files the teeth to ensure no tooth takes more than 7%. It’s expensive (about $7000), and the migraines get worse before they get better. I’m about half way through 12 treatments. My jaw no longer pops out. They also adjust the orthotic each visit, as you muscles change and your bite changes. They also want you to stop using preventative medicine, while you’re in treatment. I’m cautiously optimistic about the results.

  • Wimidwife
    3 years ago

    I liked my NTI device, until I lost it! It didn’t help my migraines, but it did really help me relax my jaw. Something recently knocked my jaw back into place. It used to clink and clunk horribly. I did something really painful and my jaw opens and closes smoothly now, but I still grind my teeth. The NTI really helped me relax my jaw. I have a lot of pain in my jaw before and during a migraine. I am having a hard time finding a dentist who fits them, since I moved.

  • Imjcn
    3 years ago

    It was about 10 years ago when I read about the NTI device and (again) thought I’d found my “answer” to migraines. I cried some happy tears as I made the appointment. After using it for a few nights and not having any breakthrough success, I was so defeated (again).
    Having something in my mouth makes me conscious of it and makes me chew and grind on it all night long. It made my situation worse. When I have gone through a 3 or 4 day stretch with migraines, I will pull it out and wear it as a last-ditch effort. But, I wouldn’t recommend it. You could get the same effect from a $20 mouth guard at the pharmacy.

  • Margaret
    3 years ago

    It would not be a good idea for me to comment on how the device would or would not work since I have not used it as yet. My dentist would like me to start to use one to protect my teeth. Comments are for me to learn to relax. The problem with that is I have suffered with migraines most of my life and I also have Celiac Disease and maybe glaucoma. Relax?
    I am looking into devices to see what if anything might help. I did find this site and there is one device that claims to help relax your jaw. Here is the link. Hope this helps.
    http://mouth-guards-for-teeth-grinding.top5reviews.com/

  • wendy nikkel
    3 years ago

    Hi I am in New Zealand my mouth device cost $600 and I have lost it but have not replaced it because I too think I am still clenching on the device instead of my teeth

  • Migraine Man
    3 years ago

    Great post MG. I’ve used a NTI appliance for the past 8 years and I can tell you that it’s primary purpose is to protect my teeth when clenching/grinding. I had initially hoped it would help with preventing bruxism, but that grinding still occurs. It got to a point where I developed abfractions on several lower teeth and chipped away my front teeth.

    Meanwhile, I have had some success with using Buspar for bruxism/jaw pain. I do 30mg am and 30mg pm. You can also just do a pm dose.

    So to sum it up – Use the NTI to protect your teeth. However, I would not expect it to solve the underlying TMJ problem.

  • JanetH
    3 years ago

    I’ve had a mouth guard for a handful of years now for the upper teeth. It helps–some. It does not stop a migraine. What it does do is minimize the clenching somewhat, so helps with the tightness in my jaw. I also have allergies, and I find it’s hard to wear that when I’m really stuffed up, for some reason. Seems to make me feel worse, so a lot of nights, I start out the night without it, then get up at some point and put it in.

  • Gail
    3 years ago

    I could have written this. I have a 35 yr. history of migraines and have tried everything. One was Botox,didn’t do much for my migraines. I did three rounds. Funny thing was the only place it hurt when injected was my jaw area. And then,stiffness, clinking, pain,everything related to my TMJ disappeared! It has been 4 years! I guess freezing those muscles and giving them time to rest and not swell, worked like a miracle! Surprised me it did t mean less migraines, still working on that. Hope this helps someone.

  • ktsf
    3 years ago

    I’ve had an NTI that fits on the bottom teeth for a few months as well.

    I was hoping the NTI would reduce muscle tension that spreads to my neck and shoulders and contributes to my chronic daily migraines. Unfortunately, I still clench pretty badly and have already worn a deep groove into the NTI.

    I feel like the NTI has changed the way I clench and grind more than anything–now I catch myself half asleep with my jaw moving front to back and side to side, almost as if it’s trying to get around the NTI. I think my bottom teeth are moving a bit as well, and the fillings that I have to fix my broken front teeth have chipped.

    It’s interesting to read that my experience is similar to others. It seems as though the NTI might be a good choice for some, but doesn’t do much good for serious clenchers and grinders, and might even cause additional problems!

  • Ally
    3 years ago

    I used an NTI for a few years covering my top teeth but my clenching was so bad that it separated my bottom teeth and I wore through the NTI within months. I now wear a full plastic molded guard on my top teeth and a hard plastic full retainer like guard for my bottom teeth so that my teeth don’t separate. It has helped but I still have migraines. Also, I did physical therapy for my TMJ to get exercises to help with the muscle tension from clenching so much at night.
    I have found that I need, like many, a combination of treatments to help with the daily migraines.

  • Lori Mancini
    3 years ago

    Here is the thing about these devices.. they do not STOP you from clenching.. they make it so when you do clench you are doing it at an angle that does not strain your muscles as much as when you do it teeth on teeth. it also protects your teeth. if you clench your teeth together you can feel your muscle tighten.. now do it at an open angle, you will see your muscles are not as strained. that is where the benefit of wearing it comes in.

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