• tmjd.com > articles & information > tmjd.com Interviews Jim Boyd, D.D.S.

My pain. I had a headache, all day, everyday, for 12 years straight. My right jaw joint made a constant popping sound with every chewing stroke. There were times when, upon waking, I could barely open my mouth. My neck was constantly stiff and sore, my teeth were extremely sensitive to cold, and I felt a nagging pressure in and around my sinuses. I took 12 Excedrin per day as my baseline maintenance dosage. I was the guy always interested in another kind of analgesic.

While training in dental school to treat TMJD, I noticed that half of the patients we saw showed little, if any, improvement...just as I hadn’t. Three years into private practice, I must have reached my limit, because it was then that I began aggressively exploring *why* my treatment (and half of my patients) was failing.

• How is the NTI any different from a "flat plane splint"?

A flat plane splint, or any splint for that matter, provides full occlusal coverage, essentially stipulating that the opposing arch will be occluding on the splint. As soon as the splint is delivered, it acknowledges that the dentist is aware that the jaws will be coming together with a degree of intensity (a muscular activity), and the design of the splint is intended to redirect the forces generated to somewhere other than into the TM joint.

While the flat plane responds and frequently succumbs to the activity, the NTI on the other hand, anticipates the muscle contraction intensity, and serves to suppress it by not allowing for the occlusal scheme necessary to create the forces.

• When we first met I had an intuition that the NTI would go international in a short time, given your passion and positive ethics. You also stated with confidence that it would go international "because it works!" Our understanding is that the NTI has yet to be officially introduced internationally, but it's certainly "known" by many TMJD patients worldwide. What’s going on?

Although the company that has licensed my patents is headquartered in Germany (Heraeus Kulzer, with US headquarters in South Bend, Indiana), they are not yet prepared to launch the NTI Clenching Suppression System in Europe.

Unlike the US, where the FDA determines whether or not a product can be marketed with specific claims, in Europe, it is the manufacturer’s responsibility to put what’s called a “CE” on a product, which is the equivalent to an FDA approval. Heraeus Kulzer is having me re-design the NTI for international distribution so as to satisfy a different set of international guidelines for medical products. In the meantime, “bootleg” NTI kits are finding their way into Europe! Essentially, it is the strength of the success in treatment outcome that continues to propel the NTI’s popularity in the dental market. What I find reassuring is that although I haven't done a single lecture to any doctors overseas, the concept’s validity carries its own weight.

Also, I suspect that within several months the NTI will be available in Europe, South America, Japan and Australia.

• Will the NTI create any permanent changes in the physiology/structure of the skull?

No. The NTI is a passive device. All it does is suppress the intensity of jaw muscle contraction, and it is the muscular contraction that is responsible for creating strain on a TM joint.

• Flat plane splints often have to be adjusted. What adjustments are needed with a patient who uses the NTI?

Eventually, very little or none. While the flat plane is constantly being “attacked” by the jaws, the NTI is suppressing the activity, therefore reducing or eliminating the need for adaptation to changing conditions.

• Is it a permanent appliance, something to be worn forever, except for meals?

The nocturnal muscular activity doesn’t seem to just go away, so the appliance is required as long as the activity persists (I’ve worn mine nightly for 10 years now). As far as daytime use goes (there is a separate design for daytime use), several weeks of use is usually significant, then tapering off. I haven’t worn a daytime appliance since 1993.

• What kind of response are you getting from patients who have had invasive surgery and are now using the NTI?

For those patients who still have all their “parts” (that is, having some type of surgical procedure where nothing is removed, such as arthoscopic lavage, i.e., rinsing out the joint space), the success is quite good. But, for example, once the condyle is removed, the chances for complete resolution of symptoms with the NTI alone is less likely. The best environment in that situation is to keep muscle intensity and the resultant strain on the site at a minimum...so an NTI would still be indicated.

• What kind of response are you getting from patients who have sought this out as part of their initial treatment without surgery?

You probably wouldn’t believe me if I told you that nearly 100% of TMJD patients realize a degree of relief, if not significant to total resolution...but that’s been the overwhelming response from doctors around the country who are actively prescribing the NTI in their practices. That would make sense, however, when you consider the NTI is directly suppressing the causative and/or perpetuating element of TMJD, rather than trying to treat the symptoms of it.

• Some dentists claim that by not using a flat plane splint you can have back molars, etc. "super-erupt," or something to that effect. Maybe I am saying that wrong, but you know what I mean... :-)

Some geographical experts used to think you would sail off the edge of the earth if you went to too far out into the ocean...I mean, it sure *seemed* like you would!

In order for a tooth to supra-erupt, that is, grow down from its socket, looking for another tooth to occlude with, it would have to go *untouched* for at least 6 to 8 weeks for the process to begin. But since it is impossible to chew food with an NTI device in place, the wearer’s teeth get *normal* functional stimulation everyday. In fact, 40 of the top chairmen in university orthodontic departments across the country were asked if supra-eruption could be initiated by using the NTI protocol. Every one said it was impossible.

The dentist who reflexively claims that supra-eruption will occur are simply saying so because it *seems* like it could happen, but quickly change their tune once they try it in practice.

After 10 years of nightly wear, *my* teeth haven’t gone anywhere, and neither have the teeth of over 1,200 other patients I’ve provided an NTI for.

• There have been reports of patients who use a flat plane splint also having a high incidence of gum disease. Is this true? And if so, how is your appliance different?

I suppose a full-coverage splint could harbor bacteria around the teeth. Since there isn’t any acrylic surrounding the teeth with an NTI (except for the two upper centrals), this would seem unlikely.

• What exactly does the NTI look like?

• Okay, I have to ask. What happens if I swallow that little thing?

To my knowledge, that has only been reported once. It seems someone mistook their NTI for their nighttime dose of medications. But don't worry, the material is harmless if swallowed.

• Sounds like a great product. I sure do like my set. And no, I haven't swallowed it yet, although I did accidentally throw it away a couple of times (luckily, I found it again). :) How does a TMJD patient get their doctor to try a set with them?

I like to suggest that a patient print out the article on bruxism on my website and present it to their dentist, along with a print-out of Heraeus Kulzer’s NTI webpage, so the dentist sees that the NTI is indeed a legit product. If the dentist is interested, I'd be happy to send some NTI devices to the dentist.

• Can you tell me a little about the history of the NTI, from creating it yourself to now being on the verge of introducing it internationally?

Without intending for it to, the NTI concept became my “calling.” Sometime during 1989, I found myself suffering as much as ever. I recalled a lecture I had been to years before, where it was recommend to add an anterior midline point stop to a patient’s splint if they were in acute muscular distress, then a day or two after relieving the patient’s discomfort, remove the little “bump.” I figured, “Hey, if two days helps acute conditions, how would chronic ones respond? And why only two days? Why not two weeks, or two months, or two years? So I tried it on myself, and within two days, I had significant relief. But a week later, I was even more miserable than before. Why? As it turns out, the jaw doesn’t just hold still in one place all night. It moves around, clenching in different places. The point stop is for one jaw position only. Once the jaw moves forward, for example, the point stop is easily defeated, and the patient is exposed to a whole new set of symptoms. Once I understood that simple concept, I began designing a retro-fitable mouthpiece whose designs anticipated various jaw positions and movements, while still providing an anterior midline point stop.

Five years later, almost half of my general dentistry practice was dedicated to treating chronic headache, migraine, and TMJD. Unlike other dentists who stayed away from such conditions, I was soliciting for it, and refusing to accept a fee if the patient wasn’t happy with their outcome. I even had advertisements in the local metro newspaper. I was pretty bold in the ads, too...new treatment, no adverse effects, no fee if no relief.

It got to the point where I wanted to dedicate my entire professional career to the concept. Since I was already well-known as a general dentist in San Diego, I needed to move to a new city and start a whole new practice. In hindsight, it was an incredible risk. I practically gave away my dentistry practice and moved my wife and one-year-old son to Bloomfield Hills, Michigan, where my wife grew up, and where her mother and sister still lived.

I started a practice simply by soliciting to migraine, headache, and TMJD patients, with the claim that if they weren’t satisfied with their treatment outcome, then they wouldn’t pay anything. This certainly generated an adequate patient flow, but that wouldn’t have mattered if no one was paying me! Eventually, after 4 years and about 1,200 patients, I was pretty confident in the NTI protocol. I was ready to stand up in front of any group of dentists or physicians and logically describe and explain what the NTI was, how it worked, and why.

• Didn't you write a book? How can the TMJD patient get a copy?

As I was developing the NTI protocol (originally in 1991), I wrote a book entitled: Splitting the Headache and Solving the Sinuses. The original intent was to provide it to a new patient a few days prior to his/her first consultation. That way, I wouldn’t have to tell the same story several times a day. I’ve updated it twice now, and the third edition in online only at DrJimBoyd.com. And it's free!

• This site is based on Reality Therapy. The basic theory we follow is that psychological need can be broken down into four basic categories: fun, freedom, love/belonging, and power/recognition. As you said before, you're not only a health care provider, but also a patient, and you have had years of pain. What are some ways you still figured out how to meet those needs, despite the pain?

I had a constant headache every single day from 1977 to 1989. I was in college and dental school during the majority of that time, and the better analgesics and abortives weren’t yet available. So like I said before, I usually took at least 12 Excedrin a day, just for my baseline level. As my headache pain would decrease in intensity, my mood would significantly swing accordingly. So as my pain subsided (it was never really gone), I became more witty and quick. As the pain increased, I became more intellectual and reserved.

I now notice that without the chronic pain, I can casually take on more than one task at a time. I’ve noticed the same in hundreds of the patients I‘ve treated. As their pain subsides, they find themselves taking on more and more tasks and responsibilities that previously would have been impossible. Given the distraction that headaches can generate, the chronic sufferer develops an ability to acutely focus on a subject and complete a project, in spite of their pain.

• I've got one last question. You often sign your name "El Jimno~" when online. Is there a story behind that?

A few years back, while I was living in Michigan, I came to lecture in San Diego. I arranged to have lunch with a couple of people who were trying to publish a book regarding the shortcomings of treatment for TMJD. It began raining as I approached the restaurant. A month later, I was in San Diego again, so another meeting was scheduled with the same couple to pick up where we left off last. Again, the day of the meeting, it rained. Now in Michigan that wouldn't have been so coincidental, but for San Diego, *any* rain is noteworthy. My lunch companions declared that I was just like the "El Nino~", in the way that the climate changes when it arrives. After a few laughs, we decided that I must be the "El Jimno~"...the TMJD climate changes when the El Jimno~ arrives!