Page 76 - Journal of Special Operations Medicine - Fall 2014

Figure 6 Sleep disturbance frequency scores collected during It was noted during the study that participants who were
the study. Solid lines = PTSD; dashed lines = mTBI/PTSD. under the influence of pain relievers or muscle relaxers
tended to score lower on MMTP examination, but these
artificially lowered scores were not associated with lesser
symptoms. No participants reported worsening of any
symptoms as a result of using the RMN at any point.
One participant noted increased salivation, but no other
side effects or adverse reactions were reported. No medi-
cation changes occurred in any subject during the course
of this study. The distribution histogram shows a nor-
mal bell curve indicating an equal distribution of mTbi,
non-mTbi, pharmacotherapy, and nonpharmacotherapy
subjects (Figure 8). Thus, confounding factors such as
brain injury and presence of psychotropics are balanced
with factors of nonpsychotropic and absence of brain in-
jury in PTSD subjects. (Variables of medication, injury,
Figure 7 Sleep disturbance intensity scores collected during and the absence of either/both are kept constant during
the study. Solid lines = PTSD; dashed lines = mTBI/PTSD. experimentation and do not compete/interfere with the
independent variable’s effect on the dependent variable.)
Figure 8 Scatter plot with regression line for the effect of the
RNM on headaches.

Discussion
Although this is a correlational study where causation
cannot be determined, there is room to suggest and sup- Data suggest that use of an RMN may be considered
port further experimental investigation into a possible a useful adjunct to psychological and pharmaceutical
cause-and-effect relationship. A reduction of movement therapy, which should be explored further under experi-
during bruxing may lead to decreased activity across mental designs. Cognitive-behavioral and exposure ther-
the trigeminal nerve (CN-V), which may also contrib- apies have been shown to be comparable to each other
ute to the observed reduction in symptoms. The device in reducing the experience of general PTSD symptoms.
21
may reduce bruxing frequency through behavioral re- Prazosin, a selective α blocker and selectivemelatonin
1
sponse blocking, abolishing the association between the receptor (MT ) antagonist, has been shown to reduce the
3
bruxing behavior and any reinforcing stimuli. It is also experience of trauma NMs in PTSD patients. Because
22
possible that the effect on CN-V may precipitate a neu- some participants were on antidepressant and pain relief
romodulatory effect in the brain. agents while displaying the same correlative response
as those who were not, it is possible that these three
It is known that not all bite guards will provide for the therapies may be administered simultaneously, and it is
same correlation as the RMN. The most striking difference therefore recommended that future studies should ex-
between common bite guards and the RMN is thickness. plore the effects of a combination treatment of sleeping
A thin bite guard may inadequately reduce pressure on with an RMN, psychotherapy, and prazosin on persons
the TMJ and inadequately reduce stimulation of CN-V. experiencing PTSD and mTBI symptoms.
If a portion of the effect depends on behavioral response
blocking, then it may also be true that an ideal interarch Scatter plot analysis with regression lines in HAs, NMs,
distance must be achieved to eliminate reinforcing stimuli. and SD indicates a strong negative correlation between

68 Journal of Special Operations Medicine Volume 14, Edition 3/Fall 2014