Hi Friends! I’m Priya Mistry the TMJ doc and today I’m going to talk to you about
orthodontic treatment and TMJ Disorders. I see many of you asking questions about how
braces or Invisalign can affect TMJD - if they can make it better, if they can make
it worse, etc. Your questions inspired me to make this video to provide some clarification
on this. Watch this video until the end to find out more about how braces or Invisalign
can affect TMJD.
For those of you who don’t know me, I’m
a general dentist with a practice in Portland Oregon where we are dedicated
to taking care of patients with TMJ disorders. I practice here with my wonderful
mentor, Dr. Arthur L Parker. If you don't already, be sure
to follow me on Instagram. I post here about
TMJD quite frequently! My Instagram handle is the_tmj_doc. Also be sure to check
out my Twitter - tweet tweet. My twitter handle is at Priya TMJ. I post lots of useful
information about TMJ disorders, tips, trivia, etc.. so if you like to nerd out
on this stuff like I do, be sure to check out my social media accounts. That being said, if
you’re looking for more information on TMJ
Disorders then this is the YouTube channel for you!
Hit that Subscribe button as I post a new informative video every Friday for people
who are suffering from TMJD!
So let’s get right into it! A good place to start is the relationship of the bite - or
how the teeth fit together - to the Temporomandibular
Joints (the TMJs). Our teeth fitting together
like cogs on a gear and the two jaw joints create what we call at my practice “the
tripod effect”. What happens when you cut off one leg of a tripod? The whole system
will go out of balance. With that analogy in mind, it totally makes sense that the bite
- the way the teeth fit together - could have a positive or negative effect on the
TMJs.
I want to STOP here and say that the bite is JUST one factor that could be contributing
to TMJD. Other factors - especially hormonal influences, postural dynamics, whiplash incidents,
and more - contribute to TMJD as well. So I don’t want anyone running out and blaming
their orthodontist for their TMJD issues. That is NOT the purpose of this video. I’ve
seen it go both ways - I’ve seen patients whose TMJD has improved with orthodontia and
I’ve seen patients whose TMJD worsened with orthodontia. It can be highly unpredictable
as to which way it goes,
especially given ALL of the other factors that contribute to TMJD.
One thing I will say is that many of our TMJD patients had their 1st premolars extracted
and all the other teeth were then moved to fit together. The way this was done was by
pulling everything back to close the gaps where the premolars were. This type of orthodontia
is called “extraction/retraction” orthodontia with “extraction” referring to extracting
those first premolars and “retraction” referring to pulling the front teeth back to close the
gaps where the premolars were. If you think of the upper arch and the lower
arch as a box that houses the tongue, that
box is essentially made smaller by extraction/retraction
orthodontia while the tongue stays the same
size. So that begs the question - where does the tongue go? There’s only one
place it can go and that’s the airspace behind the nose and the
mouth. That's called the nasopharyngeal airway.
Because the tongue is now crowding this space, that airway becomes more narrow which can then
increase the risk of having sleep apnea. Sleep
apnea and struggling for oxygen at night increase
stress levels in the body. This increased stress can then cause
increased clenching and grinding activity.
Grinding the jaw - the mandible - forward actually opens the
airway - think of the chin tilt that’s taught
in CPR courses.. Same concept. All of the increased
clenching and bruxing activity puts too much strain
on the muscles and the TMJs thereby causing TMJ disorders.
Another negative impact of extraction/retraction orthotdontia is that forward growth, which
is ideal for the anatomy of the Temporomandibular Joints, is stopped. The mandible - this entire
jaw bone here - is held in a position that’s further back than ideal. This makes it so
that the little bony knob that our jaw bone ends on - the condyle - is in a posterior
or too “far back” position within the joint. When the condyle is posterior or distalized,
the articular disk that sits on top of it can displace more easily - leading to popping
noises OR the jaw locking closed. For more information on both of these conditions, please
watch my videos “Jaw Joint Noises - Snap, Crackle, Pop” and “Jaw Locked Closed”
Parts One and Two.
AGAIN - I want to take a moment to make it crystal clear that NOT ALL people who have
had “extraction/retraction” orthodontia will end up with sleep apnea, jaw joint noises,
or the jaw locking closed. I, myself, had extraction/retraction orthodontia. I do not
have sleep apnea, I have a mild click/pop in my right TMJ with a little bit of pain sometimes,
and my jaw has never locked closed. So please do not use this video or this information
as a reason to blame anybody for what you might be going through. This video is
about ONE of MANY factors that will contribute
to TMJ Disorders.
Lastly, I wanted to talk about Phase II of TMJ Disorder treatment. Phase I is getting out of
pain and stabilizing the Temporomandibular Joints (the TMJs). That means
getting the muscles back in a functional, healthy,
and pain-free state, and eliminating jaw joint noises
and locking episodes. Once this is done, Phase
II can commence if the patient wants it. Phase II consists of creating a bite that holds
the muscles in their functional state and holds the joints in their stable state - that way
teeth, muscles, and joints are all working together
harmoniously. This can be done by orthodontia
OR by full mouth reconstruction (also called FMR). Since
this video is about orthodontia, we will focus
on that. Phase II Orthodontic work is typically done by a skilled and trained TMJ dentist
OR an orthodontist who is working with the TMJ dentist who provided Phase I treatment.
This orthodontic work is done in a very precise manner and it creates a bite that supports
the healthy and functional muscles and joints. Orthodontia, if done correctly, can do wonders
for people who have suffered from TMJD. That begs the question - do
you have to do phase II? Do you have to do Orthodontia or Full Mouth Reconstruction?
And our answer is NO. We try to be very careful to not change our patient's bite
with Phase I treatment, so they don't have to commit to Phase II.
However, sometimes it does happen. So it really depends on
whether the bite changes and if it changes significantly enough
to where the patient cannot function anymore. So Phase II can be optional,
and sometimes it's not so optional if the bite does change with Phase I.
So that's really it my friends. If you like what you heard or
learned something new, click “Like” below,
Subscribe to my channel, do all the things. Questions
and comments are always welcome. And remember, my friends -
You can never have TMI about TMJ!