BY DR. DOUGLAS JENSEN
In answering this question, a little information about jaw pain and problem diagnosis would be appropriate. A temporomandibular disorder (TMD) is a problem within the chewing system and is most often seen in people between the ages of 20 and 40. About one-third of the population has at least one TMD symptom and 3-7% of the population has TMD that is bad enough to cause them to seek treatment. Due to the complexity of the jaw joints and related parts, problems arising from this area can be due to one or several reasons. TMD pain during function or at rest is the main reason patients seek treatment, and reduction in pain is generally the main goal of treatment. Less commonly, people seek TMD treatment for temporomandibular joint (TMJ) clicking or locking, stiffness in the jaws, limited range of motion, TMJ dislocation, and unexplained changes in their bite relationship (front or back open bite, or a shift in the upper and lower dental midlines). However, TMJ noises are common among the population, are usually not concerning to the dental specialist, and do not usually respond as well to therapy as pain does. The trick is in determining what the true sources of the pain are.
As the doctor reviews a patient’s pain history, he is becoming aware of the initial event leading to pain, the pain location, pain qualities, and things that aggravate or relieve the pain. The most common initiating events are some sort of trauma that occurred to the joint system and the presence of emotional stress in life. Another kind of event arises when there is a bite misalignment, either sudden or long-standing. When the problem is a result of bite misalignment, what is observed is that teeth cusps in the wrong position interfere with smooth and harmonious functioning of the teeth and jaw muscles (such as when chewing food or grinding teeth). This effect of this misalignment is made worse if the joints are not completely seated within the sockets when a person closes their teeth together. If a person closes together and joints are not properly seated in the socket, and if tooth to tooth “interferences” are present, then there can be significant TMJ instability leading to increased stress on the system and wear on teeth. Disharmony, depending on a patient’s ability to tolerate it, can result in hyperactivity of the jaw muscles which ultimately can progress to muscle and/or joint pain. These are just three of the main reasons TMD problems arise.
All initial treatment for TMD should be conservative, reversible, and noninvasive. TMD is thought of as a repetitive motion disorder. It has many similarities to musculoskeletal disorders of other parts of the body, and treatment approaches for other musculoskeletal disorders generally apply to this disorder as well. Similar to other repetitive motion problems, TMD self-management instructions are routinely given as a first level of intervention. These instructions encourage patients to rest their jaw muscles by voluntarily limiting their use, such as avoiding hard or chewy foods and restraining from activities that overuse the chewing muscles, such as oral habits, clenching or grinding teeth, holding tension in the muscles, chewing gum, and yawning wide. Self-management instructions are also important in encouraging an awareness of the problem and elimination of detrimental physical posture and habits that perpetuate or worsen TMD. Referrals to other specialists for the treatment of emotional stress and to receive physical therapy are commonly made in order to deal with these aspects of the TMD problem.
One common reversible therapy is the placement of a bite stabilization appliance, or “night guard”. A stabilization appliance is an acrylic device worn over the teeth of one arch that has an opposing surface that creates and alters the lower jaw position and contact pattern of the teeth. Thus, when the appliance is being worn, a biting pattern is established that is in harmony with the optimum joint and bite relationship for the patient. The appliance, therefore, provides orthopedic stability and relief of symptoms in 70-90% of patients.
Irreversible therapy is any treatment that permanently alters the biting condition or jaw position. Examples are reshaping of teeth, and additive procedures designed to improve the fit of teeth while eliminating tooth cusp interferences, thereby improving chewing smoothness and joint stability. Another important treatment to alter the bite for this purpose—and this is the actual answer to the question “how can orthodontics help or fix jaw pain”—is with orthodontic treatment. When it is determined by conservative, reversible bite therapy that a patient would benefit from orthodontic treatment to modify their bite relationship in an effort to improve harmony, then orthodontics is one of the best ways to do it. In addition, more often than not, the act of moving the teeth with orthodontics tends to “deprogram” the patient’s bite which often quiets the muscles, reduces symptoms, and provides relief of pain. Because of this deprogramming phenomenon, if there are other reasons a patient is already considering orthodontics, especially for those under 20 years of age, then a stabilization appliance may not need to be worn prior to beginning orthodontics.
Another reason a patient might undergo orthodontic treatment is due to significant recent changes in the bite arising from degenerative joint problems. If a sudden change in the bite occurs and there was no known traumatic event, then orthodontics may be appropriate with other treatment approaches to improve the bite and stability of the system.
Each case must be evaluated individually. Orthodontics is often erroneously regarded as merely a cosmetic enhancement procedure for the smile. However, the ability to move teeth results in much more than just cosmetic improvement; well performed, it can actually alter how the upper and lower teeth relate to one another to effectively “rehabilitate” the function of the whole chewing system.
When considering treatment, the patient should always be mindful of the complexity of many TMDs. Sometimes, it is not always possible to be certain of the primary cause of the problem. Therefore reversible therapy is always recommended as initial treatment for patients with complex TMDs. The success or failure of this treatment may be helpful in determining the need for later irreversible bite therapy, which could include orthodontics.
Dr. Douglas Jensen
Jensen Orthodontic Arts
To get more information on how to treat your jaw pain, give Jensen Orthodontic Arts a call at 214-842-8106 today! Our team of professionals will be happy to help you and your smile!