Temporomandibular joint issues and orthodontics?
Hello, I recently visited a clinic for a consultation regarding orthodontic treatment.
However, the orthodontist mentioned that my temporomandibular joint (TMJ) issues are causing my bite to vary with each occlusion.
They recommended that I first go to a larger hospital for an examination and to create an occlusal splint to stabilize my bite.
A few days ago, I went to a nearby hospital for an evaluation, but the doctor informed me that the discomfort might be due to malocclusion and unilateral chewing, although the symptoms are mild, and I can proceed directly with orthodontic treatment.
(On the day of the orthodontic consultation, I experienced TMJ pain, but by the time of the hospital visit a week later, the pain had subsided.
Currently, I have no issues opening or closing my mouth, and there is no pain; however, there is a clicking sound from the right TMJ during movement, and the movement is not smooth.) After returning home, I tested my bite position, and indeed, it varies each time I bite down.
I am a bit concerned that if my bite position is inconsistent, can I really proceed directly with orthodontic treatment? Or should I consult the larger hospital again to see if they can assist in creating a stabilizing occlusal splint and observe for a while before proceeding with orthodontics? Thank you!
Ms. Shi, 20~29 year old female. Ask Date: 2021/09/15
Dr. Lin Jiayong reply Dentistry
Hello, it is recommended to consult a medical center that has both "oral surgery" and "orthodontics." It is advisable to receive treatment at the same medical center to facilitate any potential involvement of an oral surgeon during the orthodontic treatment process.
Sincerely, Lin Chia-Yung, Department of Dentistry, Taichung Hospital, Ministry of Health and Welfare.
Reply Date: 2021/09/15
More Info
When considering orthodontic treatment, particularly braces, for individuals with temporomandibular joint (TMJ) issues, it is crucial to approach the situation with a comprehensive understanding of both the dental and muscular-skeletal implications. Your concerns about the variability in your bite and the associated TMJ symptoms are valid and warrant careful consideration before proceeding with orthodontic treatment.
TMJ disorders can manifest in various ways, including pain, clicking sounds, and limited jaw movement. These symptoms can be exacerbated by misalignment of the teeth and jaw, which is often the very issue that orthodontics aims to correct. The fact that you have experienced pain and variability in your bite suggests that your TMJ may be sensitive to changes in your dental alignment.
The recommendation from your orthodontist to first stabilize your bite with a bite splint is a common and prudent approach. A bite splint can help alleviate pressure on the TMJ by providing a more consistent occlusal surface, which may reduce discomfort and allow the joint to heal. This stabilization phase can also provide valuable information about your bite and how it may respond to orthodontic treatment.
The subsequent evaluation at the hospital, where the physician indicated that your symptoms were mild and that you could proceed with braces, adds another layer of complexity. While it is encouraging that your symptoms have improved and that you are not experiencing pain during jaw movement, the presence of clicking sounds and the variability in your bite still raise concerns.
Here are some considerations to keep in mind:
1. Consultation with Specialists: It may be beneficial to consult with both your orthodontist and a TMJ specialist or oral surgeon. They can work together to create a treatment plan that addresses both your orthodontic needs and your TMJ issues.
2. Monitoring Symptoms: If you decide to proceed with braces, it is essential to monitor your TMJ symptoms closely. Any increase in pain or discomfort should be reported to your healthcare providers immediately.
3. Orthodontic Treatment Plan: If you choose to go ahead with braces, ensure that your orthodontist is aware of your TMJ issues. They may need to adjust their approach, such as using lighter forces or a more gradual treatment plan, to minimize stress on the TMJ.
4. Potential for Further Treatment: If your symptoms do not improve or worsen during orthodontic treatment, additional interventions may be necessary. This could include physical therapy, further splint therapy, or even surgical options in severe cases.
5. Long-term Management: After completing orthodontic treatment, ongoing management of your TMJ may be necessary. This could involve continued use of a bite splint, exercises to strengthen jaw muscles, or lifestyle modifications to reduce stress on the joint.
In conclusion, while it may be possible to proceed with braces despite your TMJ issues, it is essential to take a cautious and well-informed approach. Engaging in open communication with your orthodontist and any other specialists involved in your care will help ensure that your treatment plan is tailored to your specific needs, ultimately leading to a healthier bite and improved TMJ function. If you have lingering doubts or concerns, seeking a second opinion or further evaluation may provide additional peace of mind before making a decision.
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