advice needed: braces and TMJ

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#1 Post by **jorx** » Tue Jan 23, 2007 9:34 am

Hi,

Two years ago I started to have some TMJ pain, and my dentist made me a splint to wear at night. It worked fine for a while, and the pain almost disappeared. However, now I do have some occasional pain and my jaw is clicking again.

I visited another dentist, that told me that my problem was due to a malocclusion, that could only be solved with orthodontic treatment. She refered me to an ortho, that 'sentenced': unilateral posterior cross bite, deep bite and lower crowding. Two years in full braces + TPA or nance-button and lingual arch + elastics

Now I have lots of doubts... My lowers are very crowded, but my uppers are straight and nice, so I do not have real appearance problems. Moreover, I am not sure if braces will solve my TMJ problems -wich are not severe at all-. Do you think that I should get braces? Would it be worth it, considering that my upper teeth are already straight? Are the TPA or the nance button going to affect my speech? To what extent?Most orthos would obviously like to see everybody with their mouth full of metal, so I need some 'uninterested' advice...

#2 Post by **science teacher** » Tue Jan 23, 2007 9:56 am

There are several of us that can address this but let me be the first.

I was told 15 years ago that my jaw popping was due to a bad bite. I was too cool at 20 do get braces.

Fast forward 15 years and 2 bad bouts of TMJ later. I finally decided it didn't matter what it took I was going to stop the pain. I had an earache from my jaw for about 6 months.

My current ortho agreed with previous diagnosis. I committed to SARPE (surgery to widen my top jaw) and full braces for about 2 years.

I was just like you. There is really no cosmetic problems with my teeth. The front teeth looked fine on top and just a little bit of space between the bottom.

I was totally worth this journey to not have the earache. I would get the earache after I had to chew any food.

I hope this helps you make a decision.

Kim[/code]

#3 Post by **iBorg** » Tue Jan 23, 2007 10:53 am

TMJ is caused by bad bite, not bad alignment. I did a splint for two and a half years and was very happy that my TMJ pain (behind the ear in an atypical spot) was eliminated. Then I started getting it in the typical spot in front of the ear. After being braced, I'm finding my TMJ may flare up more often, but it quickly goes away. I used to have it for three or more hours. Now I'll feel it for ten minutes or less.

For me, the braces have been a great help with my TMJ.

Mike

#4 Post by **BracedBelle** » Tue Jan 23, 2007 6:43 pm

I had jaw problems even before I had teeth, and as my teeth grew in when I was a kid it continued to get worse and worse. Crooked teeth had nothing to do with my decision to get braces, and braces are not necessarily going to be the only thing I need to fix my jaw problems. But I can tell you that my jaws already fit together better (after 8 months in braces) and that I have less jaw pain / less popping / less aching than I ever have in my life. That's going to get better and worse and then better again throughout the treatment. I am fully aware that my problems are not average and will not be 100% resolved by braces alone, but it's a huge step in the right direction for me, and will be well worth it

#5 Post by **Chypre** » Wed Jan 24, 2007 12:16 am

TMD was my only reason for getting my braces. I've suffered from it since I was 12, but my parents never saw fit to get me braced and being a kid, I just thought that they were ugly and painful. Of course I didn't want the things! I've had flares lasting from 2 weeks to 6 months at a time ever since, with only short periods of respite (and with at least a dozen subluxations).

About 2 years ago I severely injured it, but the pain refused to go away even after more than 6 months of outpatient treatment, so they sent me off to a specialist. I spent 8 months using a splint until the joint stabilized enough for me to get my braces. At its worst the pain was about a 7 (a subjective scale low to high intensity), at best a 3. Three weeks after being braced, I was nearly pain free (a 1 or less). I seems that I had been so focused on getting accustomed to the braces themselves that I had completely forgotten why I had them in the first place! It was one of the most amazing realizations of my life!

So I'm sitting at month 9 or so and I'm a little more than halfway through my treatment. I just had another adjustment this AM, got my first set of elastics, a neat little closing spring and a segment of powerchain... and yes it hurts like hell. But it isn't nearly as intense and long lasting as the TMD pain. I suspect I'll be much better in just a few days and I can deal with that.

I let my condition go for far too long and I now have arthritic changes and significant warping to my jaw bone as a result of that neglect. I should have had this done years ago. So all I have left to say is:

I LOVE MY BRACES! (Ok... maybe not so much at the moment. Maybe next week...)

#6 Post by **jorx** » Wed Jan 24, 2007 8:53 am

Thank you very much for your replies! Fortunately, my TMJ problems do not seem to be as severe as those you have explained, although I am a little bit concerned about the possibility of a worsening in the future, as my dentist â€“and some of you- have suggested. Could the nightguard prevent a hypothetical worsening by itself?

In any case, I am almost decided about getting braces, but the fact that in september I move and will spend one year abroad has prevented me of starting the â€˜journeyâ€™ right now...And I wonâ€™t do it when I am abroad either, bc I will only stay there for 10-12 months...

#7 Post by **Chris** » Wed Jan 24, 2007 9:07 am

TMJ may improve or get worse with braces. No one can guarantee the outcome.

Make sure they check the overall health of your joints before you proceed.

Your teeth will continue to move through life, this may change your bite, hence your TMJ make act up again.

Everything has its risks.

In my humble opinion, if you get relief with the splint, stick with it.

#8 Post by **Pirate Wench** » Wed Jan 24, 2007 11:09 am

I have complained about migraine headaches for years. The doctors have never found anything that would be a specific cause. When I mentioned it to the dentist quite a few years ago he started asking me questions. I definately had symptoms of TMJ. The headaches, the jaw pain, the popping, the earaches, and the jaw joint pain. Needless to say my dentist suggested that I see an Ortho. I was young and vain and didn't want to deal with all the responsiblitly of braces........what a mistake...... My symptoms got progressively worse. I went with severe headaches/migraines for months straight

. At my last appointment with the dentist I decided to take his advice and see the Ortho. The results so far have been great

. I have only had the top braces since June of 2006 and the bottoms since November 2006. I used to eat Advil like they were candy.....I should have had shares in the Advil company

. Since the braces went on I think I have only had to take Advil for a headache 3-4 times. Of course I have had to use it for after adjustments and the first few nights with elastics, but nothing compared to before.

HTH,

#9 Post by **science teacher** » Wed Jan 24, 2007 4:52 pm

Another thing to consider is that longtime usage of a nightguard/splint may result in an open bite where your teeth don't touch any more.

If you are not sure about getting braces yet then don 't. There will come a time that you say "Now I am ready to deal with/fix this problem."
kim

#10 Post by **wmastin** » Sun Jan 28, 2007 6:56 pm

Keep in mind that you can't count on your TMJ, grinding or clenching to always remain at the level it's now at. I have TMJ and clench at night. I fractured a tooth and had to have it pulled. The oral surgeon is the one who suggested braces to correct my bite *may* alleviate the problem. I'm now in braces and have been for the past two months. FWIW, my teeth weren't terrible in appearance and the bottom really was pretty good.

I started clenching within the first couple weeks, enough that the ortho has delayed putting on the bottoms so I can continue to wear my mouth guard. At some point, I'll be filled for a splint and he'll do the bottom.

I feel that my bite issues developed because of very late arrival wisdom teeth. I was 30 and pregnant at the time they first caused pain, but by the time they could safely remove them all was fine. I left them alone and they never bothered me. They did change my bite.

If you can afford the braces and trust the opinion of your dentist, I'd certainly do it. In my case a oral surgeon, periodontist and an orthodontist all agree that braces *should* at least help, if not solve, my issues.

#11 Post by **ghostmyimag3** » Mon Jan 29, 2007 9:45 am

I have had TMJ since 2000. At night, or during the day when i was frustrated i'd start grinding away, clinching causing pain. My jaw popped all the time and loud. Now I am not clinching or grinding since my teeth are more in line, i do have some popping but its not like it was thank god!

#12 Post by **jorx** » Tue Feb 06, 2007 4:26 am

I visited another ortho, as some of you recommended me. What she said was quite different from the first one: she does not want to start treatment until my jaw is more relaxed, so she told me to wear my splint full time for 2 or 3 months and then go back to see her. She also told me that she could not guarantee me that wearing braces would solve my jaw problems, she just said that it was probable...

The first one seemed to be very interested in starting the treatment inmediatly, and this one said that it was crucial to start wit the jaw stabilized.
I wonder how is it possible to obtain such different respones... and, moreover, I have no idea on who should I trust more. My intuition tells me to go with the second plan, but I do not have any medical background to support that.

In any case, I have started to wear my splint more hours during the day, not only by night (definetly not 24/7 as she suggested, bc I find a lot of troubles speaking with the splint! We will see...

#13 Post by **wmastin** » Tue Feb 06, 2007 7:03 am

jorx wrote:I wonder how is it possible to obtain such different respones... and, moreover, I have no idea on who should I trust more. My intuition tells me to go with the second plan, but I do not have any medical background to support that.

In any case, I have started to wear my splint more hours during the day, not only by night (definetly not 24/7 as she suggested, bc I find a lot of troubles speaking with the splint! We will see...

You have to go with your gut. If you're still questioning, go for yet a third opinion trying to find someone who does work with TMJ or facial pain.

I'm not familiar with splints, because I haven't been fitted for one yet. Can you wear it while the braces are on? If you can, waiting may not be an issue at all. I will be having a splint fabricated at some point, but am unclear as to if I will have braces on both upper and lowers at that time. I guess I should ask when I go in next time!

Edited to ask why my quotes don't show up on this board as a quote. I'm using the quote link in the thread I'm quoting from. Any idea?

#14 Post by **jorx** » Tue Feb 06, 2007 8:53 am

I don't think it is possible to wear a splint while in braces: it would prevent your teeth to move, as it must fit teeth really tight...

#15 Post by **Chris** » Tue Feb 06, 2007 9:56 am

I wonder how is it possible to obtain such different respones... and, moreover, I have no idea on who should I trust more. My intuition tells me to go with the second plan, but I do not have any medical background to support that. ...

This is VERY typical! Lots of us got very different treatment options when we first started and yes, it does seem like russian roulette when it comes down to picking one. This can drive you crazy, I know. I'm going through it right now even after my braces are off and deciding on the restoration treatment (implants, bridges, etc.)

This is just my personal opinion, but I would wait and wear the splint until your jaw pain settles down. It may be that braces would eventually correct the problem, maybe it won't but it couldn't hurt to wait until the inflammation in your jaw joints is better before you proceed.

There are orthos out there that specialize in using splints while you are in braces. They continue to shave the splint until your teeth finally touch. Check out "functional orthodontics" on the web and see if there are any orthos in your area that do that. They do seem to be more concerned about your bite and TMJ than regular orthos. (hey, nobody better throw a pie in my face here.)

Just my opinion.