Brace Day - November 23rd

[Ciara]

I saw my orthodontist yesterday to get the results of my cephlogram and tomographs. Basically I have a severe deep bite, a unilateral posterior crossbite (right side), an asymmetrical midline, several tipped molars, and erosion and flattening of the both mandibular condyles, left side is worse. She said the TMD issues, including extremely tight facial muscles, have contributed to the jaw pain and locking, headaches, and muscles soreness I've had for years. She also said that all the muscles on the right side of my face are markedly underdeveloped compared with those on the left side of my face.

The asymmetrical midline is because of sifting caused by a congenitally missing upper lateral incisor. My ortho as a child/teenage moved my canine into its position and removed a lower premolar to balance both jaws. However, over time, my midline has shifted to the right (by about 1 tooth width) and it is skeletal - the shifting starts further up my face, including my nose.
She said she could try to fix the midline asymmetry, but it would never be perfect and it is difficult to fix a skeletal asymmetry in adults. It would involved moving all my teeth on the right side of both jaws, maintaining space until I got either a bridge or implants to replace the incisor and premolar. I've decided not to try to fix the midline and instead focus on fixing my crossbite, deep bite and tipped molars - an improved bite. She said she will give me exercises to help strengthen my facial muscles which will give me a balanced smile, even if my midline is way off. She said she can give me a functional bite that will stop all the uneven erosion and breaking/cracking of my teeth and help a lot with my TMD. (She is an expert in TMD and was recommended to me by several dentists, and professors at a university dental school - she lectures too on TMD.)

She spent a lot of time doing some sort of massage to try and relax my facial muscles. She has said I will need a bite plate to help with the deep bite, and braces on my upper jaw to start. When my deep bite has improved, she will put braces on my lower jaw. The bite plate is a removable retainer type, and she said I can remove it when teaching a class (I'm a university lecturer) but to wear it as much as possible.

I've also been given a long list of instructions some of which include: no pen chewing, chewing gum or other strange chewing habits, no resting my chin in my hands, holding a telephone between my shoulder and jaw, not to stick my jaw out when typing but to keep an upright balanced position, and not to sleep on one side but to sleep on my back. I am also to use both sides of my mouth when chewing......So a complete lifestyle change!

I'm now starting to freak out a little! What on earth have I got myself into! Will a bite plate work on an adult? How serious is "erosion and flattening of the both mandibular condyles"? Should I try to get the midline more asymmetrical even if it is just a little? I am doing this mainly to improve my bite and TMD issues. To get a more symmetrical smile would be nice but most people don't actually notice the asymmetry unless I tell them and I can may my smile even with effort.

Ciara

[TMJJill]

I have TMJD issues as well. I also have muscles that are stronger on one side than the other.

It took me a long time to find an orthodontist to really address my needs appropriately. I wore a lower mandibular repositioning splint for about a year. During that time, I did a lot of PT with orofacial trigger point releases to help get my muscles out of that constant spasm. Those muscle issues can be really rough. When I started Phase II of my TMJD treatment, I got my upper braces. I've had mine for about 14 months now. I wore the upper braces with my 24/7 lower mandibular splint up until I got my lower braces 3 months ago.

There is a great book called The TMJ Healing Plan by Cynthia Peterson, a physical therapist who specializes in TMJD. It gives tons of things that you can do to help with your tmjd symptoms and muscle while you are in treatment. It is pretty inexpensive and I found it to be the best book of its kind on the market. You might find it helpful.

What kind of bite plate will you be using? Is it flat or does it have bumps on it? Mine had bumps on it that cooresponded to my upper teeth to help me train my bite into a "correct" position. Over about the first 3 months, it helped with my muscle spasms immensely.

[Ciara]

I have TMJD issues as well. I also have muscles that are stronger on one side than the other.

It took me a long time to find an orthodontist to really address my needs appropriately. I wore a lower mandibular repositioning splint for about a year. During that time, I did a lot of PT with orofacial trigger point releases to help get my muscles out of that constant spasm. Those muscle issues can be really rough. When I started Phase II of my TMJD treatment, I got my upper braces. I've had mine for about 14 months now. I wore the upper braces with my 24/7 lower mandibular splint up until I got my lower braces 3 months ago.

There is a great book called The TMJ Healing Plan by Cynthia Peterson, a physical therapist who specializes in TMJD. It gives tons of things that you can do to help with your tmjd symptoms and muscle while you are in treatment. It is pretty inexpensive and I found it to be the best book of its kind on the market. You might find it helpful.

What kind of bite plate will you be using? Is it flat or does it have bumps on it? Mine had bumps on it that cooresponded to my upper teeth to help me train my bite into a "correct" position. Over about the first 3 months, it helped with my muscle spasms immensely.

Thanks, TMJJill. I'll get the book you recommended (I'm in Japan so anything in English is great!).
The orthodontist showed me a picture of the bite plate and yes, it had bumps. I told her that there is no position which feels natural for my jaw and she said this will train my jaw into a natural, relaxed position.
I've been given the run around for years - dentist - ENT doc - yet another dentist (who suggested it was all in my mind) -ENT etc - until I finally ended up with my present dentist who said that among many other issues, I had 2 fillings that were way too high. She replaced them and almost immediately a lot of the pain and stiffness was reduced (still there but at a more tolerable level). It was my present dentist too who said I had a very deep bite and recommended this orthodontist.
I'm glad to hear that you have been making progress. I don't think TMD is exactly rare so I don't really get why it is so difficult to diagnose and treat.

[Dee17]

Hello Ciara,
All the best to you as you start your journey with your braces. It's such a big step but one you will never regret, I'm sure. I'll be keeping an eye on your tread and looking forward to reading about your progress!
Dee

[dizzy34]

Hi, im new here and i get my braces on the 28th November. Upper ceramic lower metal. Good luck with yours.x

[TMJJill]

Thanks, TMJJill. I'll get the book you recommended (I'm in Japan so anything in English is great!).
The orthodontist showed me a picture of the bite plate and yes, it had bumps. I told her that there is no position which feels natural for my jaw and she said this will train my jaw into a natural, relaxed position.
I've been given the run around for years - dentist - ENT doc - yet another dentist (who suggested it was all in my mind) -ENT etc - until I finally ended up with my present dentist who said that among many other issues, I had 2 fillings that were way too high. She replaced them and almost immediately a lot of the pain and stiffness was reduced (still there but at a more tolerable level). It was my present dentist too who said I had a very deep bite and recommended this orthodontist.
I'm glad to hear that you have been making progress. I don't think TMD is exactly rare so I don't really get why it is so difficult to diagnose and treat.

Most people with bad TMJD issues don't have a good natural bite or they have two bites. I noticed that after about 3 months with my lower mandibular repositioning splint my muscles had relaxed and I'd found my 'correct' bite.

My TMJD issues manifested as ear issues first. I went to my primary care, ENT and a couple Audiologists before I found out about the possible TMJ connection on the internet. My dentist wasn't any help. It took me a couple tries to find a good TMJ specialist, but I'm loving the one I have now. Finding the right dentist is so important.

I think it is so difficult to diagnose and treat because there is really no medical or dental specialty in TMJD disorders. Some doctors and dentists just have more training than others. There are also no real established standard protocols for treatment so treatment really depends on the philosophy and training of the specialist you choose.