Braces for TMD

[NiTirannosaurus]

Hi All,

I am a long time reader of the board, since I first started treatment for TMD almost 3 years ago. I finally broke down and decided to register and post my story, either as an inspiration to other adults thinking about getting braces, or perhaps to serve as a warning:).

I had braces when I was a young teenager for about 1.5 years, and things turned out fine as I recall. Of course, being a teenager, I was not particularly interested in wearing retainers, and eventually lost them a couple of years after being debraced. If only I had known the future pain and suffering I would cause myself! My teeth steadily reverted to their crooked ways (plus bad overbite), and I also developed clicking and pain from TMD. 20+ years later, I finally decided to do something about it. I found an *excellent* Neuromuscular dentist up here in New York State (PM me if you want the name), and he began treatment back in the fall of 2008.

He started with determing the ideal position for my jaw, and created an orthotic for my lower jaw that kept things aligned in this position (it was removable, but I even had to eat with it in). It did quite a lot to stop the clicking and pain, so I was quite happy with that, and we proceeded on making this position change permanent. The orthotic was created with expansion in mind, so it was able to create some space between the 2nd to last and 3rd to last molars of the lower jaw, so we started expanding things after about 5 months of wearing it. He also added a removable palatal expander for the top, to help spread things out a bit (I had an interesting diastema for a while there!). SARPE was never discussed as an option, and I was very happy to not require any extractions (interesting story about that for another time). I had the orthotic and palatal exander in together for about 5 months in preparation for braces.

My braces (Damon 3s) were installed almost 2 years ago. Because of the maloccusion and TMD, I also had bite turbos and molar bumps (he actually trimmed down part of the orthotic for use as the "bump" on each back molar). That was definitely less than delightful! There were also the usual array of elastics, both class 2 and "vee" or "box", at times. I was pretty self conscious for a while there, especially about the bite turbos, but both the bumps and the turbos were finally removed this past spring. My front teeth were meeting well enough to eliminate the TMD problem so we could start work on bringing up the back molars with more elastics. In fact he used not just elastics but also a "piggyback" archwire to help bring the last 2 bottom molars up, so I had even *more* apparatus in my mouth for a couple of months. The piggyback archwire was wired onto the brackets for the main archwire, so you can only imagine how much wax I had to use to protect my cheeks.

Long story short, I finally have a "normal" braces setup, with no weird extras. Originally I was supposed to be done this past spring, but my teeth were taking their time getting into position, so I'm on a month to month basis. Hopefully I will be done soon!

I kind of regret not registering on the board earlier in the process, since then I could have shared the process in excruciating detail. If anyone out there is thinking of getting braces to help with TMD, I can definitely say it's been worth it. I haven't had any pain in a couple of years, and I can't remember the last time my jaw clicked. It's especially important to find a competent practitioner tho, it took me a couple of tries to find someone.

[Snowman]

I too am in braces to relieve my TMD. Luckily, I've never had pain associated with my TMD, I only have popping and cracking in both joints, which can be very annoying. I'm so grateful that my TMD is not painful, but I worried that if I didn't get the popping fixed, it would lead to pain later on.

I really wish I would've done your treatment approach and gone to a specialist. Basically, I told my orthodontist at my first consultation that I had really bad popping in my jaw joints all the time and that I wanted to know if he could fix it with braces. He sounded very confident when he told me that he could fix my TMD with Damon braces, so I believed him. I'm about 15 months into my treatment and I still have all my TMD symptoms. My teeth are straight now and my overbite is corrected, but my bottom molars are whats bothering me. They seem a lot lower than the rest of my teeth. I haven't told my orthodontist this yet because I just noticed it and I'm hoping he already knows about it. I've been wearing strong elastics from the next to last molars to my canines 24/7 for about 10 months. I thought I was going to have to wear a bunch of crazy elastic configurations like I see on many people, but he hasn't changed this configuration at all. I still have some time left in my braces so I'm hoping it will get better soon.

If you don't mind, could you explain how your dentist is "bringing your molars up"? I feel if my molars were brought up they would help my bite a lot.

I'm really happy that your treatment is going so well because I know TMD can very hard to deal with sometimes.

[NiTirannosaurus]

[quote="Snowman"]
If you don't mind, could you explain how your dentist is "bringing your molars up"? I feel if my molars were brought up they would help my bite a lot.

I'm really happy that your treatment is going so well because I know TMD can very hard to deal with sometimes.[/quote]

Sure, I'll be happy to share:). The ideal position for my jaw left about a quarter of an inch of space between my molars. I had bite turbos on my front two incisors, which my lower incisors would touch, and molar bumps on the last lower molar on either side (the bumps actually had tubes installed on them so the lower archwire would fit into it). So for a long while there, my teeth would only touch on the bumps in the back and the bite turbos in the front (eating was tough for a while, but you get used to it). That's where the crazy elastics come in, to bring the teeth in the gap area together, vertically. Once those teeth started touch (mainly in the front, like the canines especially), he removed the molar bumps and bite turbos, and we're working on bringing the molars up vertically so they can touch as well (more crazy elastics). The last molar on either side is going to take a while, since those teeth were kept apart by the molar bump for so long, but they finally came up far enough for the lower archwire to reach them (although he did switch from a square finishing wire to a lighter round wire).

I'm sorry I didn't take pictures of the process. My ortho certainly has plenty of them, but I'm not sure how well they show the sides, since their taken from the front. I'm going to make sure he gives me the before and after pictures once we're finished.

[NiTirannosaurus]

[quote="NiTirannosaurus"]
I'm sorry I didn't take pictures of the process. My ortho certainly has plenty of them, but I'm not sure how well they show the sides, since their taken from the front. I'm going to make sure he gives me the before and after pictures once we're finished.[/quote]

Man, I need an "edit" button..."they're" not "their";). It's Monday morning!

[NiTirannosaurus]

Well, it's 6 months after I posted this and I am *still* braced, despite thinking they would come off fairly soon back then. My second molars are taking their time moving it seems. My treatment hadn't changed much, with just boxed elastics for the past few months. However yesterday my ortho added a couple of springs (200 grams of force) on the top from the post to the first molars, I'm not entirely sure why. I also got a posted wire installed on the lower brackets for the first time, with a heavy elastic from the posts back to the first molars on the bottom. The archwire on the top was clipped just behind the second pre-molar, so the second molar in the back is living free, other than still having a bracket attached. The archwire on the bottom still involves the second molar, as it normally does. I also have class 2 elastics on again, from the 1st molars on the bottom to the posted archwire on the top.

I won't make any more predictions on when they'll be off, but I will have to wait a little longer to join the "Naked Tooth" forum it seems!

[olsonkd]

This was all very informative! I will begin by journey next week starting with spacers, then top braces and soon to follow bottom braces and rubber bands at some point-all to hopefully help with TMD. Glad to hear that others have the same problems and they can be helped. I too have molars that need to come up, they are barely showing in the back so I am relieved to know that this can possibly be helped with braces!! I am nervous yet excited since I have been wanting this to be corrected since I was a teenager also-I am now 41. Thank you all on here for support and information on how your journey's are going!!!!!

[NiTirannosaurus]

I am officially debraced!:) My Ortho made the decision at my appointment at the end of January that they would come off in 3 weeks (he was probably getting tired of me). He clipped both archwires behind the canine teeth, leaving the wires only on the front 6 upper and lower. Then I was instructed to chew gum for the next few weeks, to help the teeth get set in position(!?).

Getting debraced wasn't too painful (except for 1 or 2 stubborn brackets on the front teeth), and things are all nicely polished up! It's amazing how smooth my teeth feel, and they also seem very large when I look at them...I guess that's normal tho. I was outfitted with temporary Tru-Tain retainers, and I will get molds made for my permanent retainers in a couple of weeks.

The only problem I'm having is with getting the retainers off...They are tight and it hurts my fingers to remove them. I guess I'll have to order some of those hooks I saw on Dentakit.com and see how that goes (I already ordered a Sonicbrite cleaner and some other stuff).

Good luck to everyone else out there with braces, they will be off before you know it:)

[TMJJill]

Congratulations on your successful treatment. I started TMJD treatment 2 years ago and began my journey with braces almost 6 months ago. It is great to hear another TMJD success story. I still have a couple years to go and it makes me feel better I'm doing the right thing.

[pellepee]

I got really scared reading your post thinking it was another horror story! (By that I mean "braces made my TMJD worse! I regret it! etc.") I am confident in my treatment one day, then terrified that it was the wrong choice the next. These posts have re-filled my confidence in my choice. :)

I have my ideal jaw position now and am going back to my orthodontist this Monday to hopefully get my official treatment plan. I am excited and nervous at the same time.

May I ask how the palatal expansion went in more detail? I am hearing lots of stuff about it only tipping teeth and all that... but then I also read that some adults get a mix of real expansion and tipping.... what was this like in your case? Palatal expansion of my upper jaw is in my future, just how I am not exactly sure (surgery or 'slow' expansion).

Also, if you could (and this is directed at anyone)... how did you go from lower jaw re-positioning device to braces? Did you suffer from any reverting of position if that makes any sense? Did it get worse before it got better?

I thought I was like you Snowman, having popping/clicking without pain, or small amounts at least. A long story short, when an adjustment to my jaw re-positioning splint backfired my jaw went back to its old position and I had the most horrific migraine. I had blurry vision in one eye and I couldn't move without the horrid pounding in my head becoming worse. It went from below my right shoulder blade, up through the right side of my neck, behind my right eye and into my temple. I realized then that I had been suffering from TMJD pain most of my life (just not that bad of course!), but I put it down to bad posture at the computer. I didn't know I had been suffering needlessly with this for over a decade and I'm only 24! I quickly realized how important dental health is and I feel terrible for people who do suffer with this sort of pain day-in and day-out.

Love hearing success stories like this, please continue to post them!

[NiTirannosaurus]

May I ask how the palatal expansion went in more detail? I am hearing lots of stuff about it only tipping teeth and all that... but then I also read that some adults get a mix of real expansion and tipping.... what was this like in your case? Palatal expansion of my upper jaw is in my future, just how I am not exactly sure (surgery or 'slow' expansion).

Also, if you could (and this is directed at anyone)... how did you go from lower jaw re-positioning device to braces? Did you suffer from any reverting of position if that makes any sense? Did it get worse before it got better?

Let me see just how much I can remember:). I started with the splint on the lower jaw (that was expandable) in the fall of 2008 and wore that for about 6 months before I got the palatal expander up top the following spring. We didn't start the expansion on the bottom until that point, and all that really did was move my molars back (it was not for side to side expansion of the lower jaw). I'm not sure I can really quantify whether I had any true expansion or just tipping of the teeth, but I had quite a diastema between my upper incisors there for a while! I'm sure any true expansion was minimal.

I had 2 bite turbos installed on my upper incisors when I moved to braces, which made sure my lower jaw couldn't close in its old position which caused the TMD. I don't want to scare you or anything, but they are not a lot of fun...That's probably the part of the process which I liked least.

Good luck with your treatment!:) I'll read about your plan if you post it.

[pellepee]

Hi NiTirannosaurus, sorry for the delay in replying I have been busy.

I finally got my treatment plan. I don't know how I will transition away from the splint into braces yet, as I haven't spoken to my ortho after he had spoken to my prosthodontist (my 'jaw' doctor). My prosthodontist was away for awhile so he had to wait for him to come back to talk about it all.

I do recall though my prosthodontist mentioning placing a composite of some sort on my back lower teeth to help keep my jaw in position while braces are on, however I don't know how that works when the back teeth begin moving... would I go in and get the composite removed and re-added in a new shape? He said it was like the glue they stick braces on with... :S either way, I trust them! I will get elastics at some point too (titanium anchor/implants/screws... however you know them by) so maybe that is what will keep everything sitting pretty.

I have a blog like almost everyone else if you want to read more detail (it's really only for me but everyone can read it!) but nonetheless here is a quick run-down. I am getting braces in May, with an upper expander. I don't know which expander as there was a needed discussion with the prosthodontist again about which one would be best. I am getting 4 titanium anchors as well in September roughly, and wisdom teeth out at the same time. Then everything gets moving!

I was told I still might have a small cross bite on my back right side, not visible from the front; to keep my jaw stable as moving those teeth out of cross bite might move my jaw around. Meh! I can live with that! I just want my jaw stable and my open-bite closed... can't wait! Once my open-bite is closed I am having a bacon and egg roll. Any time I try and eat one I end up just pulling the bacon out whole with my teeth because I can't bite through it. Then I end up with bacon, and an egg roll. Kind of no point to having one really if they aren't together...

I am keen and looking forward to being in your position NiTirannosaurus; congratulations on beating TMJD!