Orthodontics: Cause or Cure of TMJ
Conventional orthodontics refers to any orthodontic or orthopedic correction that accepts the habitual bite relationship as the functional bite position for the patient and all treatments will be rendered to this relationship or whatever treatment relationship happens to occur during the corrections. TMJ-Orthodontics refers to a patented method of orthopedic and orthodontic corrections that do not accept the habitual bite as the best functional relationship for the patient, but instead, determine the best relationship for the jaw joints, muscles of mastication, and the upper quadrant and then render corrections to this relationship.There are dramatic differences between these two categories of treatment. The slide below on the left is of a patient that has received conventional orthodontics treatment. This form of treatment accepts and assumes the position of the lower jaw to the upper jaw as determined by the tooth position is normal. The patient suffers headaches, neck and facial pain when biting in the completed orthodontic treatment position on the left, but is pain and dysfunction free on the right.
TMJ-Orthodontics assumes that the habitual bite may not be the best functional relationship and uses a diagnostic orthotic and other methods to determine the diagnostic reversible mandibular / maxillary relationship and evaluates the patients anatomic and physiologic responses to functioning in this new association. The photograph on the right utilizes a diagnostic orthotic to determine the best functional position. The patient no longer has clicking joints, can open fully without deviation or deflection and is pain free at this diagnostic position. The conventional orthodontic treatments on the left failed to establish the functional relationship discovered on the right. Conventional orthodontic treatments are not designed to treat TMJ patients. Conventional orthodontics as well as many conventional dental treatments that accept the habitual bite as a stable relationship can be a causative factor in developing head, neck, joint, muscle and ligament pain if the habitual bite association is not stable. The American Association of Orthodontists has presented their feeling on these matters. One has to question the logic of item (5) and (6). Item (5) says orthodontic treatments do not cause TMJ problems, whereas item (6) says orthodontics treatment can assist in lessening symptoms. It does not seem logical that done in one way it can help “lessen the symptoms” of the problem, but if done in a different way it could not “cause” the problem.
The American Association of Orthodontics provided their positional report in the January American Journal of Orthodontics and Dentofacial Orthopedics. This statement best serves the orthodontic professional, not the patient. Conventional orthodontic records are completed at the patient’s habitual bite relationship (below left). The patient in this radiograph has a dislocated joint. The differential diagnosis and treatment is rendered to this relationship as the structures are considered normal. TMJ-Orthodontics evaluates the habitual bite relationship records to help determine cause/effect relationships that lead to joint, muscle, and occlusal or related upper quadrant dysfunctions. A reversible diagnostic orthotic, or other means, is used to establish an arbitrary relationship of the mandible to the maxilla and to evaluate the patient’s responses to this new relationship, or modifications are made to the relationship until the dysfunctional signs and symptoms are managed.
The conventional evaluation accepts the habitual bite as the best functional bite, while the radiograph on the right of the same patient demonstrates a significantly different treatment position. Treatments planned at the left radiograph would not consider the functional relationship of the mandible to the maxilla as important, whereas the radiograph on the right allows the practitioner additional information as to treatment options.Conventional orthodontic (see the “Retreating Orthodontic Failures” article) diagnostic measures and corrections that treat to the habitual bite are usually not able to successfully meet the needs for those patients who have joint, muscle, or upper quadrant dysfunctions that are related to abnormal mandibular / maxillary relationships. TMJ-Orthodontic corrections on the other hand are designed and are a patented method for the correction of mandibular/ maxillary relationships and corrections to established and proven stable associations. This method and appliances have been proven successful in correcting patient’s problems, even those who initially had conventional orthodontic corrections and developed TMJ problems.TMJ problems can originate during conventional or TMJ-Orthodontic corrections. However, since conventional orthodontics is not designed to manage the relationship of the mandible to the maxilla, or the condyle/disc/fossa-eminence relationship, conventional treatments are seldom if ever able to ameliorate the TMJ problems. TMJ-Orthodontics has been demonstrated to be able to correct and/or intercept a TMJ problem that arises during treatment and TMJ-Orthodontics has been demonstrated to be able to successfully correct a failed conventional orthodontic result if the tissues are not too damaged over time.
TMJ Orthodontic Evaluation, Diagnosis, and Treatment:
The initial two-dimensional records taken in the habitual bite relationship are important to help determine the conditions that exist and the compromises to the associated structures since the habitual bite is not the best functional bite. The balanced relationship between the joints, muscles, ligaments, upper quadrant structures and the bite is evaluated and reversible diagnostic method are utilized to determine tissue healing and patient improvements. If the joints are compromised, the optimal condyle/disc/eminence relationship may be impaired. Muscles that suffer compromise can cause local and referred pain patterns. The dentition may become crowded or abnormal wear may occur. If the alveolar bone undergoes degenerative alterations, bone loss may occur. Ligaments that are stretched become tender and cervical compensations cause local and referred pain patterns. The posterior neck region compensates for the anterior dysfunction and the back of the neck, shoulders and upper back can become dysfunctional, inflammation may occur and pain may result. All of these entities must be considered in the examination, diagnosis and treatment.
TMJ-Orthodontic corrections must be completed to a relationship where the joint function, muscle function, function of the upper quadrant and the dental relationships coincide. The habitual bite position must be evaluated in comparison to the best functional bite relationship where the joints, muscles, ligaments and associated structures can function without compromise. If the habitual bite is the best functional bite, then treatments can be rendered to the habitual bite relationship. Ttreatment to the habitual bite position is not the best treatment option if the habitual bite is not the best functional bite position.
Generally an orthotic or orthopedic appliance is used as a reversible diagnostic appliance to move the mandible from the compromised relationship caused by the dysfunctional habitual bite to a functional association where the related structures are able to perform without compromise. Associated physical medicine modalities are able to address muscle, joint, ligament, and postural or functional anomalies to help restore normal function. The diagnostic orthotic is a reversible diagnostic appliance that can serve multiple purposes. Generally speaking, it is designed to enable the joints and muscles to function with the arbitrary bite relationship and evaluate this over time to ensure the relationship is functional.