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FAQ:  Adult Orthodontics



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Question:
Orthodontics causing TMJ and Lock Jaw? Two months ago I decided to have orthodontic work at the age of 45 to correct my bite and straighten my teeth.

After 1 month in an expander (like a retainer) I woke up one day and could not open my mouth. I had excruciating pain in the left ear. I did everything. Ice, heat, Advil and after a week my jaw was back to normal.

So, I put the expander back in and within 6 hours my jaw was locked again and the excruciating pain was back.

Now it's been another month and my jaw is still locked and I have gotten used to the pain (the neighbors don't hear me screaming anymore when I try to brush my teeth).

I have been to a Physical Therapist and a Chiropractor. Chiro treatment was a big help. What else can I do? ....Visitor from CA

Answer:
This question cannot be explained in a few short breaths. I have neither you nor your records in front of me, but I suspect I will be very close in diagnosing your problem from your remarks. I suspect that if your orthodontist is expanding the upper arch you may be in a crossbite or where the upper teeth lie on the inside of the lower teeth. This usually requires expanding the upper jaw bone to eliminate the crossbite.

I am referring to the upper jaw bone.... not the teeth. In order to eliminate a crossbite or a constricted arch the jaw bone and teeth must be expanded together. Unfortunately, in your case you are a non-growing adult and the suture in the roof of your mouth (palate) is fused and absolutely will not expand unless it is reopened surgically.

What are sutures? They are areas in our skull where the bones grow, allowing our brain and face to grow. These structures usually fuse together somewhere in the range of 14-16 years of age for females and 17-19 years of age for males.

We know as orthodontists that we can expand the upper jaw bone up to the age of around 15 years of age, because the suture in the roof of the mouth has not yet fused. We accomplish this with a very common appliance called a rapid palatal expander with relative ease and little discomfort.

In adults, however, this procedure is performed by a competent oral maxillo-facial surgeon usually as an out-patient procedure in the office in about thirty minutes. You always want to use a fixed expander (cemented) rather than a removable expander.

The removable expanders usually do not have the retention to properly expand the upper and lower jaw and they rely on your total cooperation to keep in.

Now lets talk about your chief concern with pain. First and foremost the pain did not occur until you began activating the expander.

I suspect the problem is with the expander. This is not a problem for a chiropractor to treat, but rather your orthodontist.

What happens when you expand an adult non-surgically is the teeth are tipped down and out towards the cheeks. This usually causes the bite to open and creates excessive interferences with your back upper and lower teeth making your bite worse.

This causes you to begin clinching and grinding, especially while you are sleeping.

I need you to understand the anatomy of the joint before reading on. The joint is very similar to other joints in your body. Two bones moving back and forth with each other with a piece of cartilage in between called a disc to make the movement smooth. The disc must always stay on top of the bones, if not you can have problems such as popping and clicking or in your case ... close-lock.

The excessive clinching and grinding creates edema and swelling in the joint, pushing the disc in your joint forward. So why can you not open all the way? We refer to this as close lock.

When you open your mouth the first movement is rotation. This allows the mouth to open about 20mm. If you will recall in the morning if you measured you probably could only open the mouth to around 20mm. After rotation you have translation where the jaw bone opens further and actually comes forward. This is where closed lock begins.

You are unable to translate the lower jaw forward. A good example is think of driving a car at a speed bump at a very slow speed and the front tire hits the speed bump and the car rolls back.

Well that is exactly what is happening in the joint. As you open your mouth, the disc is forward and the jaw bone or what we refer to as your condyle is unable to make in up onto the disc. Sometimes this may cause a popping sound as the bone (condyle) pops onto the disc.

The pain you are experiencing is the ligament that holds the disc on top of the bone contains all the nerves and blood vessels to keep the disc healthy. Since the disc has been pushed forward, your bone is contacting directly on those nerves and causing pain.

Patients will commonly complain of ear pain, because anatomically the joint and the ear are very close. This is actually called referred pain. The real cause, however, is in your joint and not the ear.

You noticed after you treated yourself with ice, heat and Advil and quit using the expander the pain went away. As soon as you starting using the expander again the pain can back within 6 hours. The the problem is your retainer, diagnosis and treatment plan.

I would suggest a couple of things. Stop using the retainer and never go to a chiropractor to treat orthodontic pain. Instead, get several orthodontic opinions. When you find one who is telling you the same thing I am telling you..... stick with that one.

Editorial Staff

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