Braces and Two 2nd Premolar Extractions Will It Cause TMJ in my Case?

I am getting braces in a couple of days time; after having them on for 3 or 4 months my orthodontics wants to extract to of my 2nd premolars. I am aware that 3 ago I had symptoms of TMJ such as jaw popping and inability to open mouth widely but now I have no problems whatsoever. I also sleep with my mouth open but breathe through my nose during the day. After getting the extractions will I more likely have symptoms of TMJ again? My profile is convex after my treatment what profile would I have?

Doctor Answers 2

Your issue is airway and you are a surgery case.

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The evidence today pretty much suggest occlusion has absolutely little to do with TMD issues. But there are others that have their own opinions without looking at the evidence based dentistry that will vehemently dispute this.  Trust me!  If this was true than every patient an orthodontist see would have TMD problems, because they all have some form of malocclusion.  The fact is most TMD issues are related to what we do at night and our airway which initially manifest itself as muscular pain and many years later result in breakdown of the joint. Exactly what you are experiencing and suggest about "joint popping and not being able to open your mouth all the way"  Initially most people will experience muscular pain in the morning.  The reason is sleep apnea or upper air resistance syndrome.  When an individual experience airway issues you will get a sympathetic response.  We sleep on parasympathetic nervous system.  The sympathetic response is triggered due to a lack of oxygen.  This creates an arousal and this is why people who suffer from airway issues also complain of fatigue and tiredness during the day. They are never going into reparative sleep due to these constant arousals from the lack of oxygen.  To turn the sympathetic response off and open the airway we will clench and grind and this is called Sleep Bruxism.  This is a sleep disorder in itself and can be experience throughout the night.  This is what causes the muscular pain and fatigue experienced the next morning.  Carry a dumbbell around for 8 hours and tell me what your arm will feels like.  So guess what the normal treatment of choice for this type of pain without a definitive diagnosis.  You may have guess......a TMD splint.  This splint may work for a little while but eventually want stop the bruxing or muscular pain.  A splint placed in a truly apneic individual will rotate the jaw back and make the airway worse.  

You have a convex facial profile so you have what we would refer to as lower jaw deficiency.  The reason you are having breathing issues and sleeping with your mouth open at night has to do with airway constriction and the positioning of the lower jaw.  You see we are one of the few animals on this planet that has a free floating hyoid bone and that hyoid bone is suspended from the styloid hyoid bone posteriorly to the genio-turbercle anteriorly.  To put it in layman's terms it is controlled by the positioning of your lower jaw.  If the jaw is brought forward this will pull the hyoid bone forward, improve chin neck contour and open the airway.  This is the treatment of choice for individuals, as yourself, that can't tolerated a CPAP machine and have a retrognathic profile.

Taking out upper bicuspids in a non-growing adult and moving the upper teeth back to a deficient lower jaw is the worst treatment you could have.  This will also affect the position of you upper lip and yes you will have the same profile.  Is this considered standard of care.  Yes, we as orthodontist are trained to reduce overjet and establish cuspid guidance and taking out upper bicuspids will allow us to achieve those objectives, however it is not the best treatment for your situation.

I don't have your records, but just what you have told me in own  words "convex" and "sleep with mouth open" I know exactly what problem you are having.  

This is what I would suggest, get to an ENT and have a sleep study performed and determine our level of sleep disturbances.  I would suggest seeing a good Oral Maxillo-facial surgeon in your area that has a lot of experience with orthognathic surgery and let him refer you to an orthodontist who is well versed at setting up orthognathic cases. 

You maybe also be a candidate for a two-jaw surgery to maximize the chin advancement.  I promise if done properly you can improve your health for the rest of your life.  Google Sleep Apnea and you will find over the years left untreated is life threatening.

"Never made A's in english or grammar so forgive me"

Best regards,

Dr. Jim Awbrey

Atlanta Orthodontist

Braces and Two 2nd Premolar Extractions, Will it Cause TMJ?

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I agree with Dr. Awbrey's diagnosis but I disagree that the only way you can correct your problem is with jaw surgery. Google "epigenetic orthodontics" and find a doctor who understands how to stimulate genetic growth and you can use appliances to achieve your genetic growth potential and correct your underdeveloped upper jaw and retruded lower jaw.

If your orthodontist had made a proper diagnosis he/she would never have put braces on your teeth before correcting the CAUSE of your underdeveloped upper jaw and retruded lower jaw and then developing your upper jaw and moving your lower jaw forward FIRST.

Good luck!

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.