Braces for Open Bite and TMJ?

I will be going to the orthodonist on Wednesday to talk about getting braces, but I'm scared because I have a major open bite and TMJ problem. I'm scared because I dont want to have my jaw broken. Got any advice for me?

Doctor Answers 4

TMJ and Open Bite Correction With DNA Appliance and Neuromuscular Dentistry

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Approaching an open bite in a patient with TMJ problems requires knowledge in multiple areas.
I strongly suggest beginning treatment with a neuromuscular diagnostic orthotic and eliminating pain prior to initiating orthodontics.  The DNA Appliance is rapidly becoming the new standard of treatment due to its very low forces and ability to achieve orthopedic growth as well as orthodontic movement.

These case can be complex and Oral Myofunctional Therapists can be a very helpful addition to the treatment team.

Ira L Shapira DDS
Diplomat, American Academy of Pain Management
Diplomate, American Board of Dental Sleep Medicine
Regent & Fellow, International College of CranioMandibular Orthopedics
Chair, American Alliance of TMD Organizations

Systematic Comprehensive Approach Needed for TMJ and Open Bite Correction

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First of all, you need to understand that you have a very complex problem that if not handled correctly could lead to a much worse condition.  A comprehensive evaluation should be performed first.  The elimination of any adverse habits is critical (anterior tongue posture and mouth breathing are likely present, etc.)  Then, TMJ Dysfunction is a first treatment priority.  Your jaw likely has drifted posterior (most TMJ Dysfunctions have this characteristic) and will need to be repositioned into a healthy position for up to six months to achieve stability.  This can be done with a Neuromuscularly Balanced Orthotic which is worn on the lower teeth 24/7.  Then your upper jaw would likely need expansion (again, most anterior open bites have a narrow upper jaw). This can be done with a dentofacial orthopedic appliance (fancy removable retainer) The final stage would be braces.  With this approach, no surgery would be indicated and a very nice and stable result can be achieved. Watch my before and after section and I will post one of these cases (open bite, TMJ Dysfunction) for you to review.

Braces and possible jaw surgery can help

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The major problem with anterior openbites is only your back teeth are coming together. This can cause some excessive wearing of you back teeth and pressure in you Temporo-mandibular joint leading to pain and discomfort. If your openbite is severe and related to excessive vertical development of the upper jaw, braces in conjunction with an upper jaw impaction can help to close the bite and bring your front teeth together.

If the openbite is not a jaw issue, but rather an issue with a forward positioning of your tongue during swallowing, than braces in conjunction with myofunctional therapy to eliminate tongue thrusting can also close the bite together. I do not have your records, but my gut feeling is you do have a skeletal issue in combination with anterior tongue thrusting and both would need to be addressed during treatment.

There are no guarantees that either treatment will eliminate your TMD symptoms, because there are others who have the same issue and display no symptoms. However, in your case, there is a good chance this will improve your symptoms. Remember, that stress is one of the many contributors to TMD symptoms and not necessarily bites.

I recommend you see an orthodontist and oral surgeon who both are well experienced in orthognathic surgery.

James J. Awbrey IV, DMD
Atlanta Orthodontist

Braces can help if done right

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With an anterior open bite, the cause needs to be eliminated in advance, otherwise it will open back up when done. A common cause is a tongue thrust habit that would need to be stopped.

TMJ issues are more difficult. The TMJ should be addressed before moving the teeth, otherwise it could get worse. Surgery is usually the last resort.

My belief is a neuromuscular approach. is a good resource to finding someone nearby that uses equipment to help resolve the TMJ issues and find where the teeth could be moved to that would help.

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.