TMJ Caused by Braces

i went for 2nd orthodontic treatment at age 20 to correct my malaligned anterior teeth caused due to previous there is about 5 mm gap between my anterior teeth( over bite) and i have started having tmj pains. should i continue with the treatment until my teeth is aligned as in won't it harm my joint further or should i remove the it true that pushing back the teeth can cause tmj. should i go 4 splint therapy now. can a splint be applied over orthodontic braces?

Doctor Answers 6

TMJ and braces

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Reading over the other reviews I see that there are many dentists who still believe that there is a strong correlation between braces and TMJ problems.  Problem is, all of the most recent scientific studies do not show this to be true.  What they usually fall back on is: I see a lot of people who had braces and now have TMJ problems so it must be true!...well there are just as many who never had braces and still have TMJ problems.

Anyway....this is a very controversial issue so get a few opinions before you give up on the ortho!

Saint Louis Orthodontist

Treat the TMJ First

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I treat a lot of TMJ patients and 80% have had prior orthodontics.  Hmmm. Coincidence?  I think not.  In the past orthodontists have treated to a nice smile and a bite based on the molars lining up.  Maybe the body developed and placed the relationship between teeth, muscles, and joints in a manner to make them all work together, but this relationship didn't "look" good.  I always treat patients who have TMJ issues and want ortho with caution.  I would find a comfortable neuromuscular position for your lower jaw and make a splint or orthosis at that position. Getting you comfortable first is the first priority, then move the teeth to that position.

Did the ortho cause TMJ problems?

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The cause of most orthodontic issues are childhood breathing issues, tongue issues, allergy issues etc that lead to underdeveloped maxillas.  Many patients who had ortho and developed TMJ problems actually may have been developing them long before ortho.
I lecture nationally and internationally on the developmental aspects off TMJ disorders and sleep disordered breathing disorders.  The NHLBI  consideres sleep apnea to be a TMJ disorder.
Regardless of the cause, treatment should be given.

The best approach is usually dividing treatment into phases. The first phase is designed to eliminate pain and stabilize the bite. A diagnostic neuromuscular orthotic is usually worn 24/7 while healing. Sometime it is necessary to utilize a joint distraction appliance at night or a pull forward appliance. Both unload the joint to allow healing.

The second phase can be orthodontics but the DNA Appliance and Epigenetic orthodontics / orthopedics may give the best results.

I try to avoid surgery whenever possible.

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

TMJ Dysfunction can result from improper use of braces.

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Your question about braces causing TMJ Dysfunction is a  hotly debated one:  The answer is yes, braces can cause TMJ Dysfunction if the practitioner  is ignorant about the relationship of teeth to the TMJ.  Sadly, most orthodontic programs teaching specialists have a void in their programs when it comes to the understanding of the TMJ's.  Although it is not possible to diagnose exactly what your problem is and what the solution is, the following would be true: Any treatment that causes the lower jaw to retrude can precipitate TMJ Dysfunction.  Therefore treatment should protect against this movement and encourage the jaw to be held in a forward position.  Repositioning splints, orthotics (mouth ones), bite plates, bite ramps can help this forward position and can all be used with braces, however the most important thing for you is to work with a competent dentist/orthodontist., i.e. one who has a great deal of experience with braces and  treating TMJ Dysfunctions.  Then he/she would create an appropriate plan, and explain it to you so it makes sense.  Unfortunately this is a very common problem.  Good luck to you.

Does Braces Cause TMJ?

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I would not recommend removing the braces just yet but I would suggest that you consult with a competent dentist/orthodontist who understands the relationship between tooth movements and TMJ health.  If your treating doctor says there is no relationship between orthodontics and TMJ health you must find a different doctor.  "Pushing the teeth back" can indeed cause TMJ problems.  Not knowing your exact situation would make it difficult to prescribe treatment but the prescribed treatment may in fact include splint therapy which may or may not be doable with your braces left in place.

Good luck!

Braces and TMJ problems

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Just read the posts by several doctors and you'll get the idea that you've touched on a hot topic.  Scientific research has shown that most TMJ problems are multifactorial, meaning that a number of things contribute to the problem.  The reason that carefully controlled studies with careful methodologies are needed in medicine and dentisty is to dispell the type of thinking that is represented in some of the responses to this often complex topic, especially ones based on" anecdotal" evidence.  Bad orthodontics can contribute to TMJ problems just like bad dentisty can contribute to tooth problems that require root canals.  A well trained orthodontist will be able to ascertain where the jaw is comfortable and healthy and will put the teeth in a bite that is in harmony with this position.  Instead of trying to decide on your own if you need splint therapy, ask your doctor about how he/she plans to deal with your bite and your TMJ issues.

Brian Povolny, DDS, PhD
Seattle Orthodontist

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.