At Aura Orthodontics, Dr. Vishal Sharma, Dr. Everett Lin and Dr. Julia Koo, certified specialists in orthodontics, help patients of all ages get straighter teeth and an aligned bite. And part of having a healthy bite is achieving a harmonious relationship between the jaw, teeth, temporomandibular joints (TMJs) and chewing muscles.
Being that these structures are all related, you might think that Invisalign® or braces can cure TMJ disorder or, the opposite, cause TMJ disorder. In this post, we’ll be setting the record straight and talking about the connection between orthodontics and temporomandibular joint dysfunction.
What is TMJ/TMD?
While people will often say that they have TMJ, the acronym TMJ actually refers to the temporomandibular joint itself. Dysfunction in the temporomandibular joint is technically called a temporomandibular disorder or temporomandibular joint disorder (TMD and TMJD, respectively).
The temporomandibular joints are located on either side of the face (right in front of your ears) and connect the jaw to the temporal bones in the skull. The joints help you move your jaw up and down and side to side, so that you can open and close your mouth to bite, chew, speak and yawn.
If you have a temporomandibular disorder, or TMD, it can be related to any of your chewing system’s components, including the parts of the joint or the muscles of the jaw. For example, TMD can result if the muscles and ligaments connected to the joints get inflamed or if the actual joint is damaged from arthritis or trauma. In any case, TMD can be acute or chronic and the symptoms range from mild to severe.
What are the TMD Symptoms?
Symptoms of TMD include:
- Jaw pain and/or stiffness
- Difficulty opening your mouth fully
- Jaws that get locked in an open or closed position
- Headaches, earaches, neck aches and/or shoulder pain
- A fatigued feeling in your jaw and face
- A popping, grating or clicking noise when you open and close your mouth (these symptoms alone don’t require treatment, but they can indicate TMD when combined with pain and other symptoms)
- Swelling or tenderness on the side of your face
- Pain in multiple teeth
- Painful or difficulty chewing
- Ringing in the ears (tinnitus)
What Causes TMJ Disorder?
There can be a range of causes of TMJ disorder, such as:
- Arthritis in the temporomandibular joints
- Dislocation of the disc in the joint
- Teeth grinding and clenching, known as bruxism
- Trauma to the TMJ or the surrounding tissues
- A misaligned bite
Can Braces Cause TMJ Dysfunction?
Now that you know what TMD is and what can cause it, let’s talk about the bigger question: Can braces cause TMJ dysfunction? This line of thought has roots in a 1978 lawsuit in the United States. A patient in Michigan sued her orthodontist for giving her TMD and won the case. However, there wasn’t solid scientific evidence to prove orthodontic treatment, which in this case involved extractions and headgear, actually caused the TMD.
Since the lawsuit, there have been thousands of studies conducted to determine if orthodontic treatment, such as Invisalign and braces, can cause TMD or cure it. Currently, the research indicates that Invisalign and braces do not cause TMD or increase a patient’s risk for developing the condition. The studies also didn’t find a link between extractions, headgear and other orthodontic appliances and treatments and TMJ disorders.
Something to consider is that TMD symptoms can occur in healthy people at any time and tend to increase with age, especially from the teenage years through the early 40s. This also happens to be when a lot of people get orthodontic treatment. So, while someone might have symptoms of TMJ dysfunction while in orthodontic treatment or soon after, that doesn’t mean it’s related to the treatment.
Bottom line: Among the thousands of studies that have looked into the link between orthodontics and TMJ dysfunction, the evidence does not support the idea that Invisalign or braces can cause TMJ problems.
Can Braces Fix TMJ?
If they don’t cause it, can braces help TMJ disorder? Can Invisalign fix TMJ pain? In many cases, the answer is also no. TMD often has nothing to do with the teeth and bite and there aren’t conclusive findings that show that most types of malocclusion (improper bite) cause TMD and, therefore, can be fixed with orthodontic treatment.
That said, there are some exceptions. Both open bites and crossbites might be linked to TMJ dysfunction and pain. These issues put stress on the jaw joints, which may cause or exacerbate TMD. For some patients with an open bite or crossbite, then, yes, Invisalign or braces could possibly help with TMD.
Also, bruxism is common in patients with a misaligned bite. It’s thought that patients might subconsciously grind or clench their teeth in an effort to compensate for the misalignment. Since bruxism can cause TMD, reducing teeth grinding with orthodontic treatment could indirectly help with TMD.
Can I Get Braces or Invisalign if I Have TMD?
When you visit Aura Orthodontics, your Langley or Surrey orthodontist will perform an exam and evaluate your diagnostic records (x-rays, etc.) to determine an accurate diagnosis. This will help them assess your teeth, jaw, joints and entire chewing structure and decide whether or not you’re a candidate for Invisalign or braces.
If we think shifting your teeth and jaw will worsen your TMD, then we’d warn against getting braces or Invisalign. If that’s the case, often, you’ll need to treat your TMD first and then get braces or aligners. For example, you could wear a TMJ splint to help the joints, ligaments and muscles heal for a period of time and then start the teeth-straightening process.
In other instances, getting braces or Invisalign is possible if you have TMD. As experts in the jaw and facial structures, our orthodontists will create a plan to move the teeth in the safest way possible.
How is TMD Treated?
If you have TMD and the jaw pain and stiffness are interfering with your life, there are options! You don’t have to live with the discomfort. We recommend starting with non-surgical treatment options first. Non-invasive TMD treatments could include:
- Homecare – The first step in alleviating TMJ pain is homecare. Rest your jaw as much as possible, temporarily stick with soft foods, avoid big bites of food and don’t chew gum. For sharp pain, use a cold compress to reduce discomfort and swelling. Place it on your jaw for 20 minutes on and 20 minutes off until the pain subsides.
For a dull, persistent ache, switch it up to a warm compress. Again, use the compress for 20 minutes on and 20 minutes off until your symptoms improve. You can also take an over-the-counter pain reliever (whatever you’d normally take for a headache) as needed.
Once you’re pain-free, you can begin gentle TMJ exercises and stretches. These can help strengthen the chewing muscles and improve mobility in the joints. Only do what you can and if you feel discomfort, stop right away.
- Stress Reduction – TMD can be caused or worsened by stress. Try to incorporate relaxation into your everyday life with things like deep breathing, yoga or meditation. You might also consider speaking with a therapist or looking into biofeedback.
- Physiotherapy – Some people can benefit from physiotherapy. The therapist will likely use moist heat or cold therapy, ultrasound, and TMJ exercises to strengthen and stretch the muscles and joints.
- Custom TMJ Appliance – Talk with your dentist or orthodontist about a TMJ appliance. If your TMD is the result of bruxism, wearing a nightguard can be helpful. It will protect the joints by acting as a cushion against the grinding forces. A TMJ splint is another option. The device holds the jaw joints in a position that takes the pressure off of them and promotes healing.
- Prescription Medications – If your TMD is severe, your doctor might prescribe you medication to help. Options could include anti-inflammatories, certain types of antidepressants or muscle relaxants.
- Injections – Corticosteroid injections in the joint may relieve pain and inflammation. Some people also benefit from BOTOX® injections into the jaw muscles. By temporarily preventing the muscle from contracting, it may alleviate pain if that’s the source of your TMD dysfunction.
- Orthodontic Treatment – As we said, in most cases, Invisalign and braces don’t cause or cure TMJ disorder. But, if you do have an issue like a crossbite or open bite that’s putting stress on your TMJs, then, aligning the teeth and jaw can be beneficial.
If the non-invasive and minimally invasive treatment options fail and your TMD symptoms are severe, occasionally, surgery could be necessary. It’s important to discuss the risks and benefits of any surgical procedures with your doctor because surgery is permanent.
Connect With a Langley or Surrey, BC Orthodontist
If you have TMJ or jaw pain that you think is related to your bite, schedule a consultation at Aura Orthodontics. We can thoroughly evaluate your mouth and jaw to get to the bottom of your pain and help put you on the path to relief.