AboutJoel S. Teig, DMD, FABOMS Expertise I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.
Experience Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.
Organizations American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons
Education/Credentials BA
DMD
Awards and Honors National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude
Question I am 23-years-old and thanks to wearing a Herbst Appliance when I was 14 or 15, my teeth are nearly perfect. However, my jaw didn't fare so well. Immediately after removal of the Herbst, I noticed my jaw making "popping" noises. I thought this was normal, as my friend had a Herbst as well and her jaw made the same noises. As I have gotten older, though, I have noticed my jaw popping and feeling sore for days at a time. I was wondering if the Herbst had this affect. I haven't had any other dental issues.
I direct this question to you because while researching this problem, I found your answer to another question: "I am an oral and maxillofacial surgeon and not an orthodontist, but I am not comfortable with the use of the Herbst Appliance. I have seen this appliance cause degenerative changes in the jaw joints by applying excessive pressures to the jaw joints." Could you please explain some of the problems you have seen from this device? What can I do to treat or lessen the effects from this appliance?
Answer Becca - I do find that the results of the Herbst Appliance and other appliances that produce an effect on a the jaw can produce excess pressure within the jaw joint. With this excess pressure at least a couple of different problems often arise that negatively effects the normal functioning of the jaw.
The backwards pressure on the lower jaw compresses the cartilaginous disc within the temporomandibular joint. The compression of the disc ruins the function of the disc. The disc is a space maintainer within the joint that allows normal joint movements to proceed without interference from the normal irregular shape of the bone in the joint. Another effect is the shape of the condylar head (the ball at the end of the jaw in the joint). The pressure often flattens the joint and creates sharp irregular surfaces that are prone to produce tears with the tissues in the joint.
With the above changes, arthritis occurs and degeneration progresses and limits normal functioning. The popping you feel is the catching of the ball in the joint (either from the change in the ball shape or from the cartilage shape change or both).
So I don't agree with this appliance. I have repeatedly seen problems with children and adults and their normal jaw function. If you have additional questions, feel free to contact me again.
