Expert: Steven C. Scherr, D.D.S. - 4/10/2007

Question
QUESTION: When I open and close my mouth my jaw really deviates badly. I have pain after eating. I had braces and my bite was thrown off. My back teeth don't meet. Can anything be done regarding the pain and jaw alignment?
ANSWER: Hillary,

Your problem requires a physical exam.  The best I can do in this format is to offer some general observations and hopefully provide some direction.

Each jaw joint (TMJ) can move in two ways.  It can rotate like a barn door hinge, and it can also slide front and back like a patio sliding door.  The jaw steers like an old Flexible Flyer sled.  To move the chin to the left requires the right jaw joint to slide forward.  The left joint does most of the work when moving the chin to the right.  Deviation of the jaw can be due to damage in a jaw joint, cramps in the muscles that move the jaw, or a combination of both.

Problems with the joints and/or muscles can throw off the bite.  Likewise, problems with the bite can place more strain on the joints and contribute to dysfunction.

Once a jaw joint or muscle problem is confirmed, the next step is to determine the degree of damage and those things that are contributing to it.  Examples of contributory factors include grinding and clenching of the teeth, emotional stress, anatomic deformities, trauma, depression, sleep disorders, postural problems, and bite problems.

The more contributory factors that can be identified and controlled, the more effective therapy will be.  Initially, treatment is directed toward healing the joints and muscles.  In some cases, the bite may also need to be corrected.  There is rarely justification for making permanent alterations in the bite before the jaw joints and muscles have been confirmed to be stable.  Adjusting the bite prior to this time is unlikely to last and could make the situation worse.

I recommend you find a dentist with advanced training in facial pain and temporomandibular disorders.

Hillary, I wish you well.

Steve

---------- FOLLOW-UP ----------

QUESTION: I understand that splint therapy is one of the first options in order to relax the muscles and find the correct bite. Since I wear retainers, will I need to remove them permanently and thus have my teeth go back to being crooked? I have only been out of braces for 2 months.

Answer
If a splint is used as a part of therapy, it will act like a retainer in that it will keep the teeth in that jaw from moving.  While it is possible to wear a thin orthodontic retainer on the opposite jaw, this usually isn't done.  Since it doesn't sound like your bite is in a healthy place right now, some alteration of the bite may be needed in the future anyway.

Best wishes,

Steve