Expert: Steven C. Scherr, D.D.S. - 3/6/2007

Question
I developed TMJ pain on my one side because of missing several molars for 3 years. I had been in ortho treatment during that time and could not replace them then. When the teeth are replaced would the TMJ pain subside?

Also, why does an extraction, just by itself, sometimes trigger TMJ pain that is chronic.

Answer
Chris,

There are many different types of TMJ pain.  However, you can sort most types into one of two baskets.  The first is pain that originates from the jaw muscles, including their associated ligaments and tendons.  The second is pain that originates from inside the jaw joint (TMJ) itself.

Muscle related pain is responsible for 80-90% of TMJ pain.  Orthodontic treatment can make biting awkward and cumbersome as the teeth are moved.  The muscles must work harder.  Overworked and strained jaw muscles will become sore.  Braces use controlled forces to move the teeth.  These same forces can place strain on the jaw muscles as well.  If muscle pain is related only to the orthodontic treatment, it will tend to resolve once orthodontic treatment and tooth replacement are completed and a reasonable period of healing has been allowed to take place.  If there are other factors - teeth clenching or grinding habits for example - the pain may persist.  The forces placed on the jaws and muscles during tooth extraction can strain the muscles in a similar fashion.

Internal joint pain can be another matter.  This type of pain is associated with damage in one, the other, or both jaw joints.  Up to 80% of the adult population experiences disruption in at least one jaw joint over their lifetime.  Most of the time, there is no pain and many people are not even aware of it.  However, a damaged joint is more susceptible to further damage than is a healthy joint, and may become painful if stressed.  The additional strain and torque of orthodontic treatment, missing teeth, physical trauma, tooth extraction, clenching (or grinding), emotional stress, and/or other factors increase the risk of additional internal joint damage and pain.  This type of damage may or may not be able to repair itself after orthodontic and/or dental care.  This type of pain is less common.  Persistent pain of this type will require professional assistance.

Chris, I wish you well.

Steve