Expert: Steven C. Scherr, D.D.S. - 1/3/2007

Question
Thank you for your sincere advice. I believe I am experiencing symptoms of TMJ now after the extraction. I had an open bite before on the side of the extraction and my wisdom teeth was anchoring my jaw when I went to close it. Now that the support is not there I was compensating by clenching to get a closed bite. My question is can orthodontics such as invisilign help with my TMJ if my bite can be fixed or will I always have an unstable bite now that my wisdom teeth no longer anchor that side of the mouth.
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The text above is a follow-up to ...

-----Question-----
I'm 35yo and take tramadol on a daily basis for pain management. I had both wisdom teeth extracted from the left side of my mouth about a month and a half ago to help maintain proper cleaning otherwise they were fine and I used them to chew the majority of the time. I have pain in the upper socket even though it seems to be healing fine. The pain seems to enter the sinus. This is keeping me from being able to fall asleep. Plus I am not comfortable with my bite I tend to clench my teeth or keep them apart. I am suppose to have both the right side wisdom teeth removed but am reluctant to now I am experiencing such discomfort with the two I already have out. Question, what could cause tooth pain in an upper socket a month and a half after the extraction. Will I eventually get used to my new bite and stop clenching or clicking my teeth. Finally do I need to have the other wisdom teeth removed if they are not causing any problems.
-----Answer-----
Max,

Assuming there is no physical problem such as an infection, sinus disease or unremoved tooth fragment, the pain is most likely related to a hyper-excited nervous system.  In addition, the perceived alteration in the bite can contribute to the development of habits like clenching and clicking.  These, in turn, can irritate an already hyper-excited nervous system and further contribute to the pain.  In time, these symptoms are likely to improve.  If not, you may need to seek professional intervention.  If your dentist is unable to help with this, ask for a referral to a dentist with advanced training in atypical facial pain.  If you live near a dental school, you can ask if they have a facial pain clinic.

The decision about the remaining wisdom teeth depends on the relative risks of removing them vs. keeping them.  Your dentist is in the best position to help you with this decision.

Max, I wish you well.

Steve

Answer
Max,

Only reversible procedures should be considered until any TMJ problem is stabilized.  Orthodontics is not a reversible procedure.

The TMJ, or TemporoMandibular Joint, is a hinge that allows the jaw to open and close.  Think of it like a door hinge.  If a door no longer closes smoothly into its frame and the hinges are loose, would it make any sense to trim the frame before tightening the hinges?  If you did, the loose hinges would likely cause the misfit between door and frame to return rather quickly.  However, if the hinges are tightened first, and then the frame is adjusted, a smooth, stable fit is achieved.  The TMJ is like the hinge and the teeth are like the frame.  The TMJ must be stable before modifying the teeth or the result will be unstable.

You will need professional help to get the TMJ problem under control.  As part of therapy, a removable oral appliance can be fabricate to create an ideal bite that reduces the strain on the TMJs and promotes healing.  This appliance will need to be modified over time to keep pace with the healing process.  Once the joints are confirmed to be stable, irreversible procedures like orthodontics or bite adjustment can be considered if needed.

Best wishes,

Steve