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Oral Surgery/What is causing my TMJ? Will orthodontics help?

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I have had pain on the left side of my neck, right under my ear which increases and goes all the way to the shoulder blade. It was manageable but has progressively become worse. Every time I visit the dentist for scaling, checkups or fillings, the pain becomes unbearable for weeks afterwards.  

I got an impacted wisdom teeth removed from the left side ten months ago and the pain has certainly been recurring a lot more since then. All my teeth on the left side, specially the upper premolars have started to hurt and they have no cavities/gum disease. Finally I found a TMJ expert (there aren't to many in my city/country). The first one told me that I have a recurring muscle spasm and asked me to seek physiotherapy along with muscle relaxants. I got some relief and was pain free for many months afterwards. But when I went for my bi-annual scaling two months ago, the pain returned, only much worse than before. This was despite my dentist giving me a break every five to ten minutes during the procedure.

I was referred to another oral-maxillofacial surgeon and he gave me this cause: he told me I had a broken first molar on the right side that couldn't be restored after a root canal with a crown for a year as I was out of my home country and it was too expensive to get it in Europe. It caused the upper molar to supraerupt and the bite to change and become traumatic. I didn't have a good bite to begin with and have very limited anterior guidance, causing the jaw trauma. He recommended an orthodontic treatment to intrude the upper molar, followed by restoration of the lower one at a proper height. I also went through a T-scan which determined my bite forces were 60-40 (left-right) and the surgeon said its close to normal.

Now, I have consulted  an orthodontist and he has placed two titanium mini-screws connected with an elastic (that I change every day) and said that the tooth should intrude in 3-5 months. He also placed bite-risers on my molars on both sides and said that it was to prevent the elastic from breaking and should give some relief from TMJ. It worked for about 20 days and I was almost pain free. Then we had to decide to get clear aligners for the remaining orthodontic work, since I have a known allergy to metallic braces (had to remove them in my teenage years). Recently, I went to give the impressions for the braces, as soon as the orthodontist pressed my teeth into the mould, the pain returned again and has been there for a week now. I am managing it with ice packs and muscle relaxants.

Now, I am worried about the diagnosis. I wonder if the TMJ will become worse with the aligner treatment? Is it really my bite or some other issue. Who should I consult? I must add that I don't clench/grind my teeth at all and do not have a tongue thrust problem and have extracted only wisdom teeth till date. When I am in pain, the only time I feel comfortable is when I wake up in the morning. As soon as I eat my breakfast, its a downhill journey. Any advice, even on alternate medicine/therapy will be appreciated. Also, request the experts to tell me if I should go ahead with orthodontic treatment at all?

Answer
Lily -  A balanced bite is very important to allow full relaxation of the jaw muscles.  When the bite is off stress and spasms of the jaw muscles occur.  Spasms of these muscles throw the bite off more.  In addition, jaw muscle spasms can produce pain in the neck muscles, the temple region, in front of the ear and even sore throats.  For that reason, balancing your bite with orthodontic treatment is important.  

So you should go ahead with the orthodontic treatment so the orthodontist can balance your bite.  During the treatment time in orthodontics, you will have episodes of jaw muscle spasms until the bite is totally balanced.  It might not be a bad idea for the orthodontist to make a guard to fit between the upper and lower teeth during the treatment to insure muscle relaxation and a reduction in pain.

I truly wish you well and hope the doctors can properly balance your bite to enhance muscle relaxation.  If you should have additional questions, feel free to contact me again.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon 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 practicing for over 20 years. Assistant Clincal Professor at 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- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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