All About Orthotics for TMJ/TMD: Frequently Asked Questions
By Rebecca Taylor, DDS
Last week, we took at look at how orthotics can help bring relief from jaw joint dysfunction. Other benefits include
- Spinal and cranial stability.
- Reduced gum recession and tooth sensitivity.
- Increased lymph drainage in the head and neck.
- Reduced neck, shoulder, and jaw tension and pain.
- More room in the mouth for the tongue.
- Cosmetic improvement and wrinkle/line reduction from a more supported lower face.
Still, you might have some questions, just as our patients often do when we first recommend orthotic treatment to them or as they begin treatment. So we thought we’d follow up with some of the most common ones we hear.
I’m wearing my orthotic and feeling great! Now what?
Yay!!! That’s awesome!
Another feature of orthotics is that they can be a diagnostic tool, helping us determine if your bite and muscle position is linked to any of your underlying symptoms. Before we start moving teeth around, we want to stabilize the joint. Once it’s feeling good and stable, we can change the bite as needed.
It’s important that the orthotic is first worn for several months with symptom improvement before we move forward with any orthodontics. We can change the height and shape of the orthotic easily, so fine tuning the bite at this stage – and creating long-term stability and symptom relief – is crucial for creating good orthodontic outcomes.
Once we determine how much growth in the jaw is needed, we can then place expanders as necessary and then use orthodontics to move and align the teeth. This can take time – up to 2 years for some patients – and requires a financial commitment, as well. However, the result is a more stable bite that aligns with a more relaxed muscle position.
A quicker option for some patients who have several crowns in their mouths already is to replace them with taller ones, thus changing the bite and aligning the jaw with the orthotic position. (Expansion prior to crown placement is sometimes recommended.) We don’t recommend this, though, if you don’t already have a significant number of crowns. We try to avoid doing such aggressive dentistry whenever possible.
What if I don’t want to change my bite?
That’s perfectly fine. However, it’s important to remember that your regular bite is different from the one the orthotic creates. The orthotic works only when it’s in place. If it’s not worn regularly, symptoms can come back. If worn too much, though, the jaw can remodel and cause permanent changes to your bite. So if you decide not to change your bite, make sure you continue to wear your orthotic every night and during the day if needed, removing it only for meals and oral hygiene.
Can’t I just start changing my bite with orthodontics or placing crowns now? This orthotic step is annoying.
Creating jaw stability before any kind of treatment that changes the bite is essential! Read more about why here.
What about my tongue? I was told I might have a tongue-tie.
The tongue plays a big role in cranial, spinal, and muscle stability. If the tongue isn’t properly positioned (if it rests on the floor of the mouth instead of against the palate), if it doesn’t have good muscle tone or swallow correctly, this is dysfunction and can result in jaw and muscle instability. It will affect the muscles in the head and neck and can often result in pain and tightness. (Check out this video to learn more.)
This is why it’s so important to address tongue and related oromyofacial disorders. Doing so can significantly improve symptoms and clinical outcomes. We recommend that you work with a myofunctional therapist (think physical therapy for the tongue) to help retrain the brain and muscles to function correctly. If you work with a myofunctional therapist for 8-12 weeks and are having difficulty with the exercises, then a tongue-tie release may be necessary.
Do I really need to work with a myofunctional therapist?
Yes, you do. Here’s why:
Why you MUST work with a myofunctional therapist BEFORE AND AFTER tongue tie release!!! I get this question ALL THE TIME FROM PATIENTS… so I made you all a video about it. 😉👅💪
Posted by Green City Dental on Thursday, May 16, 2019
I don’t like TENS. Do I really need to do it?
How do I clean my orthotic?
Because you should be wearing it most of the day (and night) every day, your orthotic will get dirty. The best way to clean it is by brushing it with a soft toothbrush and hand soap. You can also soak it in white vinegar once a week for 20 to 30 minutes to help dissolve some of the mineral build up. When you come to the office for your appointments we will clean it in our ultrasonic cleaner.
What is the risk if I don’t do orthotic treatment?
Disease and dysfunction is always easier to treat when it’s caught early instead of late. If you don’t treat the problem now, your joints will continue to wear down, which can result in a locked jaw; pain; limited opening and range of motion; tooth wear; cracking teeth; receding gums; tooth sensitivity to cold, hot, brushing, and biting; increased risk for root canal therapy; and worsening head, neck, and jaw tightness.
Isn’t this the same thing as a nightguard?
- A nightguard just puts plastic between your teeth, providing some cushion and protection from clenching and grinding. They aren’t designed to relieve symptoms (although sometimes we’re lucky and they do). Rather, the focus is on limiting wear on your teeth.
In some ways, nightguards can even be detrimental. Some studies have shown that upper nightguards push the jaw backward, causing an increase in clenching and grinding, making snoring and sleep apnea worse! Many osteopaths hate upper nightguards because the keep the palatal suture from moving, which is needed for proper lymphatic draining of the brain and cranial rhythm.
This is why it’s so important to position the jaw in an ideal position that helps support the rest of the body. An orthotic takes into consideration where your muscles are the most comfortable and helps support your cranial bones and spine position. It also helps keep the jaw forward, which for some people can help improve breathing. Symptom relief is expected.
Can this help my airway?
An orthotic can change posture and hold the jaw in a more forward position. Although an orthotic is not a treatment for airway issues, both posture changes and a more forward jaw position can help breathing and increase the volume of the airway. So the simple answer is, in theory, yes.
How often do I need to see my chiropractor, PT, osteopath, or other bodyworker during this process?
Ideally, you would see them for a few sessions before we take the bite for the orthotic and then again on the day of delivery. Depending on your symptoms, you may need to see them every month or as much as once a week. Everyone is SO different. In general, and in my own experience, the more bodywork you get, the faster you adapt and the more successful the treatment. Intraoral massage is highly recommended if muscles are very tight and painful to palpation.
A Few Final Words of Wisdom
- You can do it. This is a process. You won’t know if the treatment will work unless you wear the appliance. The more you wear it, the faster you will adapt and the faster symptoms will subside.
- You will be sore or experience discomfort when you first start wearing the appliance. Most of these symptoms resolve after 2 to 3 weeks.
- Some patients have found it helpful to wear their orthotic for 24 hours right after they get it and stick to soft foods (soups, yogurt, etc). This makes it easier to transition.
- Keep orthotics away from pets. They love to chew on these things!
- Make sure to keep your teeth clean. Brushing and flossing is very important when wearing an orthotic. Don’t forget to come in for regular cleanings.
- When you’re not wearing your orthotic, make sure to put it in a case or your pocket. If you lose your orthotic, making you a new one will take several weeks, so be careful with where you put it.
- Stay positive. A positive mindset has been shown to increase healthcare procedure outcomes. If you go in with a positive attitude, you’re more likely to have a positive outcome. If you go in thinking negative thoughts or doubting, you won’t have results nearly so good. Don’t believe me?? Check out this article from JAMA.
- Keep us posted! We love to hear about how you are doing (good or bad). Your feedback is important because it helps us know if we need to be more aggressive with treatment or if more or less adjusting is needed.
Ready to learn more about TMJ therapy, sleep apnea, and orthodontics? Here’s one great place to start.