Orthotic Treatment for TMD, or What to Expect When You’re Expecting…an Orthotic
By Rebecca Taylor, DDS
Many folks – including doctors – don’t realize what a huge role a person’s bite plays in musculoskeletal issues. Often, it’s a missing puzzle piece to other treatments such as chiropractic, osteopathy, physical therapy, or other body work.
Your jaw is connected to your head via the TMJ (temporomandibular joint). When this joint is overused from clenching or grinding, or when it’s damaged from trauma or a poorly aligned bite, it wears down, as does the disc it sits on. The muscles get bound. Because those muscles – and the jaw – are connected to the head and neck, dysfunction from improper jaw position can cause many symptoms: neck, back, jaw, or face pain; poor posture; ringing in the ears and popping in the jaw joints; headaches and migraines; sensitive teeth and receding gums.
The first step is to unwind the body, balance the cranial bones, and align the upper cervical spine and pelvis. Once the muscles are relaxed, we can then use an orthotic device to help stabilize this position.
The image on the left below shows what a healthy TMJ looks like. The jaw is in a more forward position – the position an orthotic helps bring your jaw into. Bringing the jaw down and forward in this way takes pressure off the joint, allowing it to remodel and heal. When the jaw is positioned back, you get what you see in the image on the right – a position that compresses nerves and blood vessels, and pulls the muscles.
The next images show the difference an orthotic can make. On the left, you see a young woman with no orthotic. Notice how the jaw is back and the head posture is forward. On the right is the same young woman with her orthotic in place. See how her jaw goes down and forward? The orthotic is holding the TMJ in its proper position, decompressing the muscles and improving posture. All these things help relieve symptoms.
What Orthotic Treatment Is Like
Because the spine and cranial bones play a big role in your bite and TMJ position, it’s important to see a chiropractor, physical therapist, osteopath, or other bodyworker who can help balance the cranial bones and align the upper cervical spine. Once they’re aligned, the muscles need to be relaxed – something that can be done with hot and cold compresses, trigger point injections, or TENS therapy.
Of these, we find TENS to be most effective, using low level electrical impulses to help relax the TMJ and associated muscles. It also gives us a bite that is reproducible. Because the TENS unit pulses your jaw, it takes the guesswork out of determining your optimal bite. It’s obvious how your jaw should be position. We capture this jaw position with impression material and then send that to the lab where your orthotic is fabricated.
The device you receive will look something like this:
First, we’ll place it in your mouth to double check that the position is correct and verify that it matches your relaxed muscle position and alignment. If it’s not a good match, we may reline the appliance right there or send it back to the lab with a new bite to fabricate.
When you wear it, your lips should be closed so you breathe through your nose. Your tongue should rest against the roof of your mouth, and your upper and lower teeth should rest slightly apart.
Since the orthotic places your jaw and muscles in an optimal position, giving the TMJ an opportunity to heal, you’re instructed to wear it as much as possible. When it’s not worn, the jaw will simply get injured and irritated again, causing old symptoms to reappear or even new ones to develop.
Though you may experience symptom relief early on, it can take 6 to 12 months for the joint to heal fully. It’s important not to let symptom relief become an excuse to not wear the orthotic.
In a perfect world, you’d wear the device day and night, taking it out only when you clean your teeth (and the orthotic itself, of course). However, the device can take some getting used to, so we tell our patients to initially take it out during meals. After wearing the device for a while, you may find that you’re able to eat with it in. In fact, many patients find it more comfortable for their jaw when they wear it while eating.
While you’re getting used to wearing the orthotic, you may experience some discomfort. You may feel tightness in the muscles or soreness in the teeth, gums, and tongue. You may clench or grind a bit more, have difficulty talking, or find your mouth producing more saliva. All these are VERY common at the start of treatment, but most if not all of these resolve with time.
Simply, because we’re repositioning and changing your bite, your muscles have to get used to a new position. Your brain gets different input because you now have a different bite. This is A LOT for a body to take on, especially if your bite has been off for your entire life.
The main thing in the beginning is to take it slow and not get discouraged.
Every month or two, we’ll have you come in so we can check your bite and make any needed adjustments. If you’re doing well, we may even recommend going several months and then check your bite at a cleaning appointment.
Because we are repositioning and changing the bite, the muscles have to get used to a new position and your brain has different input because you now have a different bite. It is a lot for the body to take on, especially if your bite has been off your entire life.
If you’re very tight and having continued pain while wearing your orthotic, we may recommend you come in for TENS therapy, more intraoral muscle release, or a bite check. (TENS therapy uses low level electrical impulses to help relax the TMJ and associated muscles, offering pain relief.)
Eventually, you may find that you have a hard time getting your bite together when you take out your orthotic. What you’re experiencing is a changed bite, which tells us that the muscles are more relaxed and the treatment is working.
If you decide you’d like to permanently move your teeth into this position with orthodontics, we can prepare for that. We will still want you to wear the orthotic for 4 to 6 months before we start ortho, however. It’s a crucial step that can make or break successful results.
Personalized Treatment Is the Foundation for Best Outcomes
Every patient is different. Some LOVE the orthotic from day one. Their bite feels great. They have symptom relief. They don’t need a lot of adjustments. Other patients find it takes time to get used to or need more adjustments or supportive treatments before they begin to reap benefits. It really all depends on the kind of patient you are, your symptoms, and needs.
Remember: Your jaw and muscles have been in dysfunction a long time. Unwinding doesn’t happen overnight. It’s a process. And since everyone is different, each person will respond to treatment differently. Sometimes, non-dental therapies may be needed to create the best outcome. Chiropractors, osteopaths, physical therapists, and other bodyworkers may be involved.
Sometimes it takes a village to get people symptom-free.