The clear aligners that we use are from the ‘Spark’ company; an offshoot of the original metal braces company called ‘Ormco.’ When the Invisalign® patent expired some years ago, the Spark company figured out a way to use softer, gentler aligners to move the teeth. Once the majority of the movement has been accomplished, they would then use stiffer aligners to refine the case.  This has become a major advancement in the field of orthodontics. The gentler aligners mean less discomfort to the patient and less trauma to the teeth. In almost all cases that we see, the teeth need to be taller to support the TM joints so softer aligners mean less stress to the teeth as they erupt taller. This means higher success in lifting the teeth and a better end result for your TM joints!

The technology of digital scanners has a two-fold benefit to both the patient and the doctor. In lieu of using the old-fashioned putty impressions to make an orthodontic appliance, a digital scanner can not only make the process more comfortable, but it is by far more accurate and easier to send to the lab for manufacturing. No longer is an impression being shipped via snail mail; it is sent instantly through the computer to the lab, and they can print a plastic model of the teeth right away. This makes it safer as well, no more saliva or blood being shipped in the mail. (Even though everything was carefully disinfected, this is a huge improvement in the handling of dental cases.) The lab technicians are also safer because they digitally print the model of the teeth and no longer need to handle putty that is potentially infected.

A very new technology that will show up soon enough is the ability to use an app on your phone to digitally scan the progression of your orthodontic case. It already works and soon enough you will see it everywhere. Technology is great!

The post Hi-Tech: No More Putty or Metal Brackets for Finishing Cases first appeared on Sleep & TMJ Therapy.

Diagnosis of the problem is paramount. A really well-done MRI is critical in determining the path of treatment, and many times getting good imaging is quite difficult. So here is the first ‘delay’ in fixing the problem, getting an appointment for a well done and well-read MRI. It can take several weeks to get that appointment and quite honestly some people just do not want to wait. I can’t blame them either. Let’s get it done now!

The next delay is just getting an appointment at the office to discuss all the issues. This is where we look at the bone from the CBCT X-ray and the soft tissue from the MRI. In most cases, people want their insurance to pay at least something and that in turn creates the next delay. Next on our list is the fact that with TMJ appliances, they are custom-made. This takes time. They are not something sitting on the shelf, ready to put in the mouth. It takes weeks to make them since they are custom made for each person.

Now let’s get to the next big delay. You have to wear the devices for 12-18 months to give the discs a chance to move back into the proper position. That’s right folks, it takes that long, especially if the discs have been displaced for several years. The discs don’t just fall back into place instantly. It will take time and patience. Of course, some are not willing to devote such time (and patience) to their health, so they do not do anything. That is OK as not everyone is experiencing the same level of pain or discomfort. When it gets really bad, the patient will pursue treatment but generally now the problem is harder to fix, costs more, and takes more time. This is like most things in life.

Finally, the biggest time consumer of all – finishing after the discs are back in place. In most cases, orthodontic work is needed to grow the teeth taller to protect and support the TM joints (the jaw joints). Orthodontics can take 1 ½ -3 years, easily! So here you are, having spent all this time on appliances only to realize it’s going to take another couple of years. You are basically dedicating up to 4-5 years of your life toward fixing a TMJ problem. This is why we always tell our patients phase one is appliance therapy and phase two is finishing. Thus, the question has been answered. Now you know why TMJ treatment can take so long!

The post The Case of: “Why Does This Take So Long?” first appeared on Sleep & TMJ Therapy.

Another aspect of having a tooth pulled out is that upon removal of the tooth, the bite on that side will experience an almost immediate collapse in which the jawbone (condyle) will now go more deeply into the socket. This is where a TMJ problem begins. When that condyle jams further up into the jaw socket, it will impinge on the articular disc that covers the condyle. This can cause a gradual displacement of the disc and subsequent TMJ disorder. If multiple teeth are removed this can readily lead to the discs being pushed way out of proper placement and this can be quite painful for so many people.

With periodontal disease, the bone and gum support around the tooth becomes weaker over time. This can lead to the tooth getting loose in the socket and it can no longer be a good vertical support for the jaw joints. Just like the foundation of a house, if it starts to rot away, the whole house can tip sideways. The jaw is similar. If the teeth become looser due to periodontal disease, this can destabilize the jaw joints and the discs in those joints can become damaged more readily. By maintaining good periodontal support for your teeth, this will help the jaw joints stay healthier and stronger.

Unfortunately, oral cancer should be mentioned in this blog. Cancer in the mouth can lead to loss of teeth and bone which of course can lead to loss of TMJ support. This is why it is so important to keep up with your dentist and at least yearly have them do an oral cancer screening. This screening only takes a few minutes, yet it could save your life and your health. So many people are very afraid of cancer but if detected early enough it is fairly easy to treat.

As Dental Health awareness month is April, be smart and reach out to your dentist about your dental health. Ask questions. Ask if they are checking for periodontal disease. Ask about cavities. And most importantly, ask if they are checking for any signs of oral cancer or other diseases.

The post How Oral Health Affects the TM Joints first appeared on Sleep & TMJ Therapy.

Many people will find that the turbos do not really slow them down too much when eating, but they do need to eat softer foods than they normally might. In general, if your food is fork tender, then it should be easy enough to eat and swallow. Mastication (chewing) is good for your digestive system and muscles, yet when you have a TMJ problem, it is better to go softer for a while so the joints can heal.

Another frequent topic that arises is what exercise can be done when a person has a TMJ problem. The issue when a person has a slipped articular disc is the disc needs time to heal and try to recapture its proper position in the socket. If you work out too hard at the gym, this oftentimes causes a pull on the neck muscles (sternocleidomastoids). These muscles will pull on the slipped discs and make them worse. This is why a more carefully crafted exercise program for TMD cases has been developed.

One of the most important aspects of exercise for the TMJ patient is to make sure you do not lift above the height of the shoulder. A guide would be to not lift above the arm when it is stretched out horizontally. The reason for this is that the body will tend to ‘detach’ from this motion, and you will lose strength. Example: If you swam the ‘crawl’ as it is called, your arms would go above the shoulders, and you would pull the water toward you. In this action, you will stress the muscles in the neck and inadvertently pull on and potentially damage the discs in the joints. This is why over-the-shoulder lifting must be avoided.

There is a nicely modified program for TMD patients that involves being careful to protect the joints while still getting in a good workout. Some of these exercises involve using the elliptical machine. As an example, the Peloton is a quality elliptical type of workout. It is not recommended to use the treadmill because it is so much like running that the neck gets pounded. This can hurt the discs as well. There are several other modifications of exercise programs, but they need individual attention and modification per patient.

The post Considerations When You Have TMD first appeared on Sleep & TMJ Therapy.

Did you know that a gorgeous smile with great teeth and well-supported Temporomandibular joints also means less neck pain?  It’s so true! Time and time again it has been shown that losing a tooth means that the structural integrity of the cervical spine is compromised. This is why it is not advisable to remove any teeth unless completely necessary. In so many cases, it is necessary to remove the patient’s wisdom teeth.  For this reason, many people would benefit from wearing the ALF appliances to maintain support of the bones of the skull during the healing process. When wisdom teeth are removed, the research indicates there will be about 16 square centimeters of holes in the skull and the bone has a tendency to collapse from this. The ALF appliance will help to support the bones of the skull and more readily allow the bone to fill into the holes created by the extractions, without causing a collapsing effect.

In the past, it was much more commonplace to have all your teeth pulled out and have dentures made. The problem with the denture route is that most of the time the dentist’s lab uses a type of plastic material and the dentures have a tendency to wear down quite quickly. What happens next is the top of the jaw – the condyle – will more readily jam into the socket and we have more TMD problems. This is why it is good to avoid dentures and go the implant route.

When a person has implants done, it would be wise to get the implant crowns to the proper height. This would require working with someone like a TMJ specialist who understands that the condyles must be in the right place to protect the joints from degeneration. By paying attention to the vertical height of the implant crowns, this will allow the patient to feel better with their brand-new smile!

Another facet of dealing with a gorgeous smile is that a great smile looks better if the bones in your skull are more balanced and symmetrical. When you think about it, it kind of makes sense. If your cranial bones are level, the body is happier and looks better. Again, this is what the ALF wire is all about – symmetry and balance – and this creates a more beautiful appearance too.

So, make sure that beautiful smile translates into a beautiful and healthy YOU!

The post The Case of Why We Need a Gorgeous Smile (From a TMJ Perspective) first appeared on Sleep & TMJ Therapy.

With the work that we do at Sleep and TMJ Therapy, it is important that we all work together as a team to provide you with the very best treatment possible. When it comes to your regular dentist, this means seeing him or her regularly for the dental cleanings and checkups. Sometimes we have you see them more often – like every three months instead of the normal six months. This helps keep the teeth cleaner and healthier when heavy buildup is present or there are periodontal issues. Since our appliances rest on the teeth, it is imperative that you keep those teeth as healthy as possible!

Another reason for maintaining good teeth and healthy gums is that if you are wearing ALF wires, there will be some degree of expansion of the arches and gaps could open between the back teeth. When gaps open up, it is more important than ever to use floss every day and see your dentist regularly enough. On the back end of treatment, we advise our patients that they may need some of these small gaps closed with a filling or onlay, depending on the situation. However, in most cases, once the ALF treatment is completed, the gaps usually close all by themselves as we notice the teeth moving forward over time. This occurs naturally when the teeth and gums are healthy.

As part of the finishing up of treatment, in some cases, it is necessary for your general dentist to do some crowns or overlays of certain teeth to make them taller. This is sometimes needed with root canaled teeth because they usually will not lift up doing ALF therapy. It is quite simple for this to be done, but much easier if your dentist is kept apprised of your situation during treatment and maintains the bone and gums during the transition process.

So, keep up with those dental cleanings while we work on the TMJ disorder. Your treatment is much easier when a “team approach” keeps things in order!

The post Why You Need Your Dentist While Undergoing TMD Treatment first appeared on Sleep & TMJ Therapy.

The truth of the matter is that if you work with an experienced TMD (Temporomandibular Disorder) specialist, then such an advanced procedure is rarely necessary. The path toward surgery should always try to be avoided, but sometimes it is simply necessary.

When a patient first begins treatment, they must do an MRI to figure out how damaged the discs in the jaw joints really are. This gives the specialist a good baseline to begin with so that a comparison MRI 12-18 months later will help to determine if enough healing has occurred so that surgery is not needed. It’s all relative- if after the 12–18-month appliance therapy period, the patient just feels great, yet the discs are not quite perfect position, then no surgery is indicated. If there is still substantial discomfort, then there would be a discussion about the type of surgery and how to finish the case.

In almost all cases that require surgery, the process is either plication (put the discs back into proper anatomic position) or meniscectomy (remove the remnants of the damaged discs). In either case, the surgeon makes an incision that is only one inch long at the little crease just in front of the ear. He then goes into the joint and will fix the problem either way. Sutures are done internally to keep the discs where they should be, and external sutures are done to seal the area. These two surgeries are considered simple and logical and when done will last a lifetime in almost all cases. The key factor is having a surgeon who has done many cases over the years. It should also be mentioned that TRJ (Total Joint Replacement) is only done when the top of the jawbone (the condyle) is severely eroded beyond any reasonable chance of repair. This is a rather heavy-duty surgery because you are in full braces and the jaws are wired shut for a few months. Eating through a straw is no fun, but there are few other options.

Because TMD treatment is so misunderstood and mismanaged, there are many opinions coming from many practitioners about the proper course of treatment. Some surgeons will ONLY perform TJR while others would do arthrocentesis (flushing the joints) before considering plication or meniscectomy. For these reasons, insurance companies are hesitant to pay for a procedure and call it all ‘experimental’ which it most certainly is not. So please be well informed and understand the options!

The post The Case of the Misunderstood Surgery first appeared on Sleep & TMJ Therapy.

In the past, it was quite common for an orthodontist to order extractions of perfectly good teeth to make the process of moving teeth and creating space with the use of braces easier. So many children are now presenting with narrow arches and crowded teeth that it made sense (somewhat) to remove the crowded teeth, thus allowing the orthodontic work to go faster and easier. But somewhere along the way a few practitioners noticed that the removal of the bicuspid teeth would often cause the upper and lower jaws to collapse backward which would lead to a collapsing of the airway as well. They also rather astutely noticed that the palate would become smaller, which made breathing more difficult as well. There are still orthodontists today who practice the method of extracting the teeth to make room and the braces go easier. However, many more are learning that there just might be better techniques.

The extractions of impacted teeth are a completely different need but also can cause the same issue. In this situation, the teeth need to be removed because 1) the lack of space in the bone means the teeth cannot erupt or 2) the tooth is growing in the wrong direction or position. In this situation, the stress placed on the jaw joint can cause the disc to be displaced and in addition, put a strain on the muscles around the jaw joint.

Of course, another method of expansion is the good old-fashioned RPE (Rapid Palatal Expander), but even this has its issues. The RPE will often just open the palate rapidly and the midline suture might not form into solid bone — it might just be a cartilaginous suture that can move around over time. This would not be very effective. The reason is on a skeletal level this instability can cause changes and distortions in the cranium. Another approach to getting some expansion is to use the ALF appliance as much as possible with the understanding that a few months with the RPE might be OK.

Another problem that is frequently seen among dentists, pulling out bicuspids, which makes the upper and lower jaws move and therefore are no longer in the same position as previously. This change can affect how the condyles (top of the jawbone) fit into the sockets and in turn, can lead to a TMJ problem. When that condyle is re-positioned after extractions, it will no longer be in the same relationship to the disc that covers it. The disc can end up displaced over time. This is what can lead to head and neck pain. So many extraction patients end up with similar problems later in life.

There are some practitioners who will actually use a palatal expander to re-open the extraction spaces to put in dental implants to ‘restore’ what was taken away. This is actually a controversial topic. As we get a bit older, the bones in the skull do indeed become more solid and if you were to try expansion a lot — like the width of a bicuspid that had been removed — it might be too much for the body to handle. Does that make sense? It might be that the expansion is just too much of a  ‘stretch’ and moving bones around might lead to more pain. This is another reason why the more conservative practitioners would use the ALF appliance to get as much gentle expansion as possible while minimizing trauma to the facial bones.

So, in general, extractions for the sake of doing braces may not be the best idea. Be sure to be careful when considering this.

The post Are Teeth Extractions Helpful? first appeared on Sleep & TMJ Therapy.

Here we are in the middle of 2022, and I have to admit that every day I am in the office I see incredible things. At this point I am so used to hearing that our patients feel better, headaches are down and they are sleeping. This has become the norm. But every now and then it just does not work that way, admittedly, around 10% of the time I cannot help that person. And sometimes that is just because they need surgery to fix the problem. The more frustrating case is when I meet a new patient and the MRI shows severe degeneration and yet they feel no pain at all!

When there is severe disc displacement and the condyles (top part of the jaws) are eroding, it would only seem logical that there would be pain. Doesn’t that make sense? What I have learned over the years is the discs have been out of place for a very long time and the condyles are eroding due to compression in the sockets.

The body has set in the process of erosion to prevent the condyle from jamming hard into the socket. Think of it this way, most of the new patients I meet really should have had their teeth raised taller when they did braces so that the condyles would not jam up into the joints so hard. Yet, most people never had orthodontic work done in that fashion. The goal was to have their teeth made straighter to look good, a cosmetic case only. And now, years later, the shortness of the teeth has caused the condyles to jam up into the sockets, thus displacing the discs out of the joints. This is what I see almost every day of the week!

The way our body works is that it will always try to protect us from harm. Just like if you get a bacterial infection, the body fights back with chemicals to kill the bacteria. Well, when our body senses the condyles are too high up in the socket and are damaging the discs, sometimes the body will begin to erode away that jammed-up condyle to avoid pain. It’s really quite simple actually- our body is trying to help us. However, this so-called ‘help’ is not what needs to be done. What we really need to do is to make the back teeth taller to open up the joint space and reduce the impact of the condyle on the socket. I hope this makes sense. It seems to work quite well in some patients, but not so much with others. This is why we are human beings, there are many variables at play here. With certain patients, i.e., those with autoimmune disorders, for example, their inflammation levels are already quite high so it is more likely they will hurt due to slipped discs and degenerating condyles. With other patients who have little to no existing inflammation, they are less likely to feel the pain of their situation.

As you can imagine, some days it is difficult to figure out why one patient is hurting and the other just simply does not! Maybe this is what makes us human beings! Please give us a call if you have any concerns about your jaw health!

The post The Case of the No Pain Patient first appeared on Sleep & TMJ Therapy.