Almost every day of the week I will meet a new person that has come to our office with little or no pain in the jaw joints, yet the popping and clicking is driving them crazy! Just this morning I was meeting with a gentleman who has been with our office for the last two years and has faithfully worn his orthotic all this time. Prior to working with him, he had experienced horrific jaw popping and clicking for many years. He said it irritated people because his jaw made so much noise when he ate his meals that he would avoid anything crunchy or would need a little more effort. It was literally driving him crazy he said. There was no pain at all, just a lot of clicking and popping in both joints.
As it turned out, his situation was like so many people that I meet these days – the articular discs in the jaw joints- the TMJ discs – were slipping around in the sockets and made lots of noise as they did so. He had dental work in the past and unfortunately the dentist did not analyze the vertical positioning of the crowns and how this relates to the TMJ discs. When you look at his mouth it was quite clear that all his lower back teeth were way too short. This meant that the condyle (top of the jawbone) went way too deep into the socket and would therefore pop the disc out of the socket on both sides. This caused him to grind and clench his teeth due to the chronic irritation of being in the incorrect position.
Now, here we are two years later, and he comes in for a checkup, and we learn that he has stopped grinding/clenching and there is absolutely no wear and tear on the appliance! So what the orthotic did for him was that it helped re-determine the vertical height of his teeth- i.e. the appliance gave him back the height that was missing all these years and now his jaw was happy, less inflamed, and there was no longer the irritation that made him grind his teeth. Not every person will stop grinding, but when they do as he did, it really makes my day!
And now that this fellow is happy and no longer grinds his teeth he is asking if it is OK to not wear the appliance any longer. We talked about this extensively and he realized that the orthotic appliance has actually created the proper bite position where he is comfortable and this is where his teeth should have been all these years. So now, to finish up his case, he will need to have his lower back molars and bicuspids re-crowned to the height of the orthotic. This will keep the condyles and articular discs in a comfortable position. This is what TMJ treatment is all about – getting the vertical correct so the discs and condyles are where they should be.
After today’s appointment, I made a call to the patient’s dentist and explained that new crowns are needed. However, this time I am suggesting that it be done a little differently than it was in the past. This time, ALL the crowns will be fabricated at the same time. ALL of them will be made taller to the height of the orthotic. This means the dentist must prepare the crowns on both sides at the same time and bilaterally make them taller to the height that I determined. Remember, the orthotic appliance is a temporary device to re-establish the vertical height that was lost over time. It does take time to learn how this all works, but I have done this so many times over the years it is now quite easy. I only wish I had met this person before all the crowns were done. It would have saved him lots of time and money in the end. So, before you have a bunch of crowns done, have the vertical analyzed and make sure the TM joints are healthy and happy!