#120 Fact Checking TMD/TMJ (Part 5) Orthodontic Treatment

It may surprise you, but treating the symptoms of TMD/TMJ using “braces” on the teeth has been promoted by Orthodontists almost as long as TMD, Temporomandibular Joint Disorder, has been identified as a disease.  If ever there was an example of the adage, “If the only tool you have is a hammer, everything looks like a nail” Orthodontists treating TMD takes the cake.   

I am not saying Orthodontists have no part in treating TMD.  Orthodontic treatment does, on occasion, play an important part in the ultimate rehabilitation of the TMD patient, but only occasionally.  The fact that Orthodontists hold themselves out to be the primary health care providers for patients who present with some of the disparate TMD symptoms of headaches, earaches, jaw and neck pain, ringing in the ears, subjective hearing loss, vertigo, shoulder and arm pain, arm, hand, and finger tingling and numbness, and various kinds of jaw locking only signifies how little they know about the actual causes and pathology of the disease. 

If you ask an Orthodontist to explain how straightening the teeth leads to the resolution of TMD symptoms this is what you will hear. 

“Patients clench and grind their teeth because their teeth do not fit together correctly.  So, when I make the teeth fit together correctly, patients will stop clenching and grinding.”  The truth however is, malocclusion does not cause clenching and grinding. 

The problem with this line of reasoning is that bruxism, or clenching and grinding the teeth, is caused by stress and anxiety.  It is very clear statistically and fully agreed upon by the entire dental and scientific community that bruxism is associated with and caused by stress and anxiety.  But we don’t know how stress and anxiety, which is a mental/emotional condition, stimulates the brain to create the muscle movements of the jaws known as bruxism.  There are many theories about what parts of the brain are involved, but we really don’t know exactly what is going on within the nervous system once the anxiety starts.   

So, when the orthodontist tells the patient the solution for their TMD/TMJ symptoms is to straighten their teeth, he is ignoring the fact that bruxism, one of the three major causes of damage to the TMJ is caused by anxiety and stress.  The Orthodontist is also ignoring the other two causes of TMD/TMJ which are acute trauma to the face and jaws, and what is termed “functional malocclusion” which is a disharmony of facial growth and development.   

The Orthodontist does play a part, along with the Oral and Maxillofacial Surgeon in treating the patient with facial growth and development problems, but only after the initial symptoms of TMD/TMJ are resolved.  At that point, using a combination of orthodontic and surgical skills, the jaws and face can be placed in proper harmony.  This type of problem is relatively rare and only occurs in less than 5% of patients with TMD/TMJ. 

Why does the Orthodontist tell patients “Braces” will fix their TMD.  To give them the benefit of the doubt, I want to think it’s because “If the only tool you have is a hammer, everything looks like a nail”. They just have the proverbial blinders on.  I don’t want to accuse any of my orthodontic colleagues of intentionally misleading a patient.  I do believe, however, there have been examples of Orthodontists treating TMD out of simple ignorance of the facts.  Therefore, this article is partially intended to fill that void. 

One of the most esteemed Professor of Orthodontics at one of the most esteemed orthodontic programs in the county when asked, “What is the best way to treat a patient referred for the treatment of TMD?” answered, “Refer them to someone else.” 

This professor’s remark sums it up regarding the relationship between Orthodontists and TMD/TMJ. 

If you have some of the symptoms of TMD mentioned above, the solution to your problem can be reviewed at www.urbanektmj.com.