Does a bad bite = TMJ problems?
Let’s demystify the world of TMJ!
Many times I have been asked the question–will my bite lead to TMJ problems if left untreated? Logic would state that if a bite is not optimal, then there is greater risk of having issues with the jaw joints–whether it be popping, clicking, pain, limited opening or locking. Interestingly, the health and the function of the temporomandibular joint (TMJ) is multifactorial and much more complex then its relationship to teeth and occlusion. However there are certain malocclusions or “bad” bites that destabilize the jaw joint and definitely put a patient at higher risk for TMJ problems. Let’s demystify the world of TMJ!
First off, a little anatomy lesson is in order. The temporomandibular joint is the joint that connects your lower jaw to your skull. It is held in place by a series of ligaments and muscles that form a sling on the inside and outside of the jaw bone. At the point where the joint articulates or hinges with the skull, there is a fibrocartilaginous disc that acts as a “shock absorber” between the articulating (condylar) head of the lower jaw and the fossa of the skull. This disc serves the important role of protecting the two bony surfaces from damage as the jaw opens and closes. The disc also moves with the lower jaw providing further protection throughout the full range of motion. Speaking of which, our lower jaw goes through an interesting disarticulation to achieve maximum opening–the first half of opening is due to the rotation of the joint while the second half is due to a translation or “glide” of the lower jaw forward along the fossa in our skull. This allows us to open ~50mm on average or about the width of three fingers. Very cool!
Now, where does the pain or joint noise come from? The pain can come from different sources but the two common culprits are the muscles and jaw joints. Muscular pain can be due to overstimulation of the jaw closing muscles of which there are 2 primary muscles: the masseter and temporalis. The masseter muscle is the muscle you feel when you press on your cheek and the temporalis is the muscle by your temple that extends back behind your ear. The other source of pain can come from your joint. This can be due to a forward disc position where the condylar head is touching the tissue behind the disc, which is more highly innervated, or the pain can arise from a degenerative change in the joint due to arthritis or injury. As per noise, this is typically due to the disc being displaced forward when opening then popping back into place as the jaw is shifted.
A lot of people begin to develop TMJ symptoms in their teens but it is most commonly reported in women between the ages of 20 and 40. Fortunately, most TMJ symptoms resolve on their own with time–especially if the symptoms involve joint noises or mild locking / catching. More concerning issues involve pain–especially if the pain gradually worsens. There are some at home treatments that can be employed when TMJ symptoms flare up–especially when symptoms are acute and the onset is sudden. The application of ice and moist heat to the offending jaw joint or sore muscle along with the ingestion of an anti-inflammatory (ibuprofen or aspirin) can help reduce pain and inflammation. It is also a good idea to stay on a soft diet, limit opening wide and avoid any habits that place pressure on the jaw joint (examples include gum chewing, side sleeping, leaning on the lower jaw with the palms of the hands or cradling a phone between the shoulder and cheek). Also, be mindful not to hold tension in your jaws or clench your teeth during the day–repeat the mantra “lips together, teeth apart”. There are also some exercises that can be performed to stretch and massage the muscles to help them relax.
As stated earlier, TMJ problems are multifactorial and the presence of a malocclusion (or “unfavorable” bite) does not necessarily mean that problems with one’s jaw joints or function are looming around the corner. There are many, many people with very poor bites that have no problems with their TMJ’s and there are many patients with normal occlusions that suffer from TMJ signs and symptoms. Research has shown that patients who have malocclusions characterized by deep, impinging bites (100% coverage of their bottom teeth by their top teeth and tipped back upper teeth), open bites (only occluding on a few back teeth) and crossbites of the posterior teeth (where there is also a shift upon closure) have a tendency to experience more complications with jaw problems. Especially in conjunction with other factors such as stress, trauma, wear or disease.
If you have any questions about your bite or are experiencing jaw issues, discuss your concerns with your dentist. A referral to the orthodontist, oral surgeon or TMJ specialist may be in order. Fortunately TMJ therapy and intervention has advanced in recent years and there are many good treatment modalities if home remedies do not provide relief.
If you have questions about the benefits of Invisalign treatment, please call Visage Orthodontics at 505-670-6145 or visit our appointment page to schedule a complimentary consultation with me, Dr. Tanner, your Santa Fe Invisalign specialist. I will review everything in detail and develop a customized treatment plan to fit your lifestyle and budget.
A confident and beautiful smile is right around the corner!