Understanding TMJ Disorder

TMJ disorder affects the joints and muscles that control jaw movement. This can lead to symptoms like pain, difficulty chewing and even locking of the jaw. Despite these clear indicators, TMJ disorder often goes undiagnosed. In a study by Johansson et al. (2002), it was found that 6.7% of males and 12.4% of females experience TMJ-related pain. Additionally, data from the National Health Interview Survey in 1993 revealed that 3.5% of males and 6.9% of females reported experiencing pain in the jaw joint or in front of the ear on multiple occasions over six months. These statistics highlight a gender disparity in TMJ disorder prevalence that underscores the need for better understanding and treatment options.

The Role of Medical Training in TMJ Awareness

The limited awareness of TMJ disorder can be traced back to the training of healthcare providers. Very few dentists and medical professionals receive adequate education on TMJ disorders, which contributes to the lack of comprehensive care available for sufferers. This lack of training means the condition is often misdiagnosed or not recognized at all. As a result, many patients do not receive the specialized care they need, leading to ongoing pain and discomfort. Increasing TMJ-specific training in medical and dental programs could significantly improve diagnosis and treatment outcomes for patients. Many physicians tell their patients that it is not something they can see and refer them to other healthcare providers like an ENT, PT or Osteopath doctor.

Common Misdiagnoses and Overlapping Symptoms

TMJ disorder is frequently mistaken for other conditions due to its overlapping symptoms, such as headaches, ear pain and neck tension. For instance, the Osteoarthritis Initiative (2007) discovered that 3.8% of males and 10.9% of females aged 45-79 with a history of knee pain also reported jaw joint or ear pain in the past 30 days. This finding suggests that TMJ pain can easily be confused with other joint disorders, leading to inappropriate or delayed treatment. Educating healthcare providers to recognize these overlapping symptoms can help differentiate TMJ disorder from other conditions and prevent unnecessary treatments.

These overlapping symptoms often result in TMJ disorder being misdiagnosed as more common conditions like migraines, ear infections or even dental issues unrelated to the temporomandibular joint. Headaches caused by TMJ disorder can mimic migraines, making it difficult for both patients and doctors to identify the root cause without specialized knowledge. Ear pain, a common TMJ symptom, is often misattributed to ear infections, particularly in the absence of visible signs of ear problems. Neck tension and pain can lead to a misdiagnosis of cervical spine issues, diverting attention away from the actual problem in the jaw.

Tinnitus — hissing, buzzing and/or ringing in the ears — is often a TMJ problem. This is why an MRI is so critical in determining what the problem is. If the articular disc has slipped forward of the jaw bone (the condyle), this can readily push the condyle back and into the region of the ear. This is where so much ear pain and tinnitus can come from. The problem is that it requires an early enough diagnosis before nerves are damaged badly enough that they cannot be repaired. The TM joint is heavily innervated, meaning if the discs are slipped, they could readily damage the nerves surrounding the joints.

Healthcare providers’ limited training in TMJ disorders compounds these misdiagnoses. Very few dentists and doctors (not all) have the expertise needed to identify TMJ disorder accurately, leading to a cycle of incorrect diagnoses and ineffective treatments. Patients may undergo multiple consultations and treatments for symptoms that never fully resolve because the underlying TMJ disorder remains unaddressed. I have personally heard many stories of patients going on antibiotics for months on end to treat ear problems, or having tubes placed, when the real problem was simply a slipped disc.

Improving the education of healthcare professionals about TMJ disorder is crucial for better diagnosis and management. When doctors and dentists can more accurately identify TMJ disorder, they can provide appropriate treatment plans tailored to alleviate the specific symptoms associated with the condition or refer to a specialist. Addressing this educational gap can significantly reduce the incidence of misdiagnoses and ensure that patients receive the care they need for lasting relief. It is our mission within our practice to do so.

The Impact of Public Awareness Campaigns

Public awareness campaigns are essential for bringing TMJ disorder into the public eye. Increasing awareness can help individuals recognize symptoms early and seek the appropriate care they need. Currently, TMJ disorder has not been prominently featured in widespread public health campaigns, leaving many people unaware of its existence and impact.

Raising awareness can lead to several positive outcomes. Firstly, it can prompt individuals to seek medical advice sooner, potentially leading to earlier diagnosis and treatment. Early intervention can prevent the condition from worsening and improve the quality of life for those affected. Secondly, heightened public awareness can create a demand for more specialized care, encouraging healthcare providers to develop expertise in TMJ disorders. This, in turn, can lead to more comprehensive and effective treatment options.

Public campaigns can also help dispel myths and misconceptions about TMJ disorder. Many people might dismiss their symptoms as insignificant or believe that jaw pain is a normal part of life. Educating the public about the seriousness of TMJ disorder can help people understand that their symptoms are valid and treatable. By providing clear information about the symptoms, causes and available treatments, public health campaigns can empower individuals to take control of their health.

Additionally, increased awareness can foster a sense of community among those who suffer from TMJ disorder. People may feel isolated or misunderstood because their symptoms are not widely recognized. Public awareness initiatives can connect individuals with support groups and resources, offering a network of understanding and shared experiences.

Moreover, raising public awareness can influence policymakers and funding bodies to allocate more resources toward TMJ research and treatment. Increased funding can lead to breakthroughs in understanding the disorder and developing new, more effective treatments. By spotlighting the issue, public campaigns can drive systemic changes that benefit everyone affected by TMJ disorder.

Public awareness is a great beginning. This is a big reason we reach out to our referring providers to provide educational classes on how to screen. In addition, with our practice, we educate the patient as well. We show on models how the disc behaves and how it is affecting the patient and causing their symptoms. In addition, Dr. Brown participates as a guest speaker at seminars for healthcare providers to share cases and show how the symptoms relate to the rest of the body. The goal is always to educate and share screening techniques. This translates to how we help these patients with their craniofacial pain.

The Importance of Specialized Care

Managing TMJ disorder effectively requires specialized care from professionals who understand the condition’s complexities. TMJ disorders often involve a variety of symptoms that can be influenced by hormonal factors, especially in women. Research has shown that women who use either supplemental estrogen or oral contraceptives are more likely to seek treatment for TMJ disorders. This suggests that hormonal changes could exacerbate TMJ symptoms, making it even more crucial for healthcare providers to consider these factors when diagnosing and treating the disorder.

Additionally, TMJ disorders can be interconnected with other conditions such as fibromyalgia, rheumatoid arthritis and sleep apnea. A specialized approach can help identify these connections and tailor treatment plans accordingly. This is why a multidisciplinary approach often proves beneficial, involving dentists, orthodontists, rheumatologists and other specialists to provide comprehensive care.

In-depth knowledge of TMJ anatomy, pathophysiology and the latest treatment options is crucial for creating effective treatment plans. This includes understanding the role of physical therapy, occlusal appliances and surgical interventions when necessary. Specialized care can also focus on pain management techniques tailored specifically for TMJ-related pain, which may differ from standard pain management approaches.

By seeking care from professionals trained in TMJ disorders, patients are more likely to receive accurate diagnoses and effective treatment plans. This specialized care can lead to significant improvements in quality of life, reducing symptoms such as chronic pain, headaches and jaw dysfunction. Given the complexity and the broad impact of TMJ disorders, specialized care is not just beneficial but essential for those affected.

The actual treatment for people with TMD usually involves wearing some small appliances in the mouth that allow room for the discs to go back into place if they can. If they are unable to return to their proper position, it may be possible to manage them or do surgery to finally fix the problem. In almost all cases, surgery can be avoided and the patient can live a very normal lifestyle with displaced discs. This is why it is important to meet with a TMJ doctor who understands all the various issues.

The Future of TMJ Research and Treatment

The future of TMJ research and treatment is filled with potential advancements that could revolutionize care for those affected by this disorder. Ongoing research aims to uncover the underlying causes of TMJ disorders, which could lead to the development of more targeted and effective treatments. One promising area of research involves genetic studies, which may help identify individuals at higher risk and facilitate early intervention.

Advances in imaging technology, such as MRI and 3D CT scans, are improving our ability to diagnose TMJ disorders accurately. These tools allow for a more detailed understanding of the joint’s structure and any abnormalities present, leading to more precise treatment plans. Additionally, innovations in minimally invasive surgical techniques offer new options for patients who require surgical intervention, potentially reducing recovery times and improving outcomes.

Interdisciplinary collaboration is becoming increasingly important in TMJ research. By bringing together experts from fields such as dentistry, rheumatology, neurology and physical therapy, researchers can develop a more comprehensive understanding of TMJ disorders and create holistic treatment approaches. This collaborative effort can also lead to the discovery of connections between TMJ disorders and other conditions, such as sleep apnea and chronic pain syndromes, allowing for more integrated and effective care.

Telemedicine is also emerging as a valuable tool in the management of TMJ disorders. Virtual consultations can make specialized care more accessible, especially for patients in remote areas or those with mobility issues. This technology enables continuous monitoring and follow-up, ensuring that treatment plans are adjusted as needed to achieve the best outcomes.

The role of patient education and self-management is gaining recognition in the treatment of TMJ disorders. By providing patients with the knowledge and tools to manage their condition, healthcare providers can empower them to take an active role in their care. This approach can include techniques such as stress management, dietary modifications and exercises to improve jaw function.

As awareness of TMJ disorders increases, so too will the availability of funding for research and treatment development. This financial support is crucial for driving innovations that can ultimately improve the quality of life for those affected by TMJ disorders. With continued effort and investment, the future holds promise for more effective, accessible and comprehensive care options.

We Are Here To Help!

At Sleep & TMJ Therapy, Dr. Jeffrey Brown and the team are here to help you get the care you need for TMJ disorder symptoms in Falls Church, Virginia. Call 703-821-1103 to learn more or schedule a consultation.

The post The Mystery of TMJ Disorder Explained! first appeared on Sleep & TMJ Therapy.

At its core, the temporomandibular joint (TMJ) is an intricate mechanism crucial for facilitating a myriad of facial movements. Unlike most other joints in the body, the TMJ operates through both hinge and sliding motions, a duality that permits the extensive range of jaw movements required for talking, chewing and yawning. This joint comprises a delicate assembly of bones – the mandible, or lower jaw, and the temporal bone of the skull – cushioned by a small, shock-absorbing disc that ensures movements are smooth and frictionless.

The functionality of the TMJ relies on a balanced interaction among its components – muscles, ligaments and the disc. These elements work in harmony to manage the stresses exerted during jaw movements. However, this balance is easily disrupted, making the TMJ susceptible to disorders. The complex nature of this joint, coupled with its essential functions, underscores the critical need to understand its anatomy and physiology comprehensively.

The significance of the TMJ extends beyond mere mechanical operations; it is intertwined with a network of muscle and fascial connections throughout the head, neck and shoulders. This interconnectivity means that dysfunction in the TMJ can have cascading effects on surrounding muscles and joints, leading to a range of symptoms that may initially appear unrelated to the jaw. For instance, issues with the TMJ can trigger tension headaches, neck stiffness and even impact posture. When the discs within the TM joints are displaced, this can cause dizziness, visual problems and even tremors. In some cases, the displaced disc causes compression on the c-spine which then leads to compression of the airway.

In essence, grasping the basics of the TMJ’s structure and function is paramount for recognizing its role in daily activities and the potential consequences of its dysfunction. This understanding is the foundation for identifying early signs of TMJ disorders and taking preventive measures to avoid them, highlighting the TMJ’s pivotal role in maintaining not just oral health, but overall physical well-being. To diagnose TMJ disorder, it is important to work with a doctor who does a comprehensive analysis including an MRI of the discs, along with an X-ray: a CBCT that will examine the bones of the head and neck region. In my practice, this allows for an additional component, measuring the airway. The airway can be affected by TMJ disorder by simply causing compression of the c-spine which then pushes into the air passage.

In the fabric of our everyday existence, the temporomandibular joint (TMJ) stands out as an underappreciated hero. This small yet mighty joint is not just a mechanical marvel allowing for the opening and closing of the mouth; it is deeply embedded in the quality of our daily life, influencing eating, speaking and even emotional expression. The seamless operation of the TMJ facilitates the enjoyment of a meal, the articulation of thoughts and feelings and the subtleties of non-verbal communication through facial expressions.

The complexity of the TMJ’s role is further highlighted when considering the intricacies of tasks it supports. For instance, the act of chewing involves a delicate balance of muscular coordination and joint movement that the TMJ makes possible. Similarly, the clarity and variety of speech – from whispering to shouting – rely on the precise movements facilitated by this joint. Beyond these evident roles, the TMJ’s function extends to the realm of emotional expression. The ability to smile, frown or show surprise involves nuanced movements of the jaw that the TMJ supports, playing a critical role in human interaction and emotional connectivity. Sleep also is affected by this little disc. The pain or discomfort while trying to sleep causes disruption in sleep patterns, restlessness or in some cases insomnia.

However, this multifunctionality comes at a cost. The TMJ’s critical role in such a wide array of activities means that when disorders strike, the impact is widespread, touching upon basic functions and reducing the quality of life. The interconnectedness of the TMJ with other bodily systems underscores the importance of its health for the seamless execution of daily tasks. Recognizing the TMJ’s multifaceted role in daily life is not only a step towards appreciating its complexity and sensitivity but also a call to action for its care and preservation, ensuring that it continues to support the myriad activities that enrich our lives.

TMJ disorders manifest a variety of symptoms that can profoundly alter daily functioning and personal well-being. Individuals grappling with these conditions may experience persistent jaw discomfort, difficulty in mastication (chewing) and even challenges in articulation, which are central to both nourishment and communication. The pain may not be confined to the jaw alone; it often radiates, leading to headaches, earaches, ringing in the ear, neck pain, back pain and a pervasive sense of discomfort that can disrupt sleep and concentration. The other aspect of this disorder can cause the disc to put such force on nearby nerves causing tremors or ticks. The audible clicking or popping sounds accompanying jaw movements, a hallmark of TMJ disorders, can add an additional layer of distress, creating social and professional awkwardness.

Moreover, the restrictive effect TMJ disorders have on jaw mobility, limiting one’s ability to open or close the mouth fully—can significantly compromise eating habits and nutritional intake, leading to broader health implications. This limitation can also impinge on social interactions and personal relationships, as the simple joys of conversation and dining with others become sources of pain and frustration.

The repercussions of TMJ disorders extend into the professional realm, where sufferers may find it challenging to maintain focus and productivity due to the constant distraction of discomfort.  A malaligned body may also add discomfort. Starting with the face, one side may be elevated causing a pull on the neck which then trickles down the body causing your posture and or stance to be uneven. The resultant decrease in quality of life can also exacerbate feelings of stress and anxiety, further intensifying the physical symptoms of TMJ disorders in a relentless feedback loop.

The ripple effects of TMJ disorders highlight the critical nature of early detection and management to mitigate these impacts. Understanding the potential severity of these conditions underscores the importance of seeking prompt and effective treatment, not only to address the physical manifestations but also to safeguard one’s overall quality of life. Engaging in preventive care and adopting lifestyle adjustments can play pivotal roles in managing the delicate balance of TMJ health, thereby minimizing the risk of such profound consequences. Generally, appliance therapy use is a great way to help realign and help the disc move back into place. Within our practice we use two types of appliances: ALF and Modified Gelb. (Check out our other blogs on how these two types of appliances help the body.) Typically, the effects of wearing the appliances can be felt within two to three months. Relief from the symptoms, or at least a great reduction, is generally reported.

The Temporomandibular Joint (TMJ) serves as a critical intersection between oral functionality and systemic health. Disorders of the TMJ have been found to intersect with a variety of systemic conditions, suggesting a bidirectional relationship where each can influence the severity and progression of the other. For example, individuals with chronic inflammatory conditions such as arthritis may experience an exacerbation in TMJ symptoms, highlighting the joint’s sensitivity to systemic health changes. Similarly, conditions like fibromyalgia, which affects the musculoskeletal system, can compound the pain and dysfunction associated with TMJ disorders. Another common condition is EDS. With the lax connective tissue, the discs typically are not in place.

Moreover, the TMJ’s condition often mirrors the body’s stress levels. Stress and anxiety do not just affect mental health; they manifest physically, often tightening the jaw muscles and exacerbating TMJ discomfort. The clenching and or grinding of the teeth can lead to additional dental problems: cracked or sensitive teeth, gum recession and even tooth loss. This interplay underscores the importance of holistic health approaches in managing TMJ disorders. Effective management strategies extend beyond the physical aspects of TMJ care to include stress reduction and mental health support, reflecting the comprehensive impact of TMJ health on one’s life.

This intricate connection between the TMJ and broader health concerns suggests that maintaining TMJ health is not just about alleviating local symptoms but about supporting the body’s overall balance and well-being. The relationship emphasizes the necessity for a multidisciplinary approach to treatment, integrating dental care with broader medical and psychological support to address the full spectrum of factors influencing TMJ health and, by extension, quality of life.

Caring for your temporomandibular joint involves simple, yet effective strategies that can significantly contribute to preventing discomfort and disorders associated with TMJ. One of the key aspects of TMJ health is mindful management of stress, as tension can lead to unconscious clenching or grinding of teeth, further straining the joint. Techniques such as meditation, deep breathing exercises and yoga can be beneficial in mitigating stress levels, thereby indirectly protecting the TMJ. While in treatment within our practice, we offer additional adjunctive services to help relax the muscles to allow for the disc movement back into place. TMJ massages, non-surgical laser therapy, the Neubie machine, and Botox when needed can help get the muscles trained to relax and not always in tension.

Another critical factor is being conscious of jaw movements. Habits such as chewing gum excessively, biting nails or grinding teeth can exacerbate wear and tear on the TMJ. Being aware of such habits and working to minimize them can help maintain joint integrity. Similarly, when yawning or eating, it is advisable to avoid opening the mouth too widely to prevent overextension of the TMJ.

Implementing a routine that includes jaw exercises and stretches can also be instrumental in maintaining a healthy TMJ. Gentle stretching can help increase the flexibility of the jaw muscles, while strengthening exercises can improve their function, reducing the risk of TMJ-related issues. These exercises should be performed with care to avoid any sudden or forceful movements that could potentially harm the joint. Within our practice, treatment is a multi-dimensional approach working with a recommended physical therapist or osteopath to help realign the rest of the body as the cranium becomes more aligned and the jaw and disc are moving into the proper anatomical position. Together many have found a reduction of symptoms during the course of treatment. There are many dentists in the country who now have a good handle on treatment for TMJ disorder and they are the ones you should seek to help treat the whole body problems.

Attention to posture, particularly while working or using electronic devices for extended periods, can also impact TMJ health. Poor posture can strain the neck and shoulder muscles, creating a domino effect that places additional stress on the TMJs. The flow starts with your shoulders being slumped. This causes your head to protrude forward and causes additional strain on the c-spine (the neck). The strain is then moved to the TMJs. It is best to make sure that your workspace is ergonomically set up to support good posture. This can help alleviate unnecessary tension in the TMJ.

Finally, regular check-ups with a dental or TMJ specialist can provide early detection and intervention for any signs of TMJ disorders. These professionals can offer personalized advice and treatments to address individual needs and prevent potential complications. By adopting these preventive measures, you can support the health of your TMJ, contributing to overall well-being and quality of life.

If you have questions about TMJ treatments in Falls Church, Virginia, Dr. Jeffrey Brown and our team at Sleep & TMJ Therapy have the answers you need. We welcome you to call our office at 703-821-1103 to learn more or schedule a consultation.

The post Sensitive Areas of the Body: The Significance of TMJ first appeared on Sleep & TMJ Therapy.

As we all know, a smile makes everyone feel better. But do you know why? There are several reasons. First of all, a smile relaxes the muscles of the face and calms the nervous system. There is a nerve called the vagus nerve and when you smile, the vagus nerve is activated, and the body relaxes more. Laughing actually sends more oxygen to the brain which helps the whole body feel better. As more oxygen circulates, it helps to flush the byproducts of the cells in the body and  effectively you are doing a cleanse.

During a smile, the neurons in your body release dopamine, endorphins and serotonin which are the neurotransmitters that reduce depression and aggression. These are the ‘feel good’ neurotransmitters. Think of it like a runner’s high, you feel really good, really light and airy when on a good run and things are clear and bright. The best thing about smiling may be that it is free and easy to do.

Along with increasing the ‘feel good’ hormones being produced, there is a reduction in the stress-enhancing hormones. These hormones are cortisol and adrenaline. Cortisol and adrenaline are great hormones when we are being chased by a sabretooth tiger that is intent on eating us, as our muscles go into a high-stress mode so we can basically run away faster. However, the lactic acid will build up and make those muscles very sore later on. This is why smiling helps, less of the stress hormones and more of the calming neurotransmitters.

Another reason for a big smile is that when you show those pearly whites, you are opening yourself up to others. You are telling other people that you are happy to see them and want to be around them. We are all creatures who crave companionship and when other people want to be around you, it makes you feel wanted and cared for. Just this feeling of companionship has its own healing power. When we open up to others, we stimulate endorphins to be produced, and this is certainly a great way to improve our health. And when the other person smiles back at you, they are now producing endorphins as well. So, make someone happy, smile at them, get their endorphins going and make it a better day for everybody!

Call Today

If you would like to learn more, please call our experienced team in Falls Church, Virginia to schedule a visit with Dr. Jeffrey, Brown. Call 703-821-1103 today.

The post How Does Your Smile Make You Better? first appeared on Sleep & TMJ Therapy.

Did you know that your tongue can hold fat deposits, just like your belly? If you were ever overweight in the past, your tongue would likely have fat deposits in it, and these are kind of hard to lose. The tongue, like any other muscle in the human body, needs to exercise. But like most patients who are referred to a myofunctional therapist, they don’t go, they won’t do it. It costs money and time, and they feel like it’s kind of silly to exercise this area of the body. Well, folks, it does work and does make lots of sense, so get out there and start exercising that tongue!

In so many cases where a patient has sleep apnea, the tongue is quite large and is full of fat tissue. This can readily be seen on an X-ray that shows the tongue and what can be seen is that the tongue is elevated because it is thick due to fat deposition. Like so many areas of the human body, if you exercise the tongue and surrounding tissues, the fat will decrease over time which will effectively open the airway for better breathing. Snoring usually reduces as well as the tongue becomes smaller and tighter. The tissues around the tongue also become more toned with these exercises so if you have sleep apnea, it might reduce as you exercise this area over time. In fact, in many of the dental sleep medicine training programs, it is taught that myofunctional exercises are mandatory to improve a patient’s health.

There are other obvious benefits to exercising your tongue.  Your speech and articulation of words are improved, caused by the weakness in the tongue. If you have Dysphagia (trouble swallowing), your ability to develop a stronger tongue able to move more easily and then swallowing becomes easier. Finally, another plus is the jawline. Tongue exercises include the muscles groups below the chin and toning of the jawline begins.

So once again, dear reader, consider sticking out your tongue and making it work like it has never worked before. Get that tongue at attention! Get that tongue out there into the real world! Make that tongue healthier, happier, and improve your life!

The post The Case for Tongue Exercises – REALLY? 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.

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