orthodontics | Sleep & TMJ Therapy

TMD Treatment: So Why Does This Treatment Take So Long?

bpadmin (lorna.goodman) — Wed, 18 Dec 2024 20:38:02 +0000

In so many of our cases, the person we treat must wear their dental oral appliance for at least a year or so to see if the articular discs will actually return to their proper place in their socket. In almost every case these past years, the condyle (top of the jawbone) goes so deeply into the glenoid fossa (the socket for the jawbone) that the articular disc (the cartilage material that covers the top of the jawbone) is displaced out of the socket. It is kind of like if your kneecap slipped off and is now off to the side- the pain can be quite extreme. Well, the condyle and disc are similar. If the articular disc is slipped off the condyle, it can and will rub into nerves and blood vessels and can lead to extreme discomfort.

In many of our cases the articular disc has been displaced for years, so to expect it to simply go back into proper position in just a month or two is not logical. Generally, we reassess your situation after working on the problem for a year or so. Most people will notice a change with the appliances in, but it takes about a year to figure out if they are doing better. If there is no improvement surgery may be recommended or just continue wearing the appliances a bit longer.

In almost all cases, the patient is doing better with their appliances even if the new MRI still shows some displacement. This is why TMD treatment can be so complicated. You really do NOT need to have a displaced disc go totally back into the socket. As long as you stop the condyle from pounding into the disc, the patient can feel better and live a good life even though

the discs may not be where they ideally should be.

In almost all cases, I can help our patients in managing the displaced discs for many years to come. Case in point; I am helping two of my immediate family members manage double displacements in both joints. The reason it works is that we took our time in the appliance therapy phase–a good year or more–and then ever so slowly erupted the back teeth so they would properly support the condyles and the discs in the sockets. Because of this, the surgery rate in my office is only one percent. That means of the 100 patients that I see in a week, only one person on average will be a surgical case. Not a bad percentage!

So, after a year or more of wearing dental oral appliances, we have to finish the case with orthodontics or crowns. Doing orthodontics is slow, boring and annoyingly time-consuming. You wear either braces or aligners for at least two to three years, and sometimes longer. The reason for this is that the back teeth need to erupt; i.e. grow upward along with the gum and bone around

them, and this process is very slow at all ages. That patient is also advised to consume a cup of bone broth daily to help stimulate the osteoblast cells (the cells that help bone grow).

So there you have it. Nothing I do is fast or exciting, but it works quite well for just about everybody. This is what I like to explain at the initial consult; allow me the time I need to help you and it is highly likely that you will feel better in the coming months!

If you currently struggle with TMJ issues and want to learn more about TMJ treatments in Falls Church, Virginia, please reach out to us. Dr. Jeffrey Brown and our team at Sleep & TMJ Therapy are excited to assist you! Just call 703-821-1103 today to learn more or schedule a consultation with Dr. Brown.

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Hi-Tech: No More Putty or Metal Brackets for Finishing Cases

bpadmin (lorna.goodman) — Wed, 20 Sep 2023 06:00:45 +0000

It is no longer necessary to put metal on your teeth for almost all orthodontic treatment. The new generation of clear aligners can in most cases work better and be healthier for you than the old-style metal brackets and wires. Because of the kind of orthodontics, Sleep and TMJ Therapy, we have found a better path to lift up (erupt) the teeth in a more controlled and healthier way in terms of your oral care brushing and flossing. In the past, using metal braces, we could erupt the teeth to better support the TM joint, the discs, and the cranium. However, new research indicates that metal wires are around 12 times more forceful than the clear plastic aligners (when using the newest technology). At our office we would use only the softest, lightest, orthodontic wires available because this gentle approach allows the teeth to erupt quite nicely and with minimal force. But if there was a better, healthier way, why not use it?

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!

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The Case of: “Why Does This Take So Long?”

bpadmin (lorna.goodman) — Wed, 06 Sep 2023 06:32:30 +0000

This is a question we hear at Sleep and TMJ Therapy almost every day. When a person hears that they need to wear an appliance or two for 12-18 months they almost inevitably want to know why it takes so long. Many people feel that the slipped discs can just be ‘pushed back into place’ and then the problem is fixed. It just does not work that way, although we all wish it would be that simple. The real problem with slipped discs is that you have to figure out how they got that way: Could it have been trauma? Maybe there was an accident that popped them out of place? Or what we see in so many cases are the back teeth are simply not tall enough to keep the condyle (top of the jawbone) from banging too hard in the socket.

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!

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