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TMJ is the quick way of referring to your Temporomandibular Joint. Pardon the pun, but that’s quite a mouthful! What is this joint, what does it do, and, if your Dr. Paul Gates and our team have told you that you have a TMJ disorder, what can we do to help?

The Temporomandibular Joint

Your two temporomandibular joints are amazing works of anatomical design. These are the joints where the temporal bone in the skull meets the mandible bone of the jaw, and allow our mouths to open and close, move back and forth, and slide from side to side. Muscle, bone, and cartilage work together to provide easy movement and to cushion the joint. But sometimes, the joint doesn’t work as smoothly as it should, and this can lead to Temporomandibular Joint Disorder, or TMD.

When Should You Suspect You Have TMD?

You might have TMD if you experience any of these symptoms:

• Painful chewing
• Pain around your TMJ, or in your face or neck
• Earaches
• Changes in your bite
• Jaws that are limited in movement or lock open or shut
• Clicking, popping or grating noises when you open and shut your jaw

There are many conditions linked to TMD. If you grind your teeth at night, have arthritis in the jaw, have suffered an injury or infection in the area, or have problems with your bite, for example, you might be more likely to have TMJ problems. If you suspect you have TMD, or suffer from any of the symptoms listed above for an extended period, give us a call.

Treating TMD

During your visit to our Round Rock, TX office, we will check your medical history, and examine your head and neck. We can take an X-ray or scan if needed for further examination of the joint. Because there is no real scientific agreement yet about the best way to treat TMJ disorders, a conservative treatment plan is often best. If you do show signs of TMD, we might first suggest relaxation techniques, over-the-counter pain relievers, or the use of ice packs or moist heat compresses. A change to a softer diet can help, and you should stop chewing gum and making any exaggerated jaw movements.

If these self-care practices aren’t effective, we might suggest a nightguard. This appliance is a comfortable and flexible mouthguard custom fitted for you, and will bring relief from teeth grinding when worn at night. If this treatment is not effective, talk to us about other options.

Luckily, most cases of TMD are temporary and don’t become worse over time. But any persistent discomfort is a good reason to visit us. Whether you have TMD, or any other problem causing you pain in the head or jaw, we want to help.

Whenever we bite down, we’re applying force with our jaw muscles. Functional appliances direct these forces to create healthier tooth and jaw alignment. They’re used to help correct bite problems and to encourage symmetrical jaw growth.

Functional appliances aren’t always necessary. Because every child’s teeth and bite are different, orthodontic treatment at our Round Rock, TX office is carefully tailored to your child’s individual needs.

• For the child with minor tooth misalignment, traditional braces or aligners might be all that’s needed.
• For the child with a minor malocclusion, or bite problem, an orthodontist might use elastics (rubber bands) to bring teeth into healthy alignment.
• For the child who has a more serious malocclusion, involving both tooth and jaw alignment, an orthodontist might recommend a functional appliance.

A severe Class II malocclusion can be caused when the upper jaw or teeth are positioned too far forward, and/or the lower jaw is too small or positioned too far back. Common Class II malocclusions include:

• Open bite—the front teeth don’t touch when the back teeth bite down, or the back teeth don’t touch when the front teeth close.
• Overbite—some overbite is normal. A deep overbite occurs when the upper teeth significantly overlap the lower teeth.
• Overjet—the upper front teeth protrude further horizontally than they should.

Today’s functional appliances come in a variety of designs to treat Class II malocclusions. They can be fixed or removable. They can be used with or without braces. Some are designed to expand the upper palate to make sure there’s room for all the permanent teeth. What they all do is advance the position of the lower teeth and jaw to create a healthier, more comfortable bite.

Fixed devices are attached to the teeth and meant to be used full-time. These include the Forsus™ device, the Herbst® appliance, and the MARA appliance.

• Forsus Device

This appliance works with braces. A spring coil rod is most often attached to bands on the first molars on the upper jaw. It’s then connected to the arch wire on the lower jaw. Just like elastics—but more effective!—these spring coil rods provide gentle forward pressure that encourages the lower jaw and teeth forward.  

• Herbst Appliance

The Herbst appliance also applies forward pressure to the lower jaw using telescoping rods connecting the upper and lower teeth. The rods expand as the mouth opens, and telescope together as it closes, positioning the lower jaw further forward while the upper jaw is held back. The Herbst can be worn alone or with braces, and can also be used to expand the upper palate.

• MARA Appliance

The MARA (Mandibular Anterior Repositioning Appliance) uses an adjustable “elbow” piece connecting bands on upper and lower molars to guide the lower jaw and teeth forward when the jaw closes.

Removable appliances such as Bionator and Twin Block appliances can also improve Class II malocclusions. They are meant to be worn for a specific number of hours each day, and can be taken out for sports or other activities as needed. Because it’s essential to get all the necessary hours in, removable appliances require commitment!

• Bionators

A bionator is made of wire and acrylic, and it looks a lot like a retainer. The wire fits around the upper front teeth. It’s attached to a smooth piece of acrylic that sits behind the upper teeth and is shaped to guide the lower jaw forward when biting down. The bionator can also be adjusted to expand the upper palate.

• Twin Block Appliance

The twin block appliance uses two separate pieces made of wire and smooth acrylic. Both pieces are modeled to fit precisely over the upper and lower arches. The acrylic “blocks” fit over the biting surfaces of the teeth, working together like a 3D puzzle. When your child bites down, the upper blocks slide into place behind the lower blocks, pushing the lower jaw and teeth forward. The top plate can also be adjusted to expand the upper palate if needed.

Because these appliances are best used while a child’s bones are still growing and developing, dentists and orthodontists recommend an orthodontic evaluation by age seven. Early treatment with a functional appliance can help correct serious bite problems before or together with braces. In some cases, functional appliances may reduce the need for headgear or surgery.

Todays’ orthodontic technology has made functional appliances more comfortable and efficient than ever before. Talk to Dr. Paul Gates to discover how an individualized treatment plan and a custom appliance can give your child a healthy bite and a lasting smile.

Getting braces is a huge step in creating the beautiful smile you want. It’s easy to see how important your wires and brackets are. Week by week, you and your family and friends can see the progress you’re making as your teeth become straighter. That makes all the careful brushing, periodic adjustments at our Round Rock, TX office, and annoying loose ligatures worthwhile.

And while straight, even teeth are the visible reward you get for your months in braces, there’s a benefit that’s every bit as important that might go unnoticed by your friends and family—a healthy, properly aligned bite.

Many people have some kind of malocclusion, or bad bite. There are several different bite problems we treat. Some of the most common are:

• Overjet (the upper front teeth protrude too far forward over the bottom teeth)
• Underbite (the bottom teeth overlap the top teeth)
• Crossbite (one or more teeth haven’t come in in the proper position, often with an upper tooth fitting inside a lower tooth)
• Open bite (the upper and lower front teeth don’t touch).

When the jaws and teeth don’t fit together properly, you might be looking at damaged teeth, headaches, and painful problems with the temporomandibular joint, or jaw joint, in your future. That’s why correcting your bite early is so important. Using rubber bands with your braces is one of the most popular and effective ways to help create a better bite.

Bands are used with your braces to gradually move your teeth into their best position. Specially designed brackets with tiny hooks are bonded to very specific teeth. Why so specific? Because the placement of the brackets depends on which type of malocclusion we are correcting. Rubber bands are then attached to the bracket hooks, usually from an upper tooth to a lower one. When they are in just the right position, those little bands provide just enough force to move your teeth more quickly and effectively than braces alone can.

If you need bands to help correct any kind of malocclusion, you will play a very important part in your orthodontic treatment. It will be your job to attach your bands every day. Don’t worry—while it can seem confusing at first, we’ll make sure you know exactly how and where to place them.

How long should they stay in? You’ll probably need to wear your bands 24 hours a day. It’s while you’re moving your mouth and jaw muscles that your bands are working their hardest. Talk to us about removing them for brushing and flossing, and whether you should wear them while you eat.

Can you use the same bands over several days? Not a good idea. Bands are selected for size and strength to move your teeth very precisely from visit to visit. When bands stay on too long, they become too stretched out to supply the proper pressure needed to move your teeth efficiently. Dr. Paul Gates will let you know how long is too long for your specific bands.

Are two bands better than one? Absolutely not. Again, the bands you’re given at each visit are designed for your specific needs. Too much pressure can actually be harmful. Just keep to your recommended schedule of replacing bands, and your orthodontic treatment will stay right on track.

Attaching rubber bands? Keeping them on all during the day? Replacing them as needed? All of these responsibilities might seem a bit overwhelming at first, but we are here to give you all the information and support you need to succeed. Because straight, even teeth and a bite that is healthy and functional? That’s truly how you create your beautiful smile!

If you are planning on taking a vacation this summer, we ask that you let us know ahead of time so that we may schedule your summer appointments more efficiently. We also encourage patients and their parents to be proactive in determining when they make their summer appointments.

If you will be gone for an extended period (more than six weeks), we recommend you visit Round Rock Orthodontics prior to leaving and schedule another visit shortly after your return. Lastly, please remember not to indulge in hard, sticky, and chewy treats while enjoying your vacation. We look forward to seeing you soon and hearing about your adventures!