Dr. Kandi Disha Yermal
Dentistry
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have a TMJ problem. My jaw cramps and can be painful while opening. As for TMJ, I cannot remember ever being able to open my mouth wide open without cramping. Only recently has my left jaw joint been painful. I have had braces for two years to fix my crossbite. My lower right canine was over my upper right canine. That was fixed, but my bite is still uneven. When I bite down, my upper right canine makes contact with my lower premolar. My canine makes no contact on the left side, and only the molars and premolars bite together. I think this imbalance is causing me problems. I have had two different opinions. My current orthodontist says I should wear elastic from the upper left canine to my lower canine so they get contact. Another orthodontist disagrees and believes my upper jaw is larger than my lower jaw, so I need to shave in between my lower teeth and fit inside the upper teeth. I did my research online and thought maybe palatal expansion would be a good idea for me. I wanted to know if any orthodontist would agree with this. My upper molars seem to be uneven, and I thought palatal expansion would help my bite. I thought it made more sense than shaving in between my lower teeth. Would a device for the palate be an appropriate treatment? Do most orthodontists offer this treatment?
Hello,
Welcome to icliniq.com.
I have gone through your query and images (attachments removed to protect patient identity).
I can see braces on the upper anterior teeth only. There are no braces on the posterior teeth in the upper arch. I want to know the reason why braces are not present on the posterior teeth. In my opinion, there is no major bone discrepancy when thinking about palatal expansion. Moreover, age also matters when thinking of palatal expansion. In your case, a clinical checkup is necessary to know the exact cause of the TMJ problem, but when taking occlusal discrepancy as a cause, then in your case, if proper repositioning of the bracket and bonding of all teeth, including molars, will help to obtain an appropriate occlusion. The remaining occlusal balance or plane can be obtained by using elastic bands. It will be helpful if you upload the image of your teeth from the right and left side after occluding teeth tightly. I want to know if have a habit of bruxism because jaw cramping may be because of occlusal imbalance or bruxism.
Get back with the above details for further discussion.
Regards.
Patient's Query
Hello doctor,
Thanks for the reply.
One of the orthodontists said he would not add braces for the posterior teeth because the upper jaw is larger than the lower. The orthodontist I visit said that I do not need it. I am assuming they have a good reason. I do have bruxism, but it is a habit of unconsciously trying to put my teeth in a better place, being they do not fit well. Another thing that bothers me is trying to sleep. When I lay on my right side, my right canine catches my lower jaw and resists gravity. When I lay on my left side, my left molars fit together, and I hold my jaw that way. Which is the naturally correct side? Other things, I wonder. Should I continue to try and use an elastic on the left side to bring the left canine down? Should I ask about shaving the right canine so that it is not the first point of contact when I bite down?
Hello,
Welcome back to icliniq.com.
I have gone through your images (attachments are hidden to protect the patient's identity).
Yes, I can say that there is no major occlusal discrepancy. When occluding and biting, there should not be any premature contact of one tooth, and yes, that should be treated. The exact treatment option can be suggested only after a clinical checkup and observation for balance occlusion. As you have mentioned, you have a habit of bruxism, whatever the cause behind it, but it should not be there. It leads to the wearing or attrition of teeth and causes tooth loss. Bruxism is also one of the reasons for morning headaches and TMJ (temporomandibular joint) pain. Yes, if there is a minor occlusal discrepancy that needs minor occlusal settling, then one can use elastics for settling, but the pattern of use should be advised by your orthodontist.
For any further discussion, you are always welcome.
Stay safe and healthy.
Thank you.
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