TMJ-focused Diagnosis and Treatment for Long-term Comfort and Stability
Dr. White attended the prestigious Roth/Williams Center for Functional Occlusion in San Francisco. There he learned advanced concepts and philosophies regarding the diagnosis and treatment of TMJ disorders. He was trained for two years in the use of specialized instruments to obtain a healthy bite with a stable jaw joint position.
The foundation for a healthy bite is built by achieving a stable position of the jaw joints. The temporomandibular joints (TMJ’s) are located in front of each ear and are formed where the lower jaw connects with the upper jaw. The TMJ is a unique joint in that it not only hinges like other joints, but it also slides to provide free movement of the lower jaw. The TMJ is a “ball and socket” type of joint and it is essential that the TMJ’s are fully seated in the sockets when the upper and lower teeth contact.
In Figure A the teeth fit well in the mouth but the jaw has to deviate to allow this to happen. Deviated TMJ can lead to muscular hypertension, TMJ headaches, grinding of teeth at night, unstable tooth position, bone loss, etc.
In Figure B the jaw (TMJ) is now positioned in the proper "true" position, but the teeth do not fit anymore. This leads to stromg biting contacts on the back teeth which can lead to trauma such as bone loss around the back teeth, loose teeth, cracked teeth, etc.
Dr. White utilizes the extra diagnostic procedures mentioned below to determine the "true" jaw position before initiating orthodontic therapy. This way, the teeth and the jaws can be moved to a position that is good for both the bite in the mouth, as welll as for the jaws (TMJs).
All orthodontists use plaster models of the teeth as part of their diagnostic records. Usually, patients are instructed to bite their teeth together in the most comfortable position. For many patients, biting in this way moves the jaw joints out of position, which can lead to an unstable result. Then the bite is “analyzed” by placing the plaster models on a table and sliding them together….not very realistic or accurate! Dr. White uses an instrument called an articulator, which has “jaw joints” and simulates natural jaw movements. Orthodontic models are placed on the articulator with the jaw joints in their proper position. Dr. White then studies the fit and function of the teeth and develops a treatment plan to obtain a healthy bite and maintain the proper position of the TMJ’s.
The use of “articulated” models is an essential step in “TMJ-centered” orthodontic treatment. It is not uncommon to have a dramatic difference in models made with a patient’s “habitual” bite and those placed on an articulator with the jaw joints in their correct position. Naturally, this can lead to a significant difference in the treatment plan or less than ideal results, which may mean problems in the future such as worn teeth or headaches and jaw locking.
Articulated-Mounted Study Models
The ONLY diagnostic tool capable of determining the patient's "true" functional bite
Need several specific jaw registration recordings
Can simulate patient's actual jaw movements
Critical for determining where to move teeth to establish the "true" functional bite
Fewer than 10% of orthodontists use this extra diagnostic aid in treatment planning
During orthodontic treatment it is important that braces be placed on all of the teeth especially the second molars as these teeth are most commonly involved in bite-related TMJ dysfunction. Unfortunately, in traditional orthodontics, it is very common that braces are not placed on the second molars. Dr. White always applies braces to the second molars. He also uses “TMJ-compatible” appliances and techniques to achieve a stable, healthy bite. By utilizing a TMJ-centered approach to orthodontics, Dr. White is using the same techniques as a dentist would when replacing worn teeth with crowns…makes sense, doesn’t it?
