Self Assessment

Jaw malalignment is the cause of most TMJ conditions.  If one were to be involved in  trauma, jaw malalignment will prevent the jaw from healing.  This often makes patients think that it was all due to the trauma, when there was a pre-existing hidden condition that has kept them from healing.

Definition: Jaw Malalignment– a condition in which the teeth do not support the jaw in the same position as where the muscles suspending the jaw want the jaw to be.  This requires the jaw muscles to accommodate to the tooth position, thus causing the jaw muscles and the trigeminal nerve to become hypertonic/hyperactive.  This condition is present in over 95% of the population from suspected multigenerational dietary insufficiencies.  This condition can be made worse by dental therapies.

There are two primary requirements of a well  aligned jaw: one should bite and talk on the same trajectory (i.e. the lower jaw should not thrust forward or to the side during speech), and one should open and close on a fair arc.  Typically, these criteria are assessed by watching one count from sixty to seventy.  Overbites are a fairly reliable indication of the amount the jaw is out of alignment as most people want to bite end on end.  Biting is a skeletal phenomenon, and speaking is a muscular phenomenon, and they should be on the same trajectory.

This assessment should be done from both a side perspective and an anterior perspective.  Most of my patients that have major medical complications as a result of their bite have a shift in excess of 3 millimeters (=1/8 inch).
2.one should open and close on a fair arc.  This assessment is best done by opening wide and closing on a thin object.  With an object placed between the teeth the  brain instantly recognizes that it no longer has to accommodate to the teeth, and will usually close to the relaxed jaw position.

Note: Both of these tests are often in error when done on patients with prior orthodontic treatment in which bicuspid extraction was performed.  One would best assume that the jaw is malaligned if they have had orthodontic extraction therapy due to the way the upper anterior teeth retract, causing the lower jaw to posture excessively posteriorly.


35 Responses to Self Assessment

  1. elaine LOU says:

    Hi:

    My son has braces and at the end of his (conventional) treatment but still has a recessed jaw, poor posture, etc. He is doing orofacial myofunctional therapy with Kathy Winslow. ALF orthodontics has been recommended. Can you offer any treatment that might help pull his jaw forward and help improve his airway?

    • Dr. Jennings says:

      There is considerable medical literature that discusses the link between jaw position and posture. Orthodontist (official definition: orthodontic and dento-facial orthopedic specialist) often do the orthodontics and not the dental orthopedics. Dental orthopedics is not taught well in most dental schools. See dentalorthopedics.com

  2. Jason Kincaid says:

    I believe that I grind my teeth at night and am not sure if its due to poor jaw positioning or stress to be honest and I also feel that my front bottom teeth are pushing forward and it seems as if my inside gums on those front teeth are receiding and Im worried that my grinding will make me lose the space needed for those teeth end up losing one or more of them. Would a mouth appliance potentially widen my jaw to help this? I am interested in coming in for a consultation and will call asap.
    Thank you,
    Jason Kincaid

    • Dr. Jennings says:

      Jason:
      A mouth appliance would typically help stopping grinding and with protecting the teeth if you do gring.
      Dr. J

  3. Jennifer Tucker says:

    My jaw pops out when eating, singing, or saying certain words, then slams back in, loud enough for everyone around to hear. I have chronic jaw/ear pain and migraines. Numerous dentists et al., have tried bite guards at night, accupuncture, and jaw manipulation, none have helped, in fact bite guards and retainers only made it worse. I cannot open my mouth wide enough for teeth cleaning and the torturous use of bite blocks should be outlawed. I am losing hope that anything can ever be done to stabilize my jaw, and more worrying is that someday I may only be able to eat soft foods.

    • Dr. Jennings says:

      Jennifer: Most likely your problem is that your lower jaw is too far back, and that your nervous system is hypersensitized (to any changes). Cases such as yours have to be approached with the right appliances (usually twin blocks) and good cranial adjunct treatment. Neither of which you have likely had.

  4. Jennifer Tucker says:

    Dear Dr. Jennings
    Thanks for such a quick response! I wanted to also mention that I have significant crepitus in my left jaw and slight on the right. I agree that the focus of TMJ shouldnot be about the bite, numerous dentists have tried to fix this without ever taking an x ray or mri of my jaw. I believe an xray and mri should be first. I look forward to meeting you Dr. Jennings. I hope you can help me.

  5. Tina Scarpa says:

    I have developed dizziness and unsteadiness, clicking jaws, pain all over, hypersensitivity to smells, lights, and any stimuli, intolerance to heat and cold. I was told I have Fibromyalgia seconday to EDS type 3. I have had a bite plate made and now a MORA appliance. Is there anything I can do to further help the TMJ issue as I feel this is the cause to many of my issues. Interestingly, My mother has been DX with parkinson disease and my son has motor tics. I was wondering if all of these familial issues may be connected since mouth appliances have been know to alleviate motor tics and help parkinson disease/parkinson type tremor.

    • Dr. Jennings says:

      To reverse many of the symptoms that develop subsequent to jaw dysfunction, the jaw has to realigned very precisely or it doesn’t work. The principles of “precise dental orthopedics” are not well known. You need to make sure that you have been put on an ideal open/close trajectory (usually end on end bite), and equilibrated to molar contact only (pivoting mechanics). This needs to be worn on a full time bases to work effectively (best chance at calming trigeminal system). Mora appliance may not be the best appliance depending on your repositioning needs. Dr. J

  6. Ruth says:

    Can you recommend a colleague in Sacramento? I have a similar issue to Jennifer’s and would be interested in more information or someone who can provide treatment locally. Also what insurance do you accept and are you located near BART or public transit and is your access-able by wheelchair? Thank you

    • Dr. Jennings says:

      Ruth: I have a satalite office in Sutter Creek, 40 miles from Sacramento. Or you might want to see David Miller in Roseville. Dr. J

  7. Jess says:

    My son has an open mouth posture, though I’m not positive he is only breathing through his mouth. His dentist says he has retrognathic mandible and mentalis strain. Because he is only 3 she says there is nothing we can do about it until he is older and can have braces. Is there anything we could do sooner?

    • Dr. Jennings says:

      Jess: There are some things that can be done. You would want to check your son and find out why he is mouth breathing- possibly see an ENT doctor. My daughter had a severe retrognathic mandible, and I started treatment on her at age 3 with a Bionator (she ended up class I with all her wisdom teeth). Braces are for orthodontic correction, not orthopedic correction. Dr. J

  8. Jennifer Irvine says:

    I have had 100% constant tinnitus for over a year now along with ear crackling, migraines, lots of face pain. I finally saw my GP doctor who told me the tinnitus it was likely old age (I am 46). I then went to an audiologist and ENT who told me it was not hearing loss and likely TMJ or a result from decades of migraine triptan use. I was told to take 600mg of advil twice a day, but this did not stop the tinnitus and only lessened the face/jaw/throat pain. Dentist and doctor say my bite looks good (no evidence of grinding) but I know I must be clenching when I sleep. Can you help with this and what would be the likely path of treatment? Do you take any medical or dental insurance? Thank you.

    • Dr. Jennings says:

      The question is not whether you have a good dental bite, but whether the muscles posturing your lower jaw wants your jaw to be in a different place (muscles posturing the lower jaw have a very precise place in space that they want the jaw to be, often different than where the teeth make the jaw go). I would do an exam on you and check your jaw alignment with simple tests, followed by dome diagnostic tests. Most likely it is jaw alignment causing your problems. Treatment would likely be jaw reposition therapy using removable appliances (done in two phases: I-to find proper position and get symptom resolution; II-stabilize jaw in therapeutic position most often through orthodontic treatment (back teeth need to be grown taller in most instances). My office does not bill insurance but we give you a super bill for you to bill your own insurance. Dr. J

  9. Cynthia Speakman says:

    Hi Dr. Jennings,

    My son, Kyle, was diagnosed with Type 1 diabetes when he was 13. When he was about 18 he began having grand mal seizures and the drs. declared he had epilepsy. He is a skateboarder and has fallen frequently, once doing a face plant and breaking several teeth. He is continuously searching for reasons why he has epilepsy and diabetes and came across your site on tmj. You could be the hope we are searching for. These seizures are horrible.

  10. Nattha says:

    Dr. Jennings do you have a network of dentists that have similar training as you?

  11. Robert Menegus says:

    I had braces ten years ago and have been wearing retainers ever since. Stared having problems in the last few year. Mainly a headache localized on the left side of my head. I’ve been told by another neuromuscular dentist that wearing my retainers is making things worse, since it puts it puts all the pressure on jaw. She told me to stop wearing them, including my mouth guard (which is painful when I wear anyway). I’m worried that without wearing my mouth guard, my teeth are going to get damaged. I just started physical therapy a week ago. I know I have spine/neck problems as well. Other doctor wanted to give me a splint, but I can’t afford at the moment and I’m hoping the physical therapy will resolve most of what’s wrong. Hoping to get your opinion. I’m thinking about coming to see you after some physical therapy sessions since I wasn’t too thrilled with my past dentist.

  12. Erika says:

    I live in San Diego and am seeking a professional with expertise in cranio mandibular dentistry. My six-year-old son has recently lost three upper anterior teeth and four lower anterior teeth. He has had a significant cross bite, which in the absence of his anterior teeth appears to be an actual underbite. Further, he seems to have difficulty controlling saliva control at times. He has been diagnosed with high-functioning Autism, including sensory issues, ADHD and anxiety. Additionally, he has a difficult time effectively working his tongue while chewing. I am anxious about compounding his problems with well-intended orthodontic intervention.
    Do you know of a practitioner in San Diego or the surrounding area who may have the expertise to evaluate my son? Many thanks–

  13. Sheryl says:

    Dr. Jennings,
    I was diagnosed 6 months ago with TMJ. Caused from grinding and a bad dentist who filed my teeth because he said my teeth are drifting and the bite needed to aligned.
    I have all the classic symptoms. Am being treated now by a very good Neuromuscular Dentist. Got the nightguard, go to physical therapy, work on my posture and soft diet since October. The only time I am not in pain is when sleeping , laying down or lots of Ibuprofen.

    Do you know of any Orthopedic Dentists in Las Vegas?

    Thank you,

    • Dr. Jennings says:

      Most patients need to have their jaw repositioned 24 hours per day, not just PM with night guard. In Las Vegas, you might want to see Clayton Chan or Terrence O’Shaughnessy. Dr. J

  14. Jerry Colano says:

    Dr. Jennings:
    I am trying to determine what type of health care specialist I should see for treatment.
    Suffered from moderate depression for many years, not treated. A few months after having 8 fillings replaced with crowns (in 2009), I was waking up from deep sleep states into deep depression followed by panic. Learned to sleep lightly and wake up frequently.
    After hearing about TMJ and sleep disorder, I started having my bite adjusted by grinding (in 2015). After each session, my sleep improved. Felt almost cured after about 8 adjustments over a year. Then, one night last Feb., I was under severe stress, woke up with the intense form of the sleep attacks for the first time in years. Thought it would resolve again soon since my bite was better, but more than 1 month and I still can’t sleep without disturbances, have severe depression and panic attacks in cycles through the day, am sleep deprived again.
    I was concluding that my problems are actually psychological, that depression is leading to sleep disorder, planning to see psychiatrist (but hard to get appt) to get antidepressants and see a sleep specialist (maybe dental).
    Feeling desperate, so will see my GP and ask for antidepressant. Should I still treat this as a TMJ problem? If so, for the short-term, is there a particular antidepressant that you would recommend for my case?

    • Dr. Jennings says:

      Jerry: The general principle is that you do the most conservative treatment first (that includes least expensive, and with the least side effects). You might try anitdepressants as a quick fix, to allow you to get to the bottom of the problem.

      Having teeth adjusted helps get the bite more even, but often doesn’t get the jaw aligned which is often a big part of the problem. You might want to get someone to assess your jaw alignment.

      Jaw alignment sensors (proprioceptors) send their signal to a nucleus in the brain next to the anxiety center- hence often lots of anxiety with jaw misalignment.

  15. Adrienne says:

    Hi Dr. Jennings,
    My 9 year old son was given a palette expander on Saturday and suffered from a seizure on Tuesday in school and then a longer one on Friday at home. This was the morning of his scheduled oral surgery to remove his baby canine teeth. We immediately removed the palette expander retainer. He was in a lot of pain when he first had it. Wore it religiously for the 6 days that he had it. I have done some research and come across some of your findings. Do you think this was putting pressure on his nerve and caused a seizure? What do you think and who would you recommend in NY?

    • Dr. Jennings says:

      Yes, it is most likely that the expander caused the seizures. The expander would have caused the seizures because is was stressing the trigeminal nerve (most likely threw bite off). I am not aware of any physiological orthodontists in NY. I would check with Barry Cooper, DDS in NY to see whom he might know. Dr. J

      • Adrienne says:

        Thank you! No seizures since we took out the retainer and it’s been almost 2 weeks. Everyone thinks I’m crazy. Can you suggest some research to support this specifically making the correlation to the seizures and the expanded.Thank you so very much!

        • Adrienne says:

          Dr. Jennings,
          It has been 4 months since my son has had the expander and seizures. I ruled out epilepsy and any other disorder that I could research. I had 2 separate neurologists tell me 2 different things. One was on board, the other wanted my son on full epilepsy medication since he had 2 seizures in a week. We have begun invisalign (with a delayed increase of movement…almost double the typical) 3 weeks ago with 2 baby canine extractions. No adverse reactions to date. Thank you so much for being so supportive. I hope to help spread the word for all the kids on epilepsy medication that are having an adverse reaction to a pallet expander.

          • Dr. Jennings says:

            Invisilign as they are taught to be used can also induce very severe negative effects. I have multiple cases treated with Invisilign that ended up very disabled. Straightening front teeth without putting greater vertical height in bite causes lower jaw to be retruded, not a good thing.

  16. Tammy Evans says:

    Dr Jennings
    My son is a college football player . During the spring 2014 he suffered a Open Jaw fracture, surgery & had his jaw wired shut for 8 weeks. Even before his injury he had quite an extensive under bite developing as he was growing. The summer of his sophomore year July 2015 he was golfing and suffered a Gran Mal seizure. We went to a neurologist in the Minneapolis area had MRI, CT, 48 EEG, and all was normal. No evidence of any abnormalities . Eight months later , Easter of 2016 he suffered another Gran Mal Seizure , went back to the neurologist and it was decided he was epileptic , and was put on a seizure medication that he started 2 weeks ago. I just do not feel comfortable with this . I feel there is something causing this. I’ve been researching every possibility, & came across an article by you in 1996 regarding seizure activity . I feel that we may be dealing with a jaw alignment problem? We live in Mn , if there anyone you know of here that has knowledge on this, in our area, or if not ,we would be willing to travel , if you are seeing new patients. Desperate for answers.

    • Dr. Jennings says:

      Research is clear that substance P is cause of most seizures; its just that the medical community is not aware that jaw misalignment pushes up substance P levels. I have treated well over 60 seizure cases effectively. I am not aware of any knowledgeable practitioners in Minnesota. Dr. J

  17. Erin says:

    Hi I am 35 years old and had jaw surgury (upper and lower) when I was 17. In the last year my jaw has gotten so bad that I cannot chew unless food is tiny and soft. I have constant pain in my face and jaw and jaw lock. It is also very painful to touch my jaw. I have been told by multiple dentists nothing can be done for me. I am nice seeing a Myofunctional therapist who says I have a small tongue tie that’s causing all this? The pain is unbearable most days. I also have arthritis and fibromyalgia which causes me constant neck and back pain. I am in newfoundland, canada and I’m desperate for help!

  18. Paul says:

    Hi Dr Jennings

    I am very glad to have come across your work.
    I live in Ireland so I am not sure yet what level of expertise there is in this country in the area of dental orthopaedics.
    I have been dealing with tinnitus, eustachian tube dysfunction and symptoms of systemic inflammation for years.
    In the short term while I try to find someone in my part of the world who could competently assess my jaw alignment might it be beneficial to try cranio sacral therapy? Does it address some of the issues in play here?
    Thank you

    • Dr. Jennings says:

      If there is an underlying bite problem, cranio-sacral adjustments will generally not hold, and only help for a short time. The best appliance ever invented came from Ireland (twin blocks).

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