TMJ treatment: orthodontics vs dental orthopedics
It is embarrassing to myself and my profession that dentistry is so ill informed as to the difference between orthodontics and dental orthopedics. Orthodontics is used to straighten teeth (typically done with braces). Dental orthopedics treatment is done to shape the jaws and to align the upper and lower jaw bones to each other (dental orthopedics cannot be done with braces, typically done with appliances that contact closer to the gum level or with repositioning appliances that cover the top of the teeth). TMJ is most often caused by a jaw misalignment, an orthopedic problem; one that cannot be solved with orthodontics! Most of my patients with long term TMJ have submitted to orthodontic treatment (braces) in the past at the recommendation of well meaning dentists in an attempt to correct the TMJ dysfunction. It rarely is helpful in the least.
Patients present with dental orthopedic defects in any of three dimensions in any given dental arch, as well as frequent defects between the upper and lower dental arches. Jaws can be too narrow, not long enough, and almost always not tall enough. This causes broad muscular and neurological dysfunction leading to a wide spectrum of disease conditions.
Orthodontics as it is primarily taught in the country, is designed to give you pretty teeth, not align your jaw. In my opinion, this is due to the fact that orthodontists don’t understand the biomechanical principles of occlusion, nor do they take any functional tests to assess where the jaw posturing muscles want the jaw to be. Orthodontists typically fail to diagnose and recognize orthopedic defects. This leads to brutal therapies like extraction of bicuspids or orthognathic surgery.
And when orthodontists are in the process of doing orthodontics and encounter TMJ symptoms (headaches, facial pain, ear pain, jaw clicking, etc.) they typically continue with only braces in an effort to correct a dental orthopedic problem. This is doomed to fail. Braces move teeth, not jaws!! When orthodontist use elastics to move jaws (e.g. class II dental defect), they can be dentally successful, but rarely orthopedically successful (teeth can move without the jaw moving).
Once a dental orthopedic appliance locates the correct jaw to jaw relationship, then orthodontic techniques are often helpful to move the teeth so as to support the jaw in the new position. This protocol is poorly understood by dentists/orthodontists. Dental orthopedic treatment should precede orthodontic treatment, though rarely done by orthodontists.
Most orthodontists are also confused about the difference between intra arch dental orthopedics vs inter arch dental orthopedics. Intra arch dental orthopedics is used to develop the individual jaw bone (so as to accommodate all the teeth). Where as inter arch dental orthopedic techniques are used to align one jaw to the other (different appliances to accomplish different goals).
The very vast majority of orthodontists proceed with orthodontics without ever doing any functional tests to see if the jaw is out of alignment (most people are out of alignment). Traditional orthodontic records are only static records of structure only! It is necessary to take functional records (or do functional tests) to assess whether the jaw is aligned. How to do functional tests and check jaw alignment is not taught in dental schools.
As you can see TMJ treatment: orthodontics vs dental orthopedics is a very confused area for dentistry and medicine. Osteopathic medicine which often assesses cranial function typically does not understand how to assess whether the jaw is aligned. This leads to a lack of communication and under utilization of dental orthopedics in treating many health conditions.
For further insight into this difficult area see: dentalorthopedics.com