Desperate, Josephine came to me with this problem. After taking her history, I knew just by looking at her what the solution was. Looking at her profile, Josephine had a retruded chin. Her lower jaw was far behind her upper jaw. This is often a recipe for disaster. With the lower jaw “forced backward” the cartilage that acts as a cushion between where the lower jaw meets the skull can become dislocated. This prevents being able to open widely, and the jaw can get stuck in an open or closed position. Also, the muscles that help to move the lower jaw never have a chance to relax, putting them into chronic spasm. This will often lead to pain in the head and face.
Upon examining Josephine, I found not only was her lower jaw being forced too far back (about 10 mm), but it was also off to one side by about 5mm. Five or ten millimeters may not seem like a lot, but in the mouth, it is equivalent to a wide river.
Testing a “new bite” for Josephine
“Oh, this feels so much better!”
Note, Josephine’s jaw discrepancy was quite severe although, unfortunately, not uncommon. However, even much smaller discrepancies can cause severe problems.
Unfortunately, many TMJ problems occur after having orthodontics, especially if permanent teeth are extracted. Retreatment with functional orthodontics is often necessary.
Sometimes a night guard will alleviate the symptoms or a repositioning appliance, as discussed in the article above, will be beneficial. However, these are usually more diagnostic and further treatment is necessary.
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