TMJ Orthodontics



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What is TMJ?


The temporomandibular joint (TMJ) connects the lower jawbone to the skull, and is responsible for a wide range of motion and allowing you to chew, talk, bite, yawn, etc…  When this joint is not functioning properly, you may start to experience the complicated effects of TMJ disorder. It may surprise you to know that any dysfunction in this area may affect more than eating, drinking, or speaking. Surrounding the joint are important muscle groups, nerves and blood vessels that can also be impacted by any misalignment or tension. Because of this, there is a wide range of TMJ symptoms, but there are also many effective treatments.


What kind of malocclusions can cause TMJ disorders?


Any condition that prevents your top teeth from correctly connecting with your lower teeth may cause TMJ disorders, pain or difficulty when biting or chewing, or interference with speech. Below are a few examples of some malocclusions that may cause TMJ.

  • Overbite

    Overbite occurs when the top teeth are too far forward to correctly make contact with the lower teeth. While  this may be caused by thumb or finger sucking, it can also be caused by  genetics or specific bone development patterns.  

  • Underbite

    Underbite occurs when the lower teeth extend further forward than the upper teeth. This can be caused by irregular jaw growth in either the upper or lower jaw, or both. Missing upper teeth can also contribute to the development of an underbite.

  • Open bite

    Open bite occurs when several of the upper and lower teeth are unable to make contact with each other when the mouth is closed. This condition can also be caused by thumb or finger sucking, or can be the result of genetics or specific bone development patterns.


How can orthodontic treatment help correct TMJ and TMD disorders?


Orthodontic treatment can help adjust the teeth so that they can correctly connect, thus realigning the temporomandibular joint to alleviate the pressure and pain caused by the original dysfunction. For example, Dr. Coats can utilize an Anterior Growth Guidance Appliance to make changes to your jaw growth and development that will alleviate your TMJ symptoms.


  • Anterior Growth Guidance Appliance (AGGA)

    The Anterior Growth Guided Appliance, or AGGA, develops the palatal bone of the mid-face and jaw structure and brings it to a more forward position. Your side profile can look more youthful as a result, but the emphasis is on developing the upper jaw and nose bone structure of to allow the development of the TMJ to help forward and correct TMJ position long term.


    More about AGGA

  • Controlled Arch Orthodontics

    With Controlled Arch orthodontics, Dr. Coats can utilize the shared development pathways of the face and jaw structure to straighten your teeth and influence the size, shape, and configuration of some facial features. Controlled Arch orthodontics can also be used to address important functional changes that can improve symptoms of TMJ, snoring and sleep apnea.


    More about Controlled Arch Orthodontics


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TMJ Orthodontics FAQS


  • Can imbalance of the spine affect the muscles of the temporomandibular joint?

    The  muscles in the jaw work together in tandem with many of the muscles in the neck, meaning that imbalance in the jaw joint can ultimately lead to imbalance in the neck. This dysfunction may cause you to hold your head unevenly, though you may not notice it yourself. You might think you always have a head tilt in your selfie pictures. Did you ever wonder why? Look at your shoulder height for imbalance. If your shoulders are off, you could have a spine and neck imbalance which may be related to your temporomandibular joint and dental bite possibly being offset as well. It’s amazing how the teeth bite, TMJ, neck, and spine muscles are all related. All aspects must be evaluated prior to your TMJ disorder diagnosis. Correcting imbalance in the jaw will lead the forces of the teeth, bite, muscles, and TMJ to properly rebalance. The good news is that, with the exception of bone deformities, asymmetry caused by TMJ can be easily treated to restore an attractive, balanced appearance while also treating your pain.

  • Can jaw misalignment cause facial asymmetry?

    TMJ  disorders can cause facial asymmetry with or without pain. Most often, issues resulting from uneven jaws can be treated without surgery. These issues and many more can contribute to facial asymmetry and pain. Pain can present in a variety of ways such as jaw joint pain, muscle aches and tightness, headaches, neck aches, or even ear pain. 


    TMJ disorder is often caused by an imbalance within the components of your jaw. Although this imbalance may begin as an entirely internal event, it usually doesn’t stay that way, and as your TMJ disc and joint develops, you may experience facial asymmetry that is visible to others as well as yourself when you look in the mirror. This asymmetry may be due to tooth problems, joint displacement, bony deformities, muscle development and function, or spinal misalignments. 

  • Do TMJ disorders cause facial asymmetry?

    TMJ issues can cause facial asymmetry with or without pain.  Most often these issues occur due to uneven jaw alignment.  However, many orthodontist and oral surgeons may tell you the only way to fix this is orthognathic or jaw surgery.  Sadly, many cases get treated surgically and have even more problems afterwards such as nerve damage and metal plates for a lifetime.   This is not to say that there are no indications for surgical treatment; however, there are technologies and advanced physiologic based dental treatments that can achieve so many amazing results without surgery. Facial asymmetry can result from a bad bite, mouth breathing issues, trauma, myofunctional  habits (or tongue habits), tongue-tie, or underdeveloped upper or lower jaws. These issues and many more can contribute to facial asymmetry as well as pain. Sometimes this can cause the bottom third of the face to appear short, something that makes patients appear older.

  • Can TMJ disorder distort the face?

    TMJ disorders can contribute to changes in your face as your muscles become disorganized, with some working too much  while other muscles atrophy. The natural aesthetic of the face can be altered if your teeth shift, causing a change in chin, lip support, or lines. If bone loss occurs around teeth or teeth are missing, the muscles can be less supported on the width of the face and lips, causing a wrinkled, sunken, or distorted face. If the bite and jaw are off-balance, then the chin can look off set to one side or the muscles on the sides of the face (masseters) may look swollen.  Breathing through the mouth is caused by a tongue posture that is low in the mouth, preventing it from resting naturally in the roof of the mouth. Over time, this dysfunction may cause the development of the bones of the face and mouth to narrow, causing a long face, dry lips and even a sunken appearance under the eyes.When the dental bite and jaws develop more towards the direction of your ear, you may notice changes in your chin or in the angle of your neck to your throat. The solution to avoiding any facial distortion is to seek early treatment for children who breathe through their mouths or have other issues mentioned above. The goal of early treatment would be to achieve the following changes: the lips closed at rest, an absence of tongue habits, and the development of the dental arch and midface bones to help with healthier breathing, speech issues, and even to enhance facial aesthetics. 

  • How do you fix jaw asymmetry?

    The first step to correcting jaw asymmetry is correct diagnosis.  Many factors should be considered and evaluated such as:

    • Airway and Breathing
    • Tongue posture and position
    • Upper and Lower jaw anatomy
    • Jaw joint position
    • Muscle function of the head and neck
    • Facial asymmetry
    • Postural and spinal components

    When the bones of your face are developing, the proper airway factors affect the shape of both jaws. The lack of tongue pressure on the roof of the mouth can cause a misshapen face with a long, concave facial profile. This is consistent with a less than prominent chin or a long face. A 3D scan will help Dr. Coats identify what changes can be made as well as see where and why there is facial asymmetry. Many times, the way the teeth come together is dysfunctional, causing strain on the facial and neck muscles, facial asymmetry, and poor facial muscle balance.   Other times, the teeth may force the jawbone and muscles to one side, which also causes strain and facial asymmetry which can be corrected non-surgically.

    In these cases, utilization of sophisticated computers can help provide more information as to where to position the jaw and teeth to ensure that the muscles are all stable and balanced as well as the joints. A temporary orthotic is often made to help achieve this position. The orthotic allows the patient to adapt to the new bite as well as allows the muscles and joints to heal and return to balanced symmetry. These orthotics should not be removable so that the patient can learn now to truly eat, chew, and function in this new position. Most cases will see the facial balance return.  From this point, long-term non-surgical options can be applied to complete treatment. This could include TMJ Orthodontics to continue the transformation of the teeth to their new position or even an AGGA, Anterior growth guided appliance. An AGGA develops the bones of the face and jaws to accommodate the new balanced bite. TMJ or controlled arch braces or even some restorative dental care can sometimes achieve these results.