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TMJ is the quick way of referring to your Temporomandibular Joint. Pardon the pun, but that’s quite a mouthful! What is this joint, what does it do, and, if your Dr. Allen and our team have told you that you have a TMJ disorder, what can we do to help?

The Temporomandibular Joint

Your two temporomandibular joints are amazing works of anatomical design. These are the joints where the temporal bone in the skull meets the mandible bone of the jaw, and allow our mouths to open and close, move back and forth, and slide from side to side. Muscle, bone, and cartilage work together to provide easy movement and to cushion the joint. But sometimes, the joint doesn’t work as smoothly as it should, and this can lead to Temporomandibular Joint Disorder, or TMD.

When Should You Suspect You Have TMD?

You might have TMD if you experience any of these symptoms:

• Painful chewing
• Pain around your TMJ, or in your face or neck
• Earaches
• Changes in your bite
• Jaws that are limited in movement or lock open or shut
• Clicking, popping or grating noises when you open and shut your jaw

There are many conditions linked to TMD. If you grind your teeth at night, have arthritis in the jaw, have suffered an injury or infection in the area, or have problems with your bite, for example, you might be more likely to have TMJ problems. If you suspect you have TMD, or suffer from any of the symptoms listed above for an extended period, give us a call.

Treating TMD

During your visit to our San Diego office, we will check your medical history, and examine your head and neck. We can take an X-ray or scan if needed for further examination of the joint. Because there is no real scientific agreement yet about the best way to treat TMJ disorders, a conservative treatment plan is often best. If you do show signs of TMD, we might first suggest relaxation techniques, over-the-counter pain relievers, or the use of ice packs or moist heat compresses. A change to a softer diet can help, and you should stop chewing gum and making any exaggerated jaw movements.

If these self-care practices aren’t effective, we might suggest a nightguard. This appliance is a comfortable and flexible mouthguard custom fitted for you, and will bring relief from teeth grinding when worn at night. If this treatment is not effective, talk to us about other options.

Luckily, most cases of TMD are temporary and don’t become worse over time. But any persistent discomfort is a good reason to visit us. Whether you have TMD, or any other problem causing you pain in the head or jaw, we want to help.

By now, you’re very familiar with the basic building blocks of your braces. Brackets, wires, and ligatures are no mystery to you. But suddenly, you’re hearing a brand new term—“power chains.” What exactly are these power chains, and why does your orthodontist think you need them? Let’s see how power chains are *linked* to your orthodontic treatment.

• First, why power chains?

They’re not really chains in the necklace or bike chain sense—in fact, they’re only very rarely made with metal. These chains are most often a string of O ring loops just like your elastic ligatures, attached in a row to resemble a chain.

Chain lengths are tailored to your specific needs. Dr. Allen will attach each individual loop in the chain around a single bracket, linking selected teeth together. Chains might stretch across a few teeth, several teeth, or your entire upper or lower arch.

• Second, why power chains?

Because these chains are usually made of the same elastics that your ligatures, or bands, are made from, they want to hold their original shape. They will try to return to that original shape even as they are stretched between your brackets. As they contract, they help move your teeth together. 

Over time, just like an over-stretched rubber band, they lose their elasticity, and won’t work as effectively. That’s why you’ll probably get a new power chain whenever you come in to our San Diego office for an adjustment.

• Third, why power chains?

This is the most important question. How can a power chain improve your smile?

Usually, power chains become part of your treatment after the first phase of alignment. They can be used to help align your teeth or correct your bite, but are most often used to close gaps between the teeth.

You might have a gap after a tooth has been extracted. Or, as your teeth move into their new positions, you might suddenly see noticeable spaces between them. Power chains move the teeth closer together to eliminate these gaps, and do it more quickly than brackets and wires alone can do.

• How long will you need them?

This is something Dr. Allen will discuss with you. Whether it’s a matter of weeks or months, your treatment plan is designed to move your teeth into their best positions, and to do it carefully for a lasting, healthy alignment.

• Power chain options

Depending on the size and spacing of your teeth and your treatment plan, these chains usually take one of three forms: closed/continuous, short, and long. The only difference is the distance between the rings.

We will choose the type of chain that’s best for your treatment. Your contribution is to personalize your power chain. Power chains come in a rainbow of colors, allowing you to mix and match. You can even coordinate with your ligatures if you have ties as well as chains. If your goal is to have your braces blend in, various shades of white, silver, or clear colors are available. Want to mix things up? Choose a different color with every adjustment.

• Anything else?

You might experience some discomfort for the first few days with a new power chain, just as you might with any adjustment. Dr. Allen will have suggestions for making those first days as comfortable as possible.

Also, like brackets and ligatures, power chains can trap food particles, so be sure to follow our instructions for keeping your teeth and your braces their cleanest.

Now that you’re all caught up on what power chains are and what they can do for you, let’s mention one more benefit. This is a process where you can actually see the gaps between your teeth closing over the weeks you wear your power chains. Keep a selfie record of your progress as you create your beautiful, healthy smile. That’s an em*power*ing experience!

When does an underbite need surgery? The short answer is: when Dr. Allen and our team recommend surgery as the best way to give you a healthy, functional bite. But let’s take a longer look, and see just why your doctors might come to that conclusion.

• First, what exactly is an underbite?

In a perfect bite, the upper and lower jaws align, well, perfectly. Upper teeth overlap lower teeth very slightly, upper and lower teeth meet comfortably, and jawbones and joints function smoothly. When the alignment is off, it causes a malocclusion, or “bad bite.”

When we talk about an underbite, or Class 3 malocclusion, it means that the lower jaw protrudes further than the upper jaw. This protrusion causes the bottom teeth and jaw to overlap the upper teeth and jaw.

• What causes an underbite?

Sometimes an underbite is caused by childhood behaviors while the teeth and jaw are developing, including tongue thrusting or prolonged thumb-sucking and pacifier use. (Working to stop these behaviors before they affect tooth and jaw formation is one of the many good reasons children should have regular visits with their dentists and pediatricians.)

Most underbites are genetic, however, and tend to run in families. It’s estimated that from five to ten percent of the population has some form of underbite. The lower jawbone (mandible) might be overdeveloped, the upper jawbone (maxilla) might be underdeveloped, both bones could be affected, or, sometimes, tooth size and placement might cause an underbite. These irregularities in jaw shape and size and/or tooth crowding are not something that can be prevented, and require professional treatment.

• Why? What’s the problem with an underbite?

Even a minor underbite can cause difficulties with biting and chewing. A more severe underbite can lead to speech problems, decay and loss of enamel where the teeth overlap, mouth breathing and sleep apnea, persistent jaw and temporomandibular joint pain, and self-confidence issues.

• Can’t my dentist treat my underbite?

Most probably not. A very mild underbite can be camouflaged cosmetically with veneers, but this does not address the cause of the underbite, and will not work for moderate or severe underbites.

• Can my orthodontist treat my underbite?

Dr. Allen will create an underbite treatment plan after a detailed study of each patient’s individual dental and skeletal structure. Treatment options will vary depending on the cause of the underbite, its severity, and even the patient’s age.

Early intervention is especially important for children who show signs of an underbite. That’s why we recommend that children visit our San Diego office by the age of seven.

If an underbite is caused by tooth misalignment or crowding, braces can reposition the lower teeth. Sometimes extractions are necessary to make room for proper alignment.

If the cause is due to jaw structure, children’s bones are still forming, so treatment can actually help correct bone development. Palatal expanders, headgear, and other appliances are various methods of encouraging and guiding bone development.

But braces and appliances aren’t effective for every patient with an underbite, and especially in patients (usually those in their late teens and older) when the jawbones are already fully formed. In this case, we might suggest coordinating treatment with an oral and maxillofacial surgeon.

• What does an oral and maxillofacial surgeon do?

An oral surgeon has the training, experience, and skill to help correct an underbite by surgically reshaping and repositioning the jawbone. This corrective jaw surgery is called orthognathic surgery.

• What will happen during orthognathic surgery?

Your treatment will be tailored to your specific needs. Two of the common surgical procedures for treating an underbite involve repositioning the upper jaw to lengthen it and/or reshaping the lower jaw to shorten it.

Bone is sometimes removed or added, small bone plates or screws are sometimes used to stabilize the bone after surgery—your surgeon will let you know exactly which procedures will give you a healthy, functional bite. The surgery itself is most often performed under general anesthesia and requires a brief stay in the hospital.

• How will my orthodontist and oral surgeon coordinate my treatment?

Correcting a Class 3 malocclusion can take time. Your oral surgeon will work together with Dr. Allen to analyze the interrelationship of teeth, bones, and joints to determine dental and skeletal problems, and will develop the best treatment plan possible to create a healthy alignment.

• So, when does an underbite need surgery?

Sometimes, a minor underbite can be corrected with braces and appliances alone. A serious underbite, however, will often require the specialized skills of both Dr. Allen and an oral surgeon.

And, while it’s not the primary purpose of surgery, corrective jaw surgery and orthodontics can also make you happier with your appearance and boost your self-confidence. Achieving a lifetime of beautiful, comfortable, and healthy smiles—that’s the answer to your question.

When beginning orthodontic treatment, most patients ask Dr. Allen and our team a lot of questions about what to expect, while others choose to just "go with the flow" and leave it to us to build for them a beautiful smile. And for our team at Davis Orthodontics, that's understandable.

But for those who do ask questions, two of the ones we frequently hear are "Will my braces hurt?" and "How long will these be on?"

We explain to our patients that despite what they've heard, braces do not hurt when they're initially put on. Yes, you will experience soreness after your braces are placed and when your teeth start to move. Too often, our patients hear horror stories about how much it hurts to get the braces on, so they tend to over-worry. The truth is, after their braces are on, almost all patients say "that's it?" because it's actually easy and painless!

At Davis Orthodontics, we answer most of your other questions during your initial exam. When a patient visits our office for the first time, we give him or her a time estimate of how long it will take to achieve their ideal smile. All other questions are answered at the bonding appointment when the braces are placed. We cover all the topics, everything from eating to brushing with braces, but we also know that after your initial appointment, it's natural for you to have questions about your or your child's treatment. And we are always here for you; we are thorough and always try to answer any questions or concerns you may have. As a patient, that's one thing you never have to worry about. You will always know what's going on throughout your orthodontic experience.