Case History:
14-year-old Candice (not her real name) came to see us in 2014 complaining of jaw joint pain on her left side. Her mother had noticed that she had to “manipulate” her jaw while eating. Every time she opened and closed her mouth, there was clicking in the joints and a very noticeable deviation.
She had been suffering from pain for two years and had also experienced a “closed lock”, where the jaw gets “locked”, and it is difficult to open the mouth. This difficulty happens because the articular disc is displaced out of the housing. It cannot return and allow for the articulation of the TMJ.
Treatment Plan:
- Before bite optimisation, there was clicking in the joints and deviation in the opening and closure path.
- The first step was to take the measurements and determine the bite and neutral position of the jaw. After that, we created the orthopaedic Orthotic splint.
- Wearing the Orthotic recaptured the disc and established a physiological vertical and smooth trajectory of jaw movement.
- However, now her teeth no longer had a proper bite. So we started Invisalign treatment with corrected AP, Lateral and Vertical. After joint remodelling, we were able to establish the correct bite.
- Six months into Invisalign treatment, there were no TMJ clicks and deviation; we then continued with aligners to close the open bites in the lateral segments.
By now, there was a lot of improvement and progress. However, we still couldn’t get the teeth to bite and close at the back. We tried adding more buttons and putting more elastic to try and force the teeth in place. And yet, it didn’t work.
Getting to the Root Cause
We finally managed to get to the root cause of the problem. We noticed a lateral tongue thrust whenever Candice swallowed.
We realised that there was no way we could close the gap if the tongue was not functioning correctly and in its ideal position. During this period, we had begun learning more about myofunctional therapy, so we decided to put the knowledge into practice.
We started habit correction by teaching her how to swallow correctly and constantly practising until she no longer did the tongue thrust. After four weeks of taking the tongue away from the lateral side and improving her function, the form had changed.
There was a residual issue because of the restriction of the tongue, so we went ahead and did a frenectomy, which helped in a more significant elevation of the tongue.
Eventually, when she opened and closed her jaw, there was no longer a deviation. Thus, we successfully managed this TMJ Disorder case using a combination of gneuromuscular dentistry, aligners (Invisalign) and myofunctional therapy.
If you experience similar symptoms, do give us a call at +65 6282 0122 or visit our website. Let our trained dentists help you resolve your TMJ disorder related problems.
