TMJ Therapy – Portland, OR

Headaches & Migraines

Chances are that if you frequently experience headaches or migraines, you have already been offered countless solutions by many different people: friends, family, doctors, and even internet strangers with good intentions. Usually, these suggestions boil down to two main approaches—relaxation and medication. Unfortunately, these options only treat the symptoms and not the cause of head pain. 

How Headaches & Migraines Can Be Caused By Your Teeth: Your body is a complex, interconnected system, so issues in one specific area can readily affect other areas in ways that may not always be apparent. In any sequence, every error affects everything downstream, and nothing works well unless EVERYTHING works well. Think of an assembly line where one part just stops working correctly all of a sudden. Even though every other machine is fine, the once-smooth production process will most likely grind to a halt without warning.

A bad bite can be the underlying malfunction in question for a wide variety of bodily discomfort, including constant headaches and migraines. If the teeth are not in the right position for optimal chewing, the muscles of the jaw force them into position and hold them there. This leads to them overworking, causing a buildup of lactic acid, which makes your muscles sore after an intense workout. The jaw muscles work in conjunction with all the muscles of your head and neck, so tension in the jaw can transfer to them. The chain reaction started by a crooked bite often results in headaches and migraines that will not go away, and this is because the source of the disharmony—the bad bite—is never directly addressed by most common treatments.

How TMJ Therapy for Headache & Migraine Relief Works: If you are suffering from TMJ-related head pain, correcting your bite is the logical and correct approach. Using a computerized occlusal analysis and electromyography (EMGs),Dr. Russ Teasdale, a highly experienced TMJ dentist in Portland,  can measure how your teeth interact as you chew and thus see exactly how this is affecting your jaw muscles. This approach provides precise, objective information, something that cannot be developed by simple "bite paper" and guesswork.

After gathering detailed analytical information, Dr. Teasdale can pinpoint the irregularities and high spots in your bite, so that all adjustments are made in the most efficient and effective manner possible. Disclusion Time Reduction (DTR) then enables him to precisely align the bite so that the teeth come together properly and allow your jaw to reach a relaxed, natural resting position. As a result, the jaw muscles work far more efficiently and effectively, and do not build up excess lactic acid. The result is greater comfort and the elimination of the headache and migraines.  

Ear & Neck Pain

The only thing more frustrating than dealing with persistent ear and/or neck pain is trying to do something about it and not seeing any results, even with the help of trusted professionals. Every year, these issues send millions of Americans to various doctors, chiropractors, masseuses, and more looking for meaningful relief that lasts. Ultimately, many find themselves back where they started, dealing with daily discomfort. The reason so many people cannot seem to find a solution for their ear and neck pain is because, in many cases, the root of the problem is not found in the ears or neck, but rather the jaw!

The Overlooked Source of Ear & Neck Pain: If the bite is misaligned for any reason, this causes the muscles to strain whenever the teeth come together because the body is trying to force them into the optimal position for chewing. This leads to them overworking, tiring themselves out, and producing lactic acid. The presence of additional lactic acid is why your muscles feel stiff and sore after a rigorous workout.

This strain and discomfort often do not stay in the jaw, however, and can easily radiate into the ears and neck. The hinges of the jaw are next door neighbors to the ears, and the jaw sits right on top of the neck, so all three areas can be affected by the same overarching problem. What many people perceive to be an ear or neck issue is actually a bite issue, and this is something DTR therapy can directly address to help a patient feel better and function comfortably.

How TMJ Therapy Can Treat Ear & Neck Pain: Dr. Russ Teasdale has helped many people dealing with these exact problems achieve lasting relief and comfort using state-of-the-art DTR therapy. With DTR (Disclusion Time Reduction) therapy, the bite is evaluated using a computerized analysis as well as electromyography (EMGs), which show how the teeth are coming together, what order they are touching, and (more importantly) how this is causing the muscles to activate. Too much activity indicates strain. This highly accurate approach provides an extensive amount of information about your bite, in real time, and enables Dr. Teasdale to identify the source of the problem and make the necessary adjustments to the teeth so they come together properly.

Once the bite has been balanced, the chain of events that creates chronic ear and neck pain is put to rest. The muscles of the jaw stay relaxed and move smoothly, so there is very little to no tension left that is capable of traveling to nearby areas. The result? Dynamic improvements to your wellbeing without reliance on medication, mouthguards, and other temporary stopgaps. And unlike these other methods, the results of DTR should last a lifetime. The body’s natural orientation has been restored, and everything is working as it should.

Teeth Grinding & Clenching

There is an old joke where a patient visits the doctor’s office with a serious pain when they raise their arm or turn their head. In return, the doctor simply tells them to stop doing that action – problem solved! While this exchange may seem humorous in a hypothetical setting, many dental patients find themselves hearing very similar words from their chosen doctor when they are seeking treatment for chronic teeth grinding and clenching.

How a Bad Bites Leads to Teeth Grinding & Clenching: Back teeth are designed to absorb direct vertical pressures, but when they slide across each other, they experience lateral pressures, which is a trigger to grind food. And as these teeth constantly grind against each other, the muscles become tired, and this results in jaw pain and stiffness that will not just "go away". Facial massages, relaxation techniques, and mouthguards work to relieve pain, but they do nothing to address the cause of the pain. They can provide nothing more than just temporary relief of symptoms, because none of them address these side-to-side tooth contact issues. You can treat the muscles with BOTOX, but eventually, the pain will return because it is the result of a reflex. Instead, you have to remove the trigger of that reflex. And the removal of that trigger is what DTR (Disclusion Time Reduction) is all about.

How Treating TMJ Disorder Can Treat Teeth Grinding & Clenching: The long-term relief of problems begins with discovery of the problem and ends with a precise bite. But you really need the accuracy that is only achievable with computers to guide the "fine tuning." So, we use the computer bite analysis to guide our adjustments and confirm that the muscles are acting ideally via EMGs. Only when these two agree are we happy with your bite (but not as happy with it as you will be!). With our DTR therapy, we can see which teeth touch, in what order, how hard, and how they interact as you chew. We measure the muscles, confirm they work only when necessary, and relax all other times. This is vitally important information that you cannot get in any other manner.

Dr. Teasdale's information-rich approach, and our decades of occlusal experience, allow us to create the bite that Mother Nature intended for you, with the teeth, the muscles, the joints, and the smile all relaxed and comfortable, and all without the need for shots or impressions. 

The Complexity of TMJ Problems

The mere fact that you are reading this likely means that either you or someone you know is suffering from temporomandibular joint (TMJ) problems. It is, after all, not a subject that has a wide audience of persons not directly affected by it. Perhaps you are looking to confirm your suspicions with a TMJ diagnosis in Portland, OR, to verify that jaw joint noises (popping and clicking), jaw locking, pain in the jaw, and pain in the side of the face are all related to TMJ dysfunction.

Physical deterioration of the joints can certainly lead to all the above-mentioned problems, but when you are only measuring subjective symptoms, you often get erroneous diagnoses. If you have a limp, for example, the cause can be anything from a postural problem to an incompetent toe joint to a bad hip or knee; it could even be a pebble in your shoe. It only makes sense to diagnose the situation objectively to minimize the risk of correcting the wrong problem.

Diagnosing TMJ Issues

Most dentists receive scant education in treating TMJ/TMD and limit their exams to a list of symptoms that are verified perhaps by feeling the joint as the patient opens and closes their mouths. This may pick up popping and clicking, but provides little reliable information, other than that there is a problem in how smoothly the jaw opens and closes. To treat with such a diagnosis, without specific measurable goals, is to invite a very compromised result.

The jaw joints are the most complex joints in the body and require a great deal of coordination between them. Neither side can operate independently of the other. They rely 100% on muscular coordination on each side of the midline of the body. The position of the teeth, how they hit, and when they hit are critical to directing the joint movements. Furthermore, there is a thin and delicate disk of cartilage that needs to maintain its position throughout the movement of the jaw. This is not a mechanism that can be “fine-tuned” bit by bit without direction and objective data.

Diagnosing TMJ Problems with a Sonogram

The first step in diagnosing the health of the TMJ is to run a very easy, and completely non-invasive test that listens to the sounds of your jaw joints as it opens and closes. This objective and highly reproducible data gives us an accurate picture of how each component of each joint functions, how “out of sync” they may be, and at what stages in the open/close cycle any disturbances occur. Very simply, it lets us more accurately evaluate the ideal treatment for your very specific situation.

This exam is done via a set of headphones, but instead of delivering music to your ears, it listens to the sounds generated by your joints, as you simply open and close your mouth. It is quick, comfortable, completely non-invasive, incredibly accurate, and it provides us with essential information unavailable in any other manner.

Why is this important? It is important because the joints are the least directly correctable part of TMJ/TMD. You can adjust the bite (how the teeth interact), and through them, how the muscles react, but you cannot do anything to correct the internal physical deteriorations of the TMJ themselves without intricate surgeries. So, it is imperative to know the conditions of the joints before attempting anything else.

Please note that very few TMJ sufferers have joints that cannot be improved by refining how the teeth interact; current statistics show that fewer than 15% of TMJ sufferers are in this category. This quick screening enables us to be more candid and upfront with you by providing data unavailable by other means. Because, of course, no one wants to be frustrated in the results.

The Sonogram is so important in diagnosing TMJ that we use it with every patient, even during our complimentary consultations. The patient always deserves to know their true condition from the start, and there is no simpler, more accurate, or more comfortable way to determine this than through the sounds your jaw joints make when opening and closing. Treating TMJ/TMD can be a journey, and if you get off on the wrong path from the beginning, you will almost certainly wind up somewhere other than where you want to be.

Diagnosing TMJ Issues with a Jaw Velocity Analysis

One other factor that can influence your TMJ health and treatment is your jaw’s velocity, or the speed at which you are able to open and close your mouth. We use advanced digital technology to measure this accurately and give us a better idea of how we can help you overcome your problem.

What Is DTR Therapy?

Disclusion Time Reduction (DTR) is a computer-directed process that “fine-tunes” your teeth, muscles, and TMJ so they all work together comfortably and harmoniously. The source of most TMJ dysfunction is a misaligned bite, which creates friction. No machine lasts long or runs smoothly if it must fight against friction, and the teeth are no different. Muscles and joints work most efficiently when they have minimal interferences that cause friction. Friction causes the teeth to send messages to the muscles that tell them to grind, causing them to overwork. This puts constant stress on the muscles, which builds up lactic acid and causes severe pain, just like overworking muscles at the gym. 

The goal of DTR is to remove these interferences and allow the muscles, teeth, and joints to work with less effort, energy, and fatigue so they can perform their jobs more efficiently and effectively. DTR enables Dr. Teasdale to precisely adjust a patient’s bite so that the back teeth do not touch when the jaw slides side-to-side or front-to-back. This restores balance and prevents the muscles from straining themselves, allowing them (and you!) to completely relax.

Who Is a Good Candidate for DTR Therapy?

Dr. Teasdale recommends DTR therapy for patients dealing with some or all of the following conditions:

• Chronic jaw pain
• Persistent headaches and migraines
• Teeth grinding and clenching
• Chipped/worn-down teeth
• Frequent earaches
• Chronic neck pain
• Extremely sensitive teeth
• A mouth that often becomes stuck while opening and closing

How Does DTR Therapy Work?

Rather than using bite paper to evaluate the alignment of the teeth, DTR utilizes a computerized occlusal analysis alongside electromyography (EMG). This shows how the teeth come into contact in real-time. It reveals what order and how hard they are touching based on a computerized analysis and EMG-confirmation that the muscles are working only when required. With this information, Dr. Teasdale can determine how the bite is straining the muscles and then adjust the teeth to make them come together correctly and easily. This may involve slightly reshaping teeth by removing a small amount of enamel or building up a tooth with a custom restoration. In certain situations, orthodontics may be recommended as well. The end result is a functional bite, revitalized muscles, and no more pain!

The Advantages of DTR Therapy

If you were going to have your car tuned, how would you want the mechanic to handle the problem? Do you want them to use the latest computer technologies and techniques for a precise diagnosis, or do you want them to just kick your tires and listen to the engine before making vague recommendations?  Would you rather they use pinpoint accuracy, or rules of thumb?

This metaphor illustrates how accurate the DTR method in Portland is compared to other TMJ treatments. It allows Dr. Teasdale to gather much more data about the bite and muscles, making it far more accurate to decide which adjustments need to be made to solve the problem.

It’s important to remember that DTR also permanently fixes the bite, unlike mouthguards that can only possibly have an effect while you are wearing them. DTR removes the daily source of a patient’s pain and empowers them to function comfortably all hours of the day, for years to come.

Achieve the Relief You Have Been Waiting For

Dealing with TMJ pain can be frustrating and emotionally draining, especially if you have already visited multiple doctors and tried several treatments without getting results. When it is applied by a highly experienced TMJ dentist in Portland like Dr. Teasdale, DTR therapy is highly predictable in providing relief. At Advanced Dental Arts NW, our highly trained staff can show you exactly what is causing your pain and discuss how we can stop it using data measured from your specific and unique bite and muscles. DTR takes the uncertainty out of TMJ treatment, and you can trust Dr. Teasdale to provide the solution you need.

If you are ready to finally put your TMJ issues behind you, please give ADANW a call at 503-966-2528. Our team is focused on your comfort!

What Is Occlusal Disease?

Occlusal disease is an unfamiliar term for many patients, but it is mainly a very aggressive and accelerated form of tooth wear. It is primarily caused by a misaligned bite, which forces the muscles of the jaw to overwork as they try to push the teeth into the proper position while biting and chewing. This leads to lactic acid buildup in the muscles, places strain on the jaw joint, and creates excess pressure that causes the teeth to chip and crack over time.

The Symptoms of Occlusal Disease

Occlusal disease is related to a wide variety of symptoms, with the most common ones being:

• Persistent jaw pain
• A jaw that pops and clicks when it moves
• Lockjaw
• Extremely worn down or chipped teeth
• Loose or shifting teeth
• Gum recession
• Headaches
• Neckaches

How We Treat Occlusal Disease

Like all such diseases, occlusal disease is best treated early on and directly at the source. We take the time to evaluate your case from every angle so that our eventual treatment recommendations are sure to provide long-lasting relief.

The first step to treating occlusal disease involves taking very precise measurements of the bite. At ADANW, we use TekScan technology instead of traditional carbon bite paper to do this, as it gives us a much more accurate picture of how the teeth are coming together, in what order, and how hard they are touching. This helps us pinpoint the imbalances that are at the root of occlusal disease.  

Once we can find the interferences that are preventing the bite from functioning properly, we can correct them using DTR (Disclusion Time Reduction) therapy, an advanced type of TMJ treatment in Portland. Small adjustments are made to the teeth and/or pre-existing restorations so that the bite comes together without triggering the jaw muscles to overwork. This allows the muscles to relax and function properly, leading to a healthier, more comfortable future for the patient!

When the bite has been corrected, we can then repair the damage that has been caused by occlusal disease. This may involve building the teeth up using veneers, bonding, and crowns to replace lost dental structure. By the end of the process, the patient should look and feel like nothing was wrong with their bite in the first place!

What Is the Difference Between an Equilibration and DTR?

There is a huge difference. Equilibration is a procedure in which the dentist selects where they determine your jaw should be and then works to put your bite onto the back teeth. DTR, the polar opposite, works to direct the bite toward the front teeth, with the back teeth only touching when the mouth is fully closed. Study after study documents the far superior results accomplished by DTR while equilibrations have been performed for years with mixed results. Some traditions die hard—even in the face of something vastly more quantifiable and less subjective.

Start Feeling Better Today

If any of the symptoms touched on above sound familiar, or if you have been struggling to fix chronic jaw/mouth pain in a way that actually lasts for far too long, then you can take your first step toward true relief by giving ADANW a call today to schedule a consultation with our TMJ dentist in Portland. Dr. Russ Teasdale’s extensive experience, use of the latest technology, and commitment to long-term solutions are sure to help you achieve the oral health and harmonious smile you desire.

How Does Dental Botox® Work?

Advanced Dental Arts NW is proud and excited to be one of the first dental offices to offer dental Botox in Portland, OR for the comfort and well-being of our patients! Whether it is for the treatment of bruxism, teeth grinding, teeth clenching, TMD, facial pain, or for the associated benefits of looking younger and less stressed, Dr. Teasdale and our experienced staff are happy to help you assess this wonderful option so you can look and feel your best.

BOTOX works by "turning down" the power of the muscles, much like that dimmer switch on your ceiling lights.  When the muscles can't respond as forcefully, they exert less power, and use less energy. You can still chew, of course, but you might not be able to crush ice cubes or crunch CornNuts (two great things to avoid, anyway). Your teeth are not as stressed, and your ice water sensitivity goes away, and, because your muscles are not overworking, your face becomes thinner, especially along the jaw. The jaw relaxes at night, moving downward and forward, and making room for your tongue.  And all is right in the world...

The Benefits of Dental Botox®

Few things are quite as predictable as BOTOX, and, when used appropriately, there are very few negative side-effects. Although we usually use it for immediate relief, and then work with the patient for a more permanent solution, BOTOX may be used continuously for years without negative effect. It generally lasts for 90 days, and leaves no residual effects. Our patients are generally astonished that they feel very little if any discomfort with the injections, and with how youthful and stress-free they appear afterward. Indeed, it is sometimes called a "facelife in a syringe", because the effects are often extremely dramatic.

Relieve TMJ with Dental Botox® Treatment

Dentists and physicians have known for decades that jaw pain is seldom the result of a bad temporomandibular joint (TMJ), but is rather due to the muscles moving excessively or in an unbalanced manner. As the muscles become stressed, they trigger discomfort and pain throughout the face, head, neck, and body. Sometimes, when stimulated, “trigger points” in the TMJ can cause pain to shoot to remote sites throughout the body. This discomfort can cause or increase migraine headaches, which can be quite debilitating and last for days.

When used properly, Botox treatments for TMD can relieve and often block migraine headaches and soothe sore muscles for months at a time, providing patients with relief from symptoms they have suffered with for years. As an added bonus, the same Botox injection used to treat TMJ discomfort can give patients a more youthful, energetic, and beautiful facial appearance-- what a wonderful perk!

Dental Botox® for Teeth Grinding (Bruxism)

Teeth grinding and clenching (referred to when sleeping as Bruxism) occur when the body mistakenly assumes that food in present and must be chewed. This is a reflex triggered when the back teeth rub together, and the sensory receptors in the bone mistakes that contact as food, and tries to grind it away. But of course, it is not food, but the teeth that are contacting, and so the result is grinding, clenching, and bruxism. Pretty straightforward, isn't it?

This tooth-to-tooth contact is actually pretty destructive. It can (and will) eventually wear the enamel off the contacting teeth. It will flex the teeth, causing notching near the gums, and rounded and receding gums. It can cause bone loss around the roots, and extreme sensitivity to ice water. And it can make your face "squarer", with the lower face looking more boxy, as the jaw muscles overwork and build bulk. Oh, and did we mention TMJ pain, just as an additional symptom? Or that this is a factor in the vast majority of Obstructive Sleep Apnea cases, because, of course, when your teeth are grinding or clenching together, the space for your tongue is minimal, and it is displaced to the back of your throat, causing airway obstruction. Bruxism, Grinding, and Clenching. They just ain't no damn good. 

The comprehensive long-term solution involves adjustment of the bite, or possibly the rebuilding of the bite, to where the muscles are comfortable, and are not triggered to grind by tooth interferences. But in the short-run, one very effective way of easing the pain and symptoms is with BOTOX. 

Dental Botox® for Sleep Apnea & Bruxism

If you have obstructive sleep apnea or think you might, you should schedule a consultation with Dr. Teasdale. While sleep apnea is not something that Dr. Teasdale or any dentist can diagnose, in most cases, the disorder also causes bruxism, which IS a readily identifiable dental condition. Our conservative treatments, which may include either Botox or highly specialized sleep guards, often resolve problems with sleep apnea and are a whole lot more comfortable than the use of a CPAP unit (as any CPAP-wearer will confirm).

Please call us to schedule a consultation to discuss how Botox treatments for TMJ might be right for you. We are happy to work with you and your physician to provide you the good night sleep that your body needs and that you deserve. You cannot possibly look or feel your best without a good night’s rest. It is the key to everything!

Visit Us for a Dental Botox® Consultation Today

There is a reason we are the Number 1 Dentist in Portland for Botox--just google it and see for yourself.  Then call us for a complementary consultation, to discover the wonderful things that BOTOX may be able to bestow on you. Your Comfort and Appearance are what we are all about. Our Reason for Being.

Fixing Misaligned Teeth & Much More

The worst part of having crooked or misaligned teeth is not what you see, although that is most frequently why people are motivated to have their teeth straightened. The problem is much more serious than what you present to others in a social situation. Misaligned teeth lead directly to a multitude of problems, including gum and bone support issues, teeth grinding and clenching, temporomandibular joint dysfunction (or "TMD"), cracking of the teeth themselves near the gum line, head and neck pain, and broken teeth. There are other, less direct, ailments associated with poorly positioned teeth, including diabetes, obesity, and heart and circulatory problems.

Crooked teeth are not something to be taken lightly! It is a condition that progresses and can have a major impact on your life beyond simple cosmetics and discomfort.

We are concerned about how relaxed and comfortable the jaw muscles are, the symmetry of the face, how well the teeth themselves will work in their new arrangement, and how long the result will stay. In the process of applying orthodontics, because we put the teeth where nature originally intended, we achieve a beautiful, comfortable, and radiant smile.

Straightening Teeth While Stopping Jaw Pain

When it comes to getting teeth straightened, most patients are concerned that the end result looks even and symmetrical, a so-called "Front End Alignment" of the “Social Six” teeth that show most prominently in the smile. In reality, that is the easy part. We are far more concerned with how ALL the teeth fit together, ensuring they work as a team instead of fighting each other.

Properly addressing the position of the back teeth has great short and long term benefits. For one thing, a balanced row of teeth is largely self-supporting, with each tooth touching its neighbors in exactly the correct position, so there is less likelihood of a bad bite developing. For another, teeth that are solidly interlocked in a tight bite tend to lead to grinding, clenching, and TMJ problems. We can work to free up the bite with orthodontic treatment for TMD in Portland, OR, so the jaws are able to slide freely and easily across each other.

This is why we plan and revise each of our Invisalign® cases an average of nearly seven times before we are happy with the esthetic and functional results and why we monitor the movement of your teeth regularly. It's also why we are comfortable standing by our fee as the ONLY fee you will pay—including, if necessary, any refinements. Finally, it is why we achieve such consistently great results.

Orthodontic Treatment for Teeth Grinding & Clenching

A great many people have jaw clenching and teeth grinding issues, and many may not even realize it. At Advanced Dental Arts NW, we look for the telltale signs, such as flattened tooth surfaces, loose teeth, chipped tooth structure, little divots from the teeth near the gum line, facial asymmetries with the lower jaw, muscle tension, and TMJ issues. Most of these conditions are caused by how the teeth fit together. Because these symptoms develop slowly—sometimes over several years—individuals may not even recognize that there is a problem with their bite.

At Advanced Dental Arts NW, we treat teeth grinding and jaw clenching problems comprehensively and conservatively. Treatment could be something as minor as adjusting one spot on a single tooth, or it may require more involved treatment, using computers to pinpoint the timing and force of each tooth during a bite.

How We Use Invisalign® to Improve the Bite

Invisalign® is an orthodontic treatment which enables us to work to an endpoint that we can see before we even start—literally "begin with the end in mind." And, because we have such vast experience and expertise with this system, we recognize what is possible and we work to get there as quickly and as comfortably as we can without compromise.

We are also very happy to provide exceptionally rapid orthodontic care to cut the length of treatments like Invisalign® to less than a third of their average time. Ask us about Propel, Acceledent, and ProV5, and how they can help you complete your orthodontic treatment in far less time.

Whatever the specific need, we treat the root cause of it and not just the symptoms so that you receive the care you need to feel healthier and more energetic, and can thus better enjoy life!

How Does How My Teeth Touch Impact My Jaw and Bite Health?

If you have ever had a pebble in your shoe or a splinter in your finger, you know how a very small irritant can cause the other muscles to alter their normal routines. Your jaw is meant to move smoothly and with minimal resistance. Any “bumps” or restrictions cause the muscles to act less efficiently. They will try to either work around, or power through, or wear away any obstacles that interfere with their normal operation. This can create a number of problems, including (but not limited to):

• Muscle pain in the head and neck
• Pain in the temporomandibular joints (TMJ)
• Popping, clicking, and the occasional full-locking of the TMJ
• Extreme sensitivity to cold water and temperature changes
• Broken teeth, veneers, crowns, or fillings
• Abfractures, or what used to be called “Toothbrush Abrasion”
• Migraine headaches
• Tightness in the face and head muscles
• Pain behind the eyes, temples, or the back of the head
• Bone loss around certain teeth
• Grinding and clenching, resulting in bruxism
• Sleep apnea (in some cases)

I Thought Braces Were Supposed to Improve My Bite?

Orthodontic treatment has a number of objectives. The eventual position of the teeth depends on what’s possible within each patient’s mouth, the vision of the treating orthodontist or dentist, and the subjective opinions of esthetics and function. Unfortunately, how the teeth come and function together often receives minimal attention at the end of treatment when most patients are eager to have their braces removed. However, the bite remains key to the long-term success and comfort of any orthodontic treatment.

I’ve Already Had My Bite Adjusted, Why Do It Again?

Essentially, every dentist will do some adjustment of the bite, but the questions always are: How did they determine what and where to adjust, and how did they measure it?

If the determination is made through biting on carbon paper, then it is inherently inaccurate. Studies have shown that even highly experienced dentists only correctly identify a bite problem less than 13% of the time. This type of success rate is hardly acceptable for any type of established diagnostic procedure. But, this is essentially how all dentists attempt to identify issues with the bite simply because this is the way it has always been done. Hardly a satisfactory justification!

With the use of computer analysis, we can more comprehensively and precisely evaluate a patient’s bite. This approach shows us where the teeth are hitting, in what order, and how hard. Throughout the chewing cycle, we have comprehensive information to work with that could not otherwise be ascertained. This analysis provides a highly accurate “movie” that clearly demonstrates the dynamics of how your specific bite functions. It is the difference between looking at a single still photograph of a dancer or watching a video of their entire routine.

What Is DTR?

DTR (Disclusion Time Reduction) is a method of preventing the back teeth from touching when the jaw slides side-to-side or front-to-back. When your back teeth rub against each other, they trigger muscles in the face to redirect the jaw away from these restrictions. Over time, these muscles tire and become sore and painful. Subconsciously, you may even begin grinding your teeth in an effort to erode or break off the offending point(s). This behavior will not only further exhaust the muscles, but it can also displace, break, or abrade your teeth. More importantly, it can cause permanent damage to the TMJ itself.

The key is to precisely fine-tune the bite so that your muscles function efficiently and comfortably, because when the muscles relax, so do you.

Is DTR the Same as Neuromuscular Dentistry?

While the two fields do share some similarities, they also have some very important differences. DTR and NMD both focus on relaxing muscles that control your bite, but DTR assigns primary importance to how the teeth interact, while NMD looks first at the muscles. Additionally, DTR adjusts the bite using real-time computer analysis while concurrently monitoring muscle activity. This allows the procedure to be done in a far shorter amount of time.

NMD promotes the long-term use of mouthguards while DTR doesn’t require the use of such appliances. With DTR, there is no need for headgear or even models of your teeth as with NMD, because all adjustments are done with the patient using their normal, natural bite.

Will I Need to Wear a Splint or Mouthguard After DTR?

The purpose of mouthguards and splints (athletic protection and sleep apnea aside) is to maintain a space between the teeth so no grinding or clenching occurs. However, there are several logical and physiological reasons not to use them.

Oral appliances are only beneficial when worn, which is rarely for most people. Night appliances are only worn for between 6 to 8 hours. This still leaves the majority of the day where they do not, and cannot, work. Daytime appliances are generally too cumbersome to be worn routinely, so the benefits are likewise questionable. But, these obvious limitations still ignore some of the most important issues.

A mouthguard covers the biting surfaces of the teeth, thereby altering the bite. It may shield the teeth from direct contact, but it also creates a new bite, one that needs to be adjusted to make the muscles relax just like your natural bite. Additionally, it opens and holds your bite to at least the thickness of the appliance. Unless you have an unnaturally over-closed bite (due to tooth loss or orthodontics), this spacing can have very negative effects on the TMJ and the state of the rest of the muscles themselves. That is why these appliances need periodic replacement: to compensate for what they have changed. It is a self-perpetuating problem.

One thing that mouthguards actually do is change the chewing patterns because the teeth now hit at different heights and angles, which alters how the muscles respond. The temporary relief people sometimes experience from such appliances is not so much due to the relaxation of the muscles, but rather because the muscle tension has been shifted somewhere else.

Obviously, if you do not clench or grind your teeth, there is no benefit or need for an appliance to control those issues. Muscles in tune with the bite are happy and relaxed muscles and have no incentive or purpose to become overly-tense. After DTR, the vast majority of patients report that they feel better and more relaxed and are told they no longer grind at night.

As a general rule, most mouthguards do far more damage than good.

I Just Had Veneers/Crowns Placed, and My Dentist Said I Need to Protect Them By Wearing a Mouthguard. Should I Get One?

Mouthguards are an insurance policy against them chipping and breaking because of unconscious grinding, but that ceases to be a concern if the teeth come together properly and the bite is balanced. Mouthguards provide a false security, in that they primarily protect against breakage because the restorations were not placed with respect to how the bite works. Most chipping and fracturing of teeth or restorations occur because of incidental excessive forces as you chew, and with DTR, these are not a concern. Rather, a mouthguard should only be used when participating in athletics where a sudden impact could cause oral injury or damage to restorations. When you come to ADANW, Dr. Teasdale will examine your bite to make sure both your natural teeth and restorations are not at risk of incidental chipping due to a bite imbalance.

Can a TMJ Disorder Potentially Be Fatal?

Not directly, but a bite problem can contribute to issues that put someone’s ongoing health at risk. Chronic pain in the jaw and head might lead to depression and/or cause someone to alter their diet so it mostly includes less nutritious, easy-to-chew foods. These are typically highly processed and rich in sugar, meaning they contribute to obesity, diabetes, and heart disease. If the pain keeps someone from sleeping, sleep deprivation is also a leading contributor to motor vehicle accidents that is comparable to drunk driving.

How Long Does DTR Therapy Take?

When performed by a trained expert, DTR Therapy is a relatively quick process. Most of the work is done when analyzing the bite and muscles to determine the underlying causes of friction and tension. Once these are identified, correcting them is fairly straightforward. After the bite has been modified, many patients notice a difference almost immediately, but some may start to feel relief after a few days or weeks as their mouth and jaw adjust. Typically, the entire process takes about two to three appointments, which includes the consultation, exam, bite modification, and follow-up.

Will Treating My TMJ Disorder Affect My Appearance?

In many cases, yes, and in a positive way! Constant teeth grinding and jaw clenching can cause the masseter muscles (the ones located on the side of the jaw that move when you chew) to become overly large and look out of proportion to the rest of the face. Once the problem has been fixed, these muscles will work less and relax, causing them to shrink to a more normal size, creating a more defined jawline. Also, TMJ issues can often stem from an overbite, underbite, crossbite, or open bite, and addressing these with orthodontics can improve the overall look of the smile and face at the same time.