When the Jaw Hurts During Orthodontic Treatment
Table of Contents
Relationship between orthodontics and the TMJ
During orthodontic treatment, tooth positions change continuously and the occlusion becomes temporarily unstable. Because the TMJ functions in coordination with how the upper and lower teeth meet, occlusal changes place adaptive stress on the joint and masticatory muscles. In most cases gradual adaptation occurs, but in some patients new TMD symptoms develop or pre-existing symptoms worsen.
Why TMD develops during orthodontic treatment
- Variation in joint load due to occlusal change: When premature contact develops on a particular tooth as teeth move, an abnormal mandibular position is created to avoid that contact, applying biased forces to the joint.
- Use of elastics: Inter-arch elastics commonly used in orthodontics apply continuous posterior or lateral forces to the mandible, which can stress the articular disc.
- Increased stress: Discomfort and aesthetic concerns during treatment can heighten psychological stress, sometimes leading to increased clenching.
Distinguishing temporary from persistent symptoms
Temporary jaw discomfort lasting 1 to 2 weeks after an orthodontic adjustment can be a normal adaptive response. However, if pain, limited mouth opening, or new joint sounds persist for more than 4 weeks, TMD is likely progressing and active treatment is needed.
Collaboration between orthodontist and Korean medicine doctor
It is rarely necessary to stop the orthodontic treatment itself. If TMD symptoms are reported to the orthodontist, responses such as reducing wire forces or adjusting elastic direction are possible. The Korean medicine doctor treats the joint and muscle aspects in parallel.
Adjunctive Korean medicine treatment
- Acupuncture: Needling Xiaguan (ST7), Jiache (ST6), and Touwei (ST8) relieves hypertonicity of the masseter and temporalis and eases joint pain.
- Chuna: TMJ mobilization widens the joint space and improves disc position.
- Herbal medicine: Jakyakgamcho-tang (Shaoyao Gancao Tang) relaxes masticatory muscle tightness, while modified Soshiho-tang (Xiaochaihu-tang) addresses stress-related tension.
- Lifestyle guidance: Soft diet, correction of unilateral chewing, and bedtime jaw-relaxation exercises are advised.