Q: Dr. Crapo: I am writing because I’m in pain, I don’t know where to turn and I’m frightened about my future. I’m middle aged, in what I thought was good health, but the last three months my bite has completely changed. I can no longer get my front teeth together. When I bite, I hit on my back two teeth – nothing else. I knew my bite was not perfect, but all of a sudden, I couldn’t bite things off with my front teeth. Then I noticed a space that got wider between my front teeth every day. I went to my dentist and he said he wasn’t sure what was happening so he sent me to a specialist who took special x-rays of my jaw joint – TM Joint he called it and he said the joint looked healthy but that I’d have to have surgery to get my teeth back together. I saw an oral surgeon and he described a surgery where my jaws are broken so that the teeth could be brought back together. I saw another specialist who said the joint had some problems and the disc had slipped out of place and it should be determined if the joint was diseased before anything was done. I’m sure this must sound like nonsense and it doesn’t make sense to me. I’ve got a thousand questions because I seem to be getting answers, but I can’t put them together. I don’t know if you can help but please weigh in if you can.
A: Historically the TM Joint (temporomandibular joint) has been given low priority in most dental programs, whether for general dentists or specialist dentists.
When a middle-aged individual experiences your problem, there is almost always a history of trauma – a fall, a car accident, a sports injury, an assault etc. After the swelling has gone down (because swelling in the joint structure can open the bite – but it’s usually the posterior teeth) there may be a progressive opening of the front teeth as you’ve reported. When the bite opens so there’s a space visible between the front teeth, it’s sure to be a disc displacement between the ball and socket of the TM Joints.
My research study says it is the joint that must be dealt with. There are only a few oral surgeons in North America that provide a service that will correct the bite and rehabilitate the joint. It’s expensive treatment but the very best treatment because it deals with the true problem.
Breaking jaws and moving them into functional positions still leaves the joint in an unstable relationship and future bite problems will occur. Though I do not perform this service, I am acquainted with the foremost authority and surgeon for this problem.