Describe a recent case where your patient was suffering from jaw pain and clenching. What were their symptoms and what else did they try?

I saw a middle-aged female patient who came in and said she was having a lot of issues. She’d suffered a lot of neck problems in the past, and had seen a lot of different providers for it. She went through chiropractic care for a long time, and had gotten some relief, but it didn’t last. She was very frustrated, to say the least, but I was confident I could help her.

Even though she had completed traditional orthodontics and her teeth were aligned, the problems didn’t go away. She still had some jaw tightness, soreness, and some problems with her ears feeling a little full and occasionally some ringing (known as tinnitus).

What did you find to be a possible cause of her TMJ and neck pain?

When I evaluated her, all the signs and symptoms that I saw led me to believe that what was actually causing her problem was an underdeveloped airway, which is a sure sign of sleep apnea. I had her tested for sleep apnea, and the results confirmed the diagnosis

Get Evaluated

It’s important to have signs and symptoms of a potential sleep breathing disorder evaluated by a knowledgeable healthcare professional.

What does it mean to have an underdeveloped airway?

The analogy that I like to use with patients when they have a small airway is to think of having a really thick milkshake and trying to drink that with a stirrer straw — you’re going to struggle. You may get a little bit, but it’s probably not going to be worth the reward. Just like a tiny straw won’t get you enough milkshake, a tiny airway won’t get you enough air. When you have a bigger straw, you can actually enjoy that milkshake. When your airway is the proper size, you can breathe the way you’re supposed to.

What were the treatment options you presented?

I discussed with her some different ways we can manage this. We can put you on a C-PAP to treat your airway, but that’s not going to help with the jaw joint and neck issues though. She didn’t want a C-PAP anyway, because she didn’t want to have to wear that thing on her face.

Another option is a sleep appliance that we make in the office. It’s a custom appliance that repositions her jaw and puts it into a relaxed state. This would help with some of the jaw pain and some of the clinical things that I saw. But again, it’s just treating the symptoms of what she has, not treating the underlying cause of those symptoms.

So, the third option that we gave her was doing a form of orthodontics where we actually reshape the jaws and help bring them forward and create growth.

How does growing the jaw help?

By growing her jaws, we create a larger airway and we relax the position of the jaw joint as well. When we’re doing this we allow the jaw to go into a more neutral site. This enables us to address a lot of different causes for the pain at once, and can lead to permanent relief.
She’d already had a lot of different treatments done. She was looking for a solution, not just a treatment for her symptoms. So for her, we’ve decided that we’re going to do some growth.

Get Evaluated

It’s important to have signs and symptoms of a potential sleep breathing disorder evaluated by a knowledgeable healthcare professional.

How did you come to the conclusion that this orthodontic treatment was the right pathway for her?

To determine if she’s a candidate for this type of orthodontic treatment we do a full 3d analysis. We took an xray that’s three dimensional, and we’re able to look at where all of the bones and soft tissue are located and determine, okay, are we too small in certain areas?

We looked at her, we evaluated her and we saw that we needed to bring her upper jaw forward about almost a centimeter. And in doing that, we’re going to give her the area that she needs, not just for her teeth to fit where they’re supposed to, but her tongue to have the space and room to go where it’s supposed to as well.

We’re working with her as well on some exercises to have proper tongue placement and have a proper lip seal creating the right type of breathing. Because what we find with a lot of these patients are they read through their mouth and they’re not properly breathing through their nose. And so we have to train them to breathe through their nose as well.

What was the patient’s reaction when she discovered this specific type of treatment?

This was definitely something that was brand new to her. She had not heard of anything like it or seen anything like it. But when we were able to go through the models with her and show her what we were going to do and why we were changing the things that we were going to change, it made sense that where she was right now, everything was pulled back in really tight. And she just had no room to maneuver either for teeth or her tongue.

If other patients are struggling with TMJ pain, what should they do next?

The best way to start this process is to make sure we have a proper diagnosis. It’s like everything else in medicine. You’re not going to go get your appendix out if you don’t have appendicitis. You’re not going to go have a procedure done on a torn rotator cuff if they haven’t done the imaging to see that it’s actually torn. I diagnose the root cause first so we know we’re treating it the right way.

I want to make it as simple as possible to find out whether I can help. The next step for someone suffering with jaw pain and clenching is a simple pre-screening assessment.