The Dental Sherpa

When something is off with the alignment of your jaw, it’s hard to ignore. It can lead to a whole host of complaints, from headaches to neck pain to ringing ears. One of the most common causes of problems with the jaw and the facial muscles is temporomandibular joint disorder, or TMD. We use the term as a way to describe the jaw pain and dysfunction that can occur when something is structurally off with the temporomandibular joint itself, a problem with the muscles that support it, or both. Because the muscles and joints of the jaws are so complex and full of nerve endings, when something goes wrong, it can cause a wide range of symptoms from mild to severe.

If you’ve ever experienced any possible TMD symptoms, you may find yourself wondering exactly TMD is, and what treatments are available to help correct it. It might also seem strange that an orthodontics practice like Krieger Orthodontics is writing a blog about the topic. What does TMD have to do with orthodontics? Keep reading, because we’re going to break it all down for you below.

What is the difference between TMJ and TMD?

TMD and TMJ are used interchangeably, but incorrectly, all the time. TMJ is not actually a disease or illness. It’s an abbreviation for temporomandibular joint, the hinged points that connect the jaw bones to the head. Located directly in front of the ears, this joint gives us the ability to speak and chew our food. The TMJ has impressive mobility, and rotates, glides, and acts as a powerful hinge all at the same time. It’s also surrounded by a number of complex protectors like tendons, muscles, and joint pads. Generally speaking, these components work well together. If they get thrown off course, however, it can lead to issues like pain, popping, and inflammation. This is where TMD enters the picture. This frustrating set of conditions can be painful, and is especially problematic when you consider that the TMJ is one of the most frequently used joints we have.

Possible symptoms of TMD

TMD will affect different people in different ways. While some will experience only mild symptoms that pop up every now and then, others will have serious symptoms that persist for years. Some of the most common symptoms of TMD are:

• pain or tenderness in the face, jaw joint, neck, and shoulders
• pain in or around the ear when chewing and speaking
• pain when opening the mouth wide
• difficulty opening the mouth wide
• jaws that get stuck or locked, whether the mouth is open or closed
• popping or grating sounds in the jaw joint when the mouth is open or closed
• popping, grating, or other sounds in the jaw when chewing
• face feeling “tired”
• difficulty chewing
• feeling as though the upper and lower teeth don’t fit together properly
• swelling on the side of the face
• ringing or stuffy ears

TMD can be tricky, as its symptoms can be similar to other common dental issues, such as tooth decay and gum disease. They can also mimic medical conditions such as arthritis. In order to receive a proper diagnosis and the most appropriate treatment, you should schedule a thorough examination with an experienced dental and orthodontic professional like Dr. Krieger.

What can cause TMD to develop?

TMD symptoms tend to arise from a problem (or multiple problems) with the muscles of your jaw, or with the parts of the TMJ itself. Some of the most common causes of TMD developing are:

• grinding or clenching the teeth, which puts extra pressure on the joint
• movement of the soft cushion or disc between the ball and socket of the joint
• arthritis in the TMJ
• stress, which can tighten the facial and jaw muscles, or cause unconscious teeth clenching
• injury to the jaw, the joint, or the muscles of the head and neck

Leaving bad bites or misaligned jaws untreated can also put unnecessary stress on the sensitive components that connect the TMJ, potentially causing chronic shooting pain that may be felt throughout the face, neck, shoulders, back, and arms, among other symptoms.

How is TMD diagnosed?

Here at Krieger Orthodontics, we are able to use state-of-the-art technology and techniques to pinpoint the source of a patient’s TMD. To gain an accurate diagnosis of TMD, Dr. Krieger will measure different aspects of the teeth and jaw, determine the jaw’s proper resting position, and map out the movement of the jaw during speaking and eating. Once the source of TMD has been found and a proper diagnosis given, our team will have the foundation they need to create a customized treatment plan that addresses each patient’s specific needs.

What treatment options exist for TMD?

Many people with TMD have relatively mild symptoms that only appear periodically. These often  improve on their own within a few weeks or months, though there are things that can be done to help ease and/or eliminate any discomfort, such as eating soft foods, applying ice or moist heat to the affected area, and avoiding extreme jaw movements like wide yawning and gum chewing.

 

Whenever possible, conservative treatment that is reversible is preferred for patients with TMD, as they don’t invade the tissues of the face, jaw, or joint, or involve surgery. These treatments won’t produce any permanent changes in the structure or position of the jaw or teeth, either. An example of this kind of conservative treatment would be splints or night guards. These plastic mouthpieces fit over the upper and lower teeth to keep them from touching, and wearing one of these can lessen the effects of clenching or grinding. They can also help correct the bite by putting teeth in a more desirable position.

Even if TMD symptoms become more persistent, most patients still won’t need more aggressive types of treatment. For troublesome cases of TMD, missing teeth may need to be replaced, and crowns and bridges may be used to balance the biting surfaces of the teeth. For patients who require more complex bite correction, orthodontic treatment such as braces or Invisalign may be required.

If left untreated, TMD can lead to long-term issues with inflammation, swelling, and chronic pain. It can also contribute to progressive dental problems, such as premature tooth wear and periodontal disease. For this reason, anyone with TMD symptoms should get in touch with an experienced dentist or orthodontist like Dr. Krieger to schedule a thorough examination and consultation.

TMD diagnosis & treatment with Krieger Orthodontics

Have you noticed any symptoms of TMD in yourself or a loved one? Are you interested in learning more about the diagnosis and treatment of TMD? If so, we invite you to contact us and set up a time to come in to our Lewisville office for a consultation with Dr. Krieger. When it comes to looking out for your oral health, we’re on the front line!

 

Whether you’ve had your braces on for years, or been wearing Invisalign aligners for a few months, it’s an exciting time when you finally have them removed or can quit wearing them. With this first step of orthodontic treatment completed, you can feel a little freer and smile a little brighter. But don’t get too carried away in your celebrations just yet – you’ve got a little further to go!

 

Whatever orthodontic method you used to straighten your teeth, there’s a second step of treatment necessary to round out the process and help maintain your beautiful new smile. Wearing a retainer regularly is an integral part of keeping your teeth in their new and improved positions, which is why our patients here at Krieger Orthodontics will hear us drive that point home many, many times over the course of treatment!

 

Because routine retainer use is so essential to prevent your teeth from drifting back into their old placements, our team has put together this helpful guide to help you understand why retainers are so important after the first phase of orthodontic treatment. Keep reading to learn more!

So, what exactly is a retainer?

A retainer is a fairly straightforward orthodontic appliance that’s molded and designed to fit each individual patient’s mouth. They’re primarily made by taking an impression of your newly straightened teeth, then fabricating the retainer out of a clear plastic material (for an Essix retainer) or from wire and an acrylic material (for a Hawley retainer).

 

Most orthodontists now recommend that some type of retainer be worn part-time for the rest of your life after the teeth have been straightened. We know that sounds completely overwhelming at first! However, with a little patience and practice, wearing your retainer can easily become a part of your daily routine. Before you know it, wearing it a few nights a week while you’re sleeping will be all you need to keep your teeth in the desired positions permanently.

 

When you first wear the retainer, it may feel a little weird, and it can sometimes affect your speech temporarily. But even if there’s some initial discomfort, you’ll still need to commit to wearing it as recommended. Failing to do so can keep it from doing its job, which means your teeth could begin shifting back, eventually leaving you right where you started.

 

The types of retainers

There are two types of retainers: fixed and removable. Before deciding which type would be best for you, we take several factors into consideration, including your specific case, your preferences and lifestyle, and the overall compliance expected.

 

Fixed retainers

A fixed retainer will usually consist of a thin wire positioned across the interior surface of the lower or upper front teeth. This is then bonded into place with a glue similar to the one used to attach braces to teeth. The wire will stretch across several teeth, so dental care is more or less the same as it was when you were in braces, particularly when it comes to flossing. If you’re thinking about a fixed retainer, don’t toss that floss threader just yet! It can be very helpful in accessing those interproximal spaces between the teeth to keep them clean.

 

Although this type of retainer takes a little more work to keep clean, it tends to have the best outcome overall. This is because the bonded wire is able to hold the newly straightened teeth in a more ideal alignment over time.

 

Removable retainers

Removable retainers are made up of a wire going across the front teeth. This is held in place with an acrylic material and clasps. The clasps wrap around the back teeth to hold the retainer in place. You may hear this referred to as a Hawley retainer. There’s also a type of removable retainer that looks very similar to an Invisalign aligner, which is often called an Essix retainer.

 

Cleaning your teeth is easier with these retainers, but you will have to remember to wear it daily. At the beginning of this second step of treatment, it’s likely that you’ll need to wear it all day and all night for at least three months. At the end of this period, your teeth will be assessed. If no movement is detected, then you may be able to wear the retainer less often, like only at night, or for a few hours during the day.

 

These retainers do tend to be more prone to loss and damage, so be careful with them. If you have pets, be sure you don’t leave one laying out, since dogs love to use them as a chew toy! There’s usually a charge to replace a lost of broken (or chewed on) retainer, so keep them in a safe place when not in use.

Gum and bone alignment

After your braces come off or your last Invisalign aligner is used, your teeth aren’t the only things we need to stay put! The gums and bones in your mouth will need to align to these new positions, too. The soft and hard tissues that are around the teeth can sometimes take a little longer to align to a different position, but by wearing your retainer as directed, you can help the gums and bones to realign, and your new bite to stabilize.

 

Teeth aren’t just fixed in the jaw. Each tooth is held in its socket by elastic ligaments that attach the roots to the bone. Those ligaments are living tissue affected by the movement of the teeth, and it’s actually this attachment that allows for the small movements of the teeth during treatment. When tension is placed in and around the teeth via braces or Invisalign, new ligaments, and sometimes even bone, are formed.

 

Once the remodeling phase has been completed, those tissues, ligaments, and bone will need time to stabilize. Without the help of a retainer to hold these new positions as they stabilize, the teeth will almost always migrate back to their old positions. It can take anywhere from several months to a few years for the new position of your teeth to become more permanent.

Care for braces and beyond with Krieger Orthodontics

If you’re in Lewisville daydreaming of the day your braces finally come off, or simply needing a refresher on the importance of retainers, Krieger Orthodontics is here to help you! For more information on the role retainers play after orthodontic treatment, get in touch with us today and we’ll be happy to answer any questions or concerns you may have. Krieger Orthodontics can keep your teeth in place and keep a smile on your face!

 

Whether you’ve had your braces on for years, or been wearing Invisalign aligners for a few months, it’s an exciting time when you finally have them removed or can quit wearing them. With this first step of orthodontic treatment completed, you can feel a little freer and smile a little brighter. But don’t get too carried away in your celebrations just yet – you’ve got a little further to go!

 

Whatever orthodontic method you used to straighten your teeth, there’s a second step of treatment necessary to round out the process and help maintain your beautiful new smile. Wearing a retainer regularly is an integral part of keeping your teeth in their new and improved positions, which is why our patients here at Krieger Orthodontics will hear us drive that point home many, many times over the course of treatment!

 

Because routine retainer use is so essential to prevent your teeth from drifting back into their old placements, our team has put together this helpful guide to help you understand why retainers are so important after the first phase of orthodontic treatment. Keep reading to learn more!

So, what exactly is a retainer?

A retainer is a fairly straightforward orthodontic appliance that’s molded and designed to fit each individual patient’s mouth. They’re primarily made by taking an impression of your newly straightened teeth, then fabricating the retainer out of a clear plastic material (for an Essix retainer) or from wire and an acrylic material (for a Hawley retainer).

 

Most orthodontists now recommend that some type of retainer be worn part-time for the rest of your life after the teeth have been straightened. We know that sounds completely overwhelming at first! However, with a little patience and practice, wearing your retainer can easily become a part of your daily routine. Before you know it, wearing it a few nights a week while you’re sleeping will be all you need to keep your teeth in the desired positions permanently.

 

When you first wear the retainer, it may feel a little weird, and it can sometimes affect your speech temporarily. But even if there’s some initial discomfort, you’ll still need to commit to wearing it as recommended. Failing to do so can keep it from doing its job, which means your teeth could begin shifting back, eventually leaving you right where you started.

 

The types of retainers

There are two types of retainers: fixed and removable. Before deciding which type would be best for you, we take several factors into consideration, including your specific case, your preferences and lifestyle, and the overall compliance expected.

 

Fixed retainers

A fixed retainer will usually consist of a thin wire positioned across the interior surface of the lower or upper front teeth. This is then bonded into place with a glue similar to the one used to attach braces to teeth. The wire will stretch across several teeth, so dental care is more or less the same as it was when you were in braces, particularly when it comes to flossing. If you’re thinking about a fixed retainer, don’t toss that floss threader just yet! It can be very helpful in accessing those interproximal spaces between the teeth to keep them clean.

 

Although this type of retainer takes a little more work to keep clean, it tends to have the best outcome overall. This is because the bonded wire is able to hold the newly straightened teeth in a more ideal alignment over time.

 

Removable retainers

Removable retainers are made up of a wire going across the front teeth. This is held in place with an acrylic material and clasps. The clasps wrap around the back teeth to hold the retainer in place. You may hear this referred to as a Hawley retainer. There’s also a type of removable retainer that looks very similar to an Invisalign aligner, which is often called an Essix retainer.

 

Cleaning your teeth is easier with these retainers, but you will have to remember to wear it daily. At the beginning of this second step of treatment, it’s likely that you’ll need to wear it all day and all night for at least three months. At the end of this period, your teeth will be assessed. If no movement is detected, then you may be able to wear the retainer less often, like only at night, or for a few hours during the day.

 

These retainers do tend to be more prone to loss and damage, so be careful with them. If you have pets, be sure you don’t leave one laying out, since dogs love to use them as a chew toy! There’s usually a charge to replace a lost of broken (or chewed on) retainer, so keep them in a safe place when not in use.

Gum and bone alignment

After your braces come off or your last Invisalign aligner is used, your teeth aren’t the only things we need to stay put! The gums and bones in your mouth will need to align to these new positions, too. The soft and hard tissues that are around the teeth can sometimes take a little longer to align to a different position, but by wearing your retainer as directed, you can help the gums and bones to realign, and your new bite to stabilize.

 

Teeth aren’t just fixed in the jaw. Each tooth is held in its socket by elastic ligaments that attach the roots to the bone. Those ligaments are living tissue affected by the movement of the teeth, and it’s actually this attachment that allows for the small movements of the teeth during treatment. When tension is placed in and around the teeth via braces or Invisalign, new ligaments, and sometimes even bone, are formed.

 

Once the remodeling phase has been completed, those tissues, ligaments, and bone will need time to stabilize. Without the help of a retainer to hold these new positions as they stabilize, the teeth will almost always migrate back to their old positions. It can take anywhere from several months to a few years for the new position of your teeth to become more permanent.

Care for braces and beyond with Krieger Orthodontics

If you’re in Lewisville daydreaming of the day your braces finally come off, or simply needing a refresher on the importance of retainers, Krieger Orthodontics is here to help you! For more information on the role retainers play after orthodontic treatment, get in touch with us today and we’ll be happy to answer any questions or concerns you may have. Krieger Orthodontics can keep your teeth in place and keep a smile on your face!

 

Whether you’ve had your braces on for years, or been wearing Invisalign aligners for a few months, it’s an exciting time when you finally have them removed or can quit wearing them. With this first step of orthodontic treatment completed, you can feel a little freer and smile a little brighter. But don’t get too carried away in your celebrations just yet – you’ve got a little further to go!

 

Whatever orthodontic method you used to straighten your teeth, there’s a second step of treatment necessary to round out the process and help maintain your beautiful new smile. Wearing a retainer regularly is an integral part of keeping your teeth in their new and improved positions, which is why our patients here at Krieger Orthodontics will hear us drive that point home many, many times over the course of treatment!

 

Because routine retainer use is so essential to prevent your teeth from drifting back into their old placements, our team has put together this helpful guide to help you understand why retainers are so important after the first phase of orthodontic treatment. Keep reading to learn more!

So, what exactly is a retainer?

A retainer is a fairly straightforward orthodontic appliance that’s molded and designed to fit each individual patient’s mouth. They’re primarily made by taking an impression of your newly straightened teeth, then fabricating the retainer out of a clear plastic material (for an Essix retainer) or from wire and an acrylic material (for a Hawley retainer).

 

Most orthodontists now recommend that some type of retainer be worn part-time for the rest of your life after the teeth have been straightened. We know that sounds completely overwhelming at first! However, with a little patience and practice, wearing your retainer can easily become a part of your daily routine. Before you know it, wearing it a few nights a week while you’re sleeping will be all you need to keep your teeth in the desired positions permanently.

 

When you first wear the retainer, it may feel a little weird, and it can sometimes affect your speech temporarily. But even if there’s some initial discomfort, you’ll still need to commit to wearing it as recommended. Failing to do so can keep it from doing its job, which means your teeth could begin shifting back, eventually leaving you right where you started.

 

The types of retainers

There are two types of retainers: fixed and removable. Before deciding which type would be best for you, we take several factors into consideration, including your specific case, your preferences and lifestyle, and the overall compliance expected.

 

Fixed retainers

A fixed retainer will usually consist of a thin wire positioned across the interior surface of the lower or upper front teeth. This is then bonded into place with a glue similar to the one used to attach braces to teeth. The wire will stretch across several teeth, so dental care is more or less the same as it was when you were in braces, particularly when it comes to flossing. If you’re thinking about a fixed retainer, don’t toss that floss threader just yet! It can be very helpful in accessing those interproximal spaces between the teeth to keep them clean.

 

Although this type of retainer takes a little more work to keep clean, it tends to have the best outcome overall. This is because the bonded wire is able to hold the newly straightened teeth in a more ideal alignment over time.

 

Removable retainers

Removable retainers are made up of a wire going across the front teeth. This is held in place with an acrylic material and clasps. The clasps wrap around the back teeth to hold the retainer in place. You may hear this referred to as a Hawley retainer. There’s also a type of removable retainer that looks very similar to an Invisalign aligner, which is often called an Essix retainer.

 

Cleaning your teeth is easier with these retainers, but you will have to remember to wear it daily. At the beginning of this second step of treatment, it’s likely that you’ll need to wear it all day and all night for at least three months. At the end of this period, your teeth will be assessed. If no movement is detected, then you may be able to wear the retainer less often, like only at night, or for a few hours during the day.

 

These retainers do tend to be more prone to loss and damage, so be careful with them. If you have pets, be sure you don’t leave one laying out, since dogs love to use them as a chew toy! There’s usually a charge to replace a lost of broken (or chewed on) retainer, so keep them in a safe place when not in use.

Gum and bone alignment

After your braces come off or your last Invisalign aligner is used, your teeth aren’t the only things we need to stay put! The gums and bones in your mouth will need to align to these new positions, too. The soft and hard tissues that are around the teeth can sometimes take a little longer to align to a different position, but by wearing your retainer as directed, you can help the gums and bones to realign, and your new bite to stabilize.

 

Teeth aren’t just fixed in the jaw. Each tooth is held in its socket by elastic ligaments that attach the roots to the bone. Those ligaments are living tissue affected by the movement of the teeth, and it’s actually this attachment that allows for the small movements of the teeth during treatment. When tension is placed in and around the teeth via braces or Invisalign, new ligaments, and sometimes even bone, are formed.

 

Once the remodeling phase has been completed, those tissues, ligaments, and bone will need time to stabilize. Without the help of a retainer to hold these new positions as they stabilize, the teeth will almost always migrate back to their old positions. It can take anywhere from several months to a few years for the new position of your teeth to become more permanent.

Care for braces and beyond with Krieger Orthodontics

If you’re in Lewisville daydreaming of the day your braces finally come off, or simply needing a refresher on the importance of retainers, Krieger Orthodontics is here to help you! For more information on the role retainers play after orthodontic treatment, get in touch with us today and we’ll be happy to answer any questions or concerns you may have. Krieger Orthodontics can keep your teeth in place and keep a smile on your face!

 

Invisalign is a method of straightening teeth where removable plastic trays can be used to put selective pressure on certain teeth to move them instead of using traditional braces and wires. The advantages include no dietary restrictions, no wires or brackets to cut lips or cheeks and the ability to floss and clean teeth better.

For years, I was a huge opponent of the idea of Invisalign. When I got certified back in 2004 and did about 50 cases as a general dentist, I never got gorgeous results. Then I became an orthodontist, spent 2 1/2 years learning about how teeth really move and how faces grow and still felt that wires and brackets were still the right way to move teeth.

In the last several years, Invisalign has done a phenomenal job of changing the tools that allow clinicians to move teeth using plastic trays. The “attachments” they use are now allowing more predictable outcomes and having thrown myself into hundreds of hours of Invisalign education from the best in the world, I can safely tell you that my Invisalign outcomes not only compare to my traditional “braces” outcomes, but I’m getting there quicker and more predictably. I can handle even the most difficult Invisalign case with ease and have even had gorgeous outcomes on younger patients. YES, you CAN do Invisalign on younger patients.

But there are several things you MUST know before you consider Invisalign:

1. Don’t get impressions taken using molds. I use the Itero scanner shown below. No more “goopy” molds. No more mess and best of all, it’s far more accurate than the old methods. In less than 10 minutes I create a digital 3D version of the patient’s mouth and can send it digitally to Invisalign. I can’t believe that anyone would still use the old method of impressions for Invisalign because they are far less accurate, comfortable or predictable than digital scanning.
   
2. A general dentist is NOT a specialist. I was a general dentist for 20 years before becoming an orthodontist. Don’t let any general dentist convince you that they can do tooth moving anywhere near as well as someone who only moves teeth for a living. Don’t believe me? Ask any general dentist if they would let a general surgeon do their hip replacement, or if they would go to an orthopedist who has the additional training only in hips. I’ve seen horrible Invisalign outcomes that have lifelong consequences for the patients who trusted a general dentist.
3. There will always be a refinement. When one gets scanned for Invisalign, all of their trays are delivered to the orthodontist at once. If the teeth don’t move as the computer expected, it’s no big deal. I can simply scan real quickly and get new trays made again. I tell patients that every single good Invisalign provider I know does at least one refinement for every case. General dentists do them rarely.  See point number 2.
4. Don’t accept cheap knockoffs. There are many cheaper alternatives to Invisalign. At the time of this writing, the ONLY reason why anyone would consider any option to Invisalign is that they want to save money. Invisalign is a brand name and is still the flagship way of straightening teeth using clear aligners and their doctor interface and finish and delivery of their aligners are unmatched by any other program. Don’t be fooled by cheaper imitations.
5. The devil is in the details. Everyone thinks that the orthodontist scans the patient, sends it to Invisalign and they do all the work. The truth is that there is a thing called the “clinicheck” where the clinician tells Invisalign what to do and how to move the teeth. If one just follows Invisalign’s suggestions and doesn’t know how to move teeth (see point 2) the outcomes won’t be the same. The skill of the clinician providing Invisalign plays a huge role in the outcome.
6. Free consultations are the norm. If someone charges you for an Invisalign consultation, run. Not much more needs to be said about this.

I’m always here for you if you have any questions about how to get a straighter smile. Just email me at doc@KriegerOrthodontics.com or call the office at 972-899-1465 to schedule a complementary consultation for you or your child.

Wishing you the best,

Glenn Krieger, DDS, MS, FAGD