Neuromuscular orthodontics brings TMJ relief to patients in Carlsbad, CA

Does your face ache? Does pain or limited mobility in your jaw muscles and joints prevent you from eating or sleeping well? Do you chronically have a stiff neck and shoulders? Or maybe ringing in the ears, ear aches, headaches, and migraines? These (and more) are common symptoms of temporomandibular joint disorder. As a Master of the International College of Cranio-Mandibular Orthopedics, Dr. Al A. Fallah takes the situation seriously. Rather than masking symptoms with pain-blocking medications, he offers patients in the Carlsbad, CA area a healthy, lasting treatment option – neuromuscular orthodontics.

Oral epidemic

An estimated ten million people in the United States experience TMJ disorders. The number is approximate because many simply live with the discomfort. Since symptoms of TMD are quite varied, countless other cases are misdiagnosed. Temporomandibular joint disorder can be defined as discomfort or reduced oral function resulting from imbalanced occlusion – bite. Why do so many people have this condition? In many cases, it begins at birth.

As an infant nurses from mother, the suckling action causes baby’s tongue to rise to the roof of the mouth. At this early stage, bones of the face and head are soft. Breastfeeding fosters a healthy growth pattern, with the tongue expanding the maxilla (upper jaw) and helping to shape palatal, pterygoid, and cranial bones properly. Good tongue position expands both the width and length of the maxilla. The pre-maxilla area consisting of incisors and canines moves forward, and bicuspids and molars expand laterally. This opens up space in the airway as well as the dental arch. Normal development in a baby sets the stage for optimal oral function and breathing throughout life. Without it, infants grow into children, teens, and adults with TMD and sleep apnea.

In the past decade or two, bottle-feeding became a popular trend. While the more natural method is back in favor, in our modern fast-paced culture, mothers often do not get to nurse their babies for more than a few weeks. Since the overall health benefits of breast milk are well-recognized today, the mother who returns to work may express it to provide for her baby. That is commendable, but it does not substitute for the oral development advantages of nursing.

Tongue-tie also contributes to a restricted maxilla. The frenum is a band of fibrous tissue that anchors the tongue to the floor of the mouth. In a tongue-tied baby, that attachment point is too far forward, preventing the tongue from moving upward. An astute lactation specialist recognizes this early, referring to a dentist trained in a laser procedure to release the tie. Freeing the tongue allows the baby to latch on better and suckle properly.

Understanding neuromuscular orthodontics

Conventional orthodontic treatment is a means to straighten teeth – often beginning with multiple extractions. An attractive smile is important, but it is not enough. The goal of neuromuscular orthodontics (or NMO) is to create proper jaw size, jaw-to-jaw positioning, and functionality . . . as well as a beautiful smile. That’s why this specialty is also known as functional orthodontic treatment.

When the upper jaw is narrow, the lower jaw is forced to retract. As it goes back, it restricts the airway. It also puts unusual pressure on temporomandibular joints, and strain on neck structures. Properly administered NMO allows the lower jaw to come down and forward. Expanding the upper jaw and bringing it forward matches it to the physiologic placement of the lower jaw. This harmonious alignment restores comfort and function, and gives the patient a big, broad smile.

Options in neuromuscular orthodontics at Carlsbad, CA practice

Dr. Fallah personalizes treatment for pre-adolescent (to prevent TMJ issues) teens, and adult patients. He utilizes training, experience, and a variety of tools and techniques including: Expanders – The Wilson appliance is one example of Stage I orthodontics addressing macro-occlusion. It resides on the lingual or inside aspect of the upper jaw. As you might guess, this type of device expands the arch side to side, simultaneously drawing the upper front teeth forward. The appliance and facemask (if needed) is worn during sleep time. Braces – Ideally, expander treatment is followed by a Stage II course of orthodontics for micro-occlusion, to bring teeth into proper alignment in the newly-broadened arch. DNA appliance – This device is similar to an expander, with a mechanism to expand molars, bicuspids, and canine teeth laterally. Then it moves canines and incisors forward, advancing the maxilla. This discreet device is worn at nighttime and possibly a few extra hours during the day. As a side benefit, many patients find improvement in sleep apnea while using the DNA appliance. Invisalign – Removable aligner treatment alone can only expand the maxilla by one or two millimeters – not enough to resolve TMD or sleep disordered breathing. However, as a follow-up to DNA appliance therapy, the correct Invisalign prescription completes treatment beautifully. This is a suitable path for an adult patient who does not want to wear braces, have the appearance of teeth modified with porcelain veneers, or consider full mouth reconstruction.

Why choose neuromuscular dentistry?

The alternative to NMO is orthodontic jaw surgery. An oral & maxillofacial surgeon breaks the jaw in specific areas to expand it and bring it forward. The surgeon has just one chance to reposition it correctly. This is a big challenge considering the patient is anesthetized with the lower jaw sliding back, so gravitational forces and physiologic bite position must be estimated.

Dr. Fallah uses advanced diagnostic techniques taking precise measurements determining where the jaw needs to be. NMO treatment moves incrementally in that direction, so course corrections can be made, and change is reversible if necessary. At the conclusion of NMO, Dr. Fallah uses T-scan technology to evaluate bite landing. This reveals tiny contact points that can trigger muscle and joint problems. He makes sure Stage I and Stage II treatment has balanced the bite ideally.