Josh Bernstein, DDS, Cosmetic Dentist

Does Extracting Teeth for Orthodontics Cause TMJ and Sleep Apnea?

 

Our Piedmont practice treats orthodontic cases with Invisalign for patients in Piedmont, Oakland, San Francisco, Berkeley, Orinda, Lafayette, Walnut Creek and throughout entire San Francisco Bay Area.

 

Because my dental practice is one of the few offices in the San Francisco Bay Area that treats TMJ problems, I have a unique perspective on orthodontics.  Many of the TMJ patients I see were not suffering until an orthodontist treated them.  Why is this happening?

 

First of all, I have to say that orthodontists are very conscientious.  They are doing exactly what they have been trained to do.  They go to continuing education and they care a lot about their patients.

 

In my opinion, orthodontic research that hard-working orthodontists are following is not paying close enough attention to the importance of airway, tongue space, and some technical biting principles.  Research also seems to be ignoring certain clinical realities.

 

In my practice, nearly every TMJ case I see has some form of airway obstruction problem—from mouth breathers to patients on CPAP machines for Obstructive Sleep Apnea. 

 

Proper oral posture during development causes proper oral development.  Ideal oral posture is when the lips are together and the tongue is resting gently just behind the upper two front teeth.  When the tongue is at rest and the cheeks are at rest, the jaws grow normally. 

 

If a patient cannot breathe through their nose due to allergies, sinus problems, enlarged adenoids etc., they breathe through their mouth, causing the tongue to posture forward and the cheeks to collapse inward.  The tongue and cheeks provide their own orthodontic forces causing a narrow mouth, crowded teeth and a bad bite.  This is a common cause of orthodontic problems.

 

However, the problem gets worse when the traditionally trained orthodontist sees the crowding and decides to extract 2 or 4 bicuspid teeth to "make room."  This makes room for the teeth as the dental arch is constrained, but decreases room for the tongue, exacerbating the larger problem.  With further crowding of the tongue, the problem repeats itself if the patient does not wear their retainers.  

 

Because too much space between the teeth is often created by the extractions, the orthodontist frequently has to angle the teeth inward to close the gaps.  When the teeth are angled inward they bite together at an off angle, not parallel to the long axis of the root of the tooth. This can be very painful to the muscles in the face as off-angled biting skews the jaw in micro movements in various directions.  When the upper front teeth are angled backwards, the lower jaw becomes trapped too far back, leading to jaw muscle fatigue.

 

When the bicuspid teeth are extracted, all the front teeth are typically moved backwards, along with the jaws and this is what crowds the tongue. The airway is sandwiched between the tongue and the spine, so if the jaws are set too far back, the mid airway can become compromised to the point of blockage.  This is a common cause of Obstructive Sleep Apnea.

 

When the jaws are set back, when the tongue is crowded, when the teeth are angled improperly, TMJ problems develop.  Most TMJ problems are muscular in nature—that is where it hurts.  If you consciously pull your tongue backward toward your throat as you're reading this, you will feel your lower jaw move backward and the muscles near your jaw joint become tense.  If a patient is in this state constantly, chronic muscle fatigue can develop and become quite painful in the form of headaches, facial pain and a number of other symptoms. Additionally, when the jaw is being pushed backward constantly if that is the way the teeth fit together, the ball aspect of the joint is too far back in the socket, allowing the disc to pop forward when it is supposed to act as a cushion between ball and socket.  Without proper jaw joint function, the disc and the joint can wear out. 

 

The general solution to this problem in my opinion is to expand the dental arch, rather than constrict it, whenever possible.  Generally avoid extracting teeth for orthodontic purposes.  Align the teeth so that they are upright and angled ideally, directing biting forces along the long axis of the root of the tooth.  Make sure that patients can breathe through their noses and that all other possible obstructions to breathing are properly addressed by qualified professionals.

 

A significant obstacle to proper treatment is that orthodontic research says that you cannot expand the jaws or the palate after a certain age.  The fact is that many dentists practicing orthodontics, who are aware of the problems described in this article, are successfully expanding jaws and palates with orthodontic appliances.  Is the research wrong? 

 

If you are looking for an orthodontic approach to avoid TMJ problems, to maintain or improve airway, and to retain healthy natural teeth, please call our office.  Many of these cases can be treated in our office with Invisalign.  For those cases that cannot, we can provide you a referral for orthodontic care consistent with our approach. 

 

We treat orthodontic cases with Invisalign for patients in Piedmont, San Francisco, Oakland, Berkeley, Orinda, Lafayette, Walnut Creek and cities throughout the Bay Area.  For more information please call our office at 510-601-7645 or go to http://www.allnewsmiles.com/invisalign.html. 

Josh Bernstein, DDS