In the facebook TMJ/TMD Discussion Group discussion one person posts the above picture asking if that splint will help with her TMD. It opened up an interesting discussion out of which reveals most doctors don’t have clear explanation of what causes TMD?
John Mew states that all bite splints cause the face to lengthen.
I asked Mike Mew on this matter and he agrees, one of the reason being overtime the masseter muscle will become accustomed to being lengthened and this will surely cause an increase in vertical dimensions. To me this is symptom alleviation and not addressing the cause.
The cause of all these issues is Cranial Facial Dystrophy or Maxilla that has dropped down and back.
John Mew posted in the comment section and shares his ideas on this matter.
I feel like most clinicians are so focused on looking at the problem, they only go the route of pain alleviation. Which is understandable when the patient is at their door in massive amounts of pain. They don’t have the time to ask “why?” this has happened in the patient.
The big picture that is missing and what John is trying to open people’s eyes to is that when people have forward maxilla they never have this problem in the first place.
The reason for maxilla that’s down and back? Open mouth posture & low tongue posture therefore the way to resolve TMJ & TMD is to correct your posture.
Some Rival Hypothesis for TMJ
- Occlusal disharmony precipitates TMD: Siche (1949) was one of the first to explain, if cusps clash during mastication, the two sliding surface of the joint are put under torsion and damage may result. Treatment requires grinding of teeth down. The problem is believed to be the teeth and jaw (irregular teeth contact, sliding contacts, cross bites, deviation of jaw). Clear evidence of improvement with this form of treatment is lacking and it fails to provide clear reason for development of occlusal disharmony in the first place.
- Certain types of malocclusion cause TMD: Mohlin’s (1989) findings suggest that most TMD is associated with crossbites (30{ae022d2295c0485893c83c8425b5bfafafba893c2d19b1bb9bc4c7c9bf3eeba6}), increased overjets (20{ae022d2295c0485893c83c8425b5bfafafba893c2d19b1bb9bc4c7c9bf3eeba6}), while least are found with deep bites (5{ae022d2295c0485893c83c8425b5bfafafba893c2d19b1bb9bc4c7c9bf3eeba6})and pre normal bites (2{ae022d2295c0485893c83c8425b5bfafafba893c2d19b1bb9bc4c7c9bf3eeba6}). To some extent these numbers only reflect the distribution of malocclusion themselves. Cases of people with severe malocclusion with all types Class I, II, III without TMD indicate that malocclusoin itself is not the precipitating factor. (although it is connected to the cause)
- TMD is caused by malformed condyles: MRI allows doctors to see that TMD suffers often have condyle shapes that are not ideal, however it is not clear if this is the true cause or if this is the effect of some other underlying problem.
- TMD is result of previous trauma: This is a populate belief among many clinicians. Yet most children take a blow to the face at one time or another yet there is no global symptoms of TMD arising from this. & This theory doesn’t explain how primitive cultures didn’t have TMD when their life circumstances would allow for more incidences of receiving physical trauma. Many patients that do break the jaw or condyles which is clear physical trauma recover and do not have precipitating TMD problems after. So evidence that counter this theory is so strong, it holds no water.
- Bruxism causes TMD: Some theorize that clenching & grinding puts heavy load on the joints and damages them, yet there are many people that brux and they never have TMD.
- Stress precipitates TMD: Psychological counseling has proved to be helpful for TMD but cure rates are not there for this form of treatment to be the go-to
There are few more theories on TMD and there all lacking in any clear explanation of why TMD occurs.
Studying mouth posture is difficult so many clinicians dismiss it. You can observe if the lips are closed or not but almost impossible to know where the tongue is. Also people when in company of others may keep their mouth closed but this may not be their true resting posture when others are not around.
Peterson (1983) found that patient’s with cross bites usually posture with their teeth apart and we know that TMD patients tend to have cross bites and tooth apart resting postures (Williamson 1990).
Teeth height
Profits work on oral posture & tooth eruption showed that occlusal height of any individual represent the product of the period time the teeth are in contact and the biting forces applied. Interpolating from his findings and personal research, John states that if teeth are not kept in light contact for between 4 to 8 hours each day they will continue to erupt. Presumably they continue to do so until they reach the limit of alveolar support or some other obstruction such as the tongue if stored between the teeth.
The accumulated evidence leaves little doubt that both malocclusion and TMD are linked with tooth-apart-postures. -John Mew
John’s Hypothesis TMD is caused by open mouth postures.
“Joints are highly adaptable and will always remodel to suit habitual rest positions (A). If the mouth is held open continuously (B) the condyle and fossa will re-contour so that the head is in or near the center of the fossa when the jaw is in the position (C). If following this, the mouth was closed, the head of the condyle will move upwards and backwards (D) to occupy a position frequently seen in TMD cases.
This hypothesis provides a specific explanation for six of the common signs of TMD: Retroposed Condyles – Open Mouth Posture – Tongue between Teeth Posture – Occlusal Irregularities – Lingual Inclination of the teeth – Deformation of the condyle and fossa.
Crucially it also explains why a joint that at other times can reform completely is unable to adjust one or two millimeters: -It can not adapt to suit the closed mouth position if this is only intermittent. It also explains why bite splints are so successful in the short term: -rest position and the contact position become the same and why they often fail in the long term: -the joint remodels to suit the new tooth apart posture.” – John Mew
Applying the tropic premise to TMD
- There is little to suggest that our ancestors had any issues with their jaw joints.
- Mouth open postures are endemic in modern population
- All joints naturally adapt so the ball is near the center of the socket in the resting position.
- If the teeth are apart for long periods, the condyle will remodel distally and the upper incisors will move lingually.
- if they close their mouth the head of the condyle is forced distally.
- If they clench their teeth, there will be pain and damage.
Basically the condyles remodels to the resting jaw posture. Condyles should be at the position when teeth is together. But when it remodels to when teeth is apart, it is now improper placement for when the teeth actually bite down or clench.
John’s Treatment
An appliance that force the patient’s mouth closed first at the same bite-open position for 4-8 hours a day then gradually reducing the height (thickness) of appliance so the patient eventually gets to teeth together posture while the condyle remodels forwards.
Conclusion
The aesthetic faces of the world have horizontal jaws & small noses because of forward maxilla. These people like our ancestors do not suffer with TMJ/TMD.
This is because they have closed mouth postures with teeth in light contact that held & supported their maxilla, which allows the lower jaw to rest in a position that is further up and forwards and condyles to remodel forwards to show what people call the “nice jawline”
Therefore placing any sort of bite splint between teeth which will cause the lower jaw to rest more vertical encourages condyles to remodel further down & back, & it may provide temporary relief to condyle Joint TMD TMJ pain but facial aesthetics may decline overtime.
-CP
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Dr. Gerald H. Smith says that all TMD/TMJ problems all related to skull issues.
Such as skull deviations and skull torques from trauma and/or from teeth extractions.
If Dr. John Mew is correct with his theories and can help people why did Ian Hedley from the Uk fly all the way to the US? Also, Ian works with the Mews, did they not have any options for him?
Thanks for your article and want to let you know that I am not bashing the Mews, I am just simply asking why would someone fly eleven hours to another country when you supposedly work for the best in the field?
Thanks,
B. 🙂
I don’t think Ian knew about the Mews back then
If I’m using an appliance with a bite block, how can I minimise the vertical effect? I’m only wearing the appliance for several hours at night and during the day I have my teeth together and tongue up, as well as chewing Falim gum.
How long are these people wearing the TMJ splints for?
building good muscle tone should be able to overcome it, but I don’t recommend bite block for too long. Ppl wear splints for 2 years + and has shown to see change in bone
Don’t people leave splints in for 24 hours a day too?
Also, I’d really appreciate your help on this one. My dentist is adamant that I need the bite plane to stop any further eruption/extrusion while I’m expanding, and he doesn’t feel the bite plane is an issue.
I, on the other hand, feel like it keeps my bite open while I’m sleeping but it’s probably no worse than being a mouth breather while sleeping (which I already was).
Should I get him to thin down the bite plane as possible? All he wanted was some occlusal coverage so I don’t see why it needs to be very think.
I was in your same situation. I ended up calling my ortho and had him make me a new appliance. My new one is called the “hang expancer”. It was a pain in the ass using an appliance with a bite block. I couldn’t eat with it and I felt self conscious because it made my face look longer. My ortho told me for adults the best/fastest method is to keep it in as much as you can. Hence the name functional alliance. You’re supposed to function with it. If you don’t think you can do that with your current appliance I’d suggest you do yourself a favor and ask for a new one. In the long run you’re only hurting yourself if you stay with an appliance you’re unhappy with because your doctor is getting paid anyhow.
you stop extrusion by keeping the teeth in light contact 8 or more hours per day, not the bite plane
CP, could you possibly go into more detail about your intrusion process at some stage? So many people say this process is difficult at best, yet you’ve had success just keeping your teeth in contact. Over what period of time did your teeth intrude, and any idea how much in terms of millimeters? And, why just in light contact – is any more pressure counter-productive?
CP: I appreciate the fact that you take this matter seriously and addressed the questions from the Starecta post with this post. It’s really helpful for someone like.men who’s with one foot in each camp and who just wants to solve the issues at hand. This actually answers my questions. It makes total sense. Thank you!
B. Afaik Ian was all ready being treated by Dr.Smith when hej started working with the Mews about a year ago. Julpynt ships mid treatment, after having invested and before being totally familiar with the other practitioners treatment modalities is hardly something that points towards the Mews theory being off.
The fact that Mr.Hedley is in dental school and is aspiring to work through the orthotropic lens is more than enough to convince me.
Hi,
Sometimes, I’ve seen people with pretty decent cheekbones but a receded mandible. (I find myself analysing faces a lot more lol!)
My theory is that if a young child ate tough foods and had good oral posture, their cheekbones would become well developed regardless if they adopt a soft foods diet/poor posture later on. Maybe the body is always in expectation of what it adapted to during early childhood even if it never reverts back to that? Doesn’t explain the short mandible though…
i can confirm that ever since i stopped wearing my mouth guard at night my TMJ has been better (knock on wood)
A question,
I recently ordered a pack of mastic gum from Greece. Now, my question is as follows:
My left side (my “good” side) seem to be much more developed than my right, the mandible almost flares out and the cheekbone protrudes a bit more. My theory is that ever since I was a child, I have primarily chewed the food on that particular side, chewing on the right side feels almost unnatural.
I’m planning on chewing the mastic gum for 3 hours a day, should I chew a bit more on the right, say 2 hours on the right and 1 hour on the left? Also, how much gum (crystals) should I be chewing? Will this, in all, give me a more symmetrical appearance over time?
I think I had the same thing so I started chewing more on the developed side, I think it is having subtle effects. But I try to chew more evenly now
Hi again Cp,
I have started treatment with the Myobrace and expanders (and braces after) to bring my jaw forward and restore balance to my face after extractions due to traditional braces when i was younger. I have a longer, vertical face and a weaker chin and a overbite, as compared to my siblings, who did not get braces.
From what i understand, the Myobrace is a kind of splint (https://en.m.wikipedia.org/wiki/Splint_activator). Will wearing the Myobrace cause an unwanted increase in vertical growth?
Also, i have a narrow arched and high vaulted palate and collapsed airways as a result of old orthodontic work. I have an underdeveloped palate, like that of a child. my tongue is a bit constricted and has no space to rest; it overlaps the front teeth when fully resting.
Would you happen to know how the changes (expanding the palate, bringing my jaw forward, creating gaps to reverse extraction work) will change my sound production and tone when singing ?
Will the high palate eventually be lowered down to a lower height when expanding?
CP, I would also be interested to know you opinion on whether the Myobrace will cause unwanted vertical growth!
Yes your tone of voice should improve, and high palate will gradually lower. I haven’t actually held the Myobrace, just make sure to make your muscle tone strong and you should be able to counter act it, if it goes between teeth, which I don’t like very much but hopefully it is thin
Im still abit confused. so the tongue suppose to rest on the roof top of the mouth. but is the tongue suppose push against the front teeth as well? for me, i find it better when the tongue isnt touching the front teeth. can anyone clarify this? thanks
tip of tongue should not touch front teeth, it should touch the incisive papilla
?
Hi again Cp,
As a result of bad ortho work in the past, I have a deep bite. When I align my front teeth and lower front teeth together without expander or myobrace, i have open gaps/space at the back molars. When I bite down at the back of my molars, my front teeth overlap with the front bottom teeth in that the bottom teeth cannot be seen anymore.
Wearing the myobrace aligns the lower jaw with the top jaw, and I think it looks like my face lengthens vertically when i align the top front teeth with the bottom front teeth when I have the myobrace on.
Wearing my expander also makes me have to align my lower front teeth with the top front teeth ( i have to move the lower jaw forward). It looks like my face is lengthened when I am doing this, and I worry if this will be the end result or just a temporary thing? It’s freaking me out! Images online of before and after overbite cases look like their faces lengthened vertically!
Please help!!
The cause of your deep bite is primarily from posturing your tongue between your teeth, you need to begin correcting your tongue posture to the roof of your mouth
http://claimingpower.com/tongue-posture/
I have not used MyoBrace so I’m not too familiar but I believe you can still get good tongue posture with it in.
Before and after pictures for the MyoBrace, or just in general (ie:traditional ortho work)?
“Open mouth posture & low tongue posture therefore the way to resolve TMJ & TMD is to correct your posture.”
I have a long face. Breathing problems. Sleep apnea. Deviated septum. Small lower jaw. Jaw pain on chewing. Overbite. I can’t breath through my nostrils at all most of the time. How do I correct my tongue posture when I have to have an open mouth to breathe? I’ll do anything. Quality of life having been reduced to low. My question: Will fitting a device to open my narrow upper jaw be enough?
adult palate expansion will help, also look up buteyko breathing method
Hello CP ! I’d like to know what you think about stick-out ears …Because I see that people with square lower jaw ,Forward Maxilla and high cheek bones don’t have ears sticking out from head..This kind of problem just happen with ones who got a long face with maxilla back…Can this problem be associated with our modern cranium distrophy ? And can it be corrected without surgery by face remodeling ?
Hey CP,
So I take it you don’t plan on wearing any sort of retainer or device at night? Are you concerned at all about stability?
I am getting my braces off in three months and the ortho puts everyone in a night retainer. Perhaps stability is not as big an issue for a case like yours where the extractions are being replaced but for those of us where our extractions are not replaced with implants, do you have any thoughts on the long term viability of our orthodontic work?
Thank you,
What if you have a displaced articular disc? I’ve been suffering with TMJ for a few years, and only now I can associate my child habits to my jaw developtment. I’ve kept my mouth open most of my childhood, resulting in a short lip and vertical growth of the face, as well as teeth crowding, which made my orthodontist remove two bicuspids. I look good but I know I could look AND FEEL so much better.
Funny thing, i have a horizontal jaw, but a big nose, TMJ and Tinnitus. never had an accident or a trauma.
Hi. I have TMD and my doctor recommend to have fillers to fix up the disk and that the clicking sound disappear and limit movement of mandible so far when opening it . So do you think this will shorten face ? Even thought my teeth are in normal contact I have tmd and got vertical growth ! What do I do ?
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