Dental Orthopaedics refers to the branch of dentistry concerned with conditions involving the realignment and development of the jaws and musculoskeletal system. Osteopathy is an approach to healthcare that works with the functional balance of the musculoskeletal system.
It is important to align the jaws correctly and ensure that their development is optimum in order to give the permanent teeth the best chance to erupt into their correct position. The final position of the teeth is one of least resistance between the forces of the soft tissues on either side of the dental arch. The final arrangement of the teeth is a result of the balance of forces in the mouth. Jaw misalignment has an effect on head/neck posture and the rest of the body and also when the body is misaligned problems can occur in the jaw relationship.
Dr Christina A. Kyrkou has been in general practice for more than 20 years and has more recently pursued an interest in dental occlusion, pain management, and jaw misalignment treatment. During consultation all of your treatment options will be explained to you in detail, treatment when possible is carried out conservatively and patients are only referred to other specialist practitioners if the case is extremely complicated.
TMJ (temporomandibular joint) refers to the joints right below the ear that connect the lower jaw to the skull. It is used every time we bite, chew, swallow, speak, make facial expressions. The joint is made up of two bones separated by a disc made of cartilage, ligaments and muscles are attached to the joint. Problems are very frequently seen, some affecting the muscles others the cartilage and ligaments. Dysfunction in the joints in the form of disc displacement can lead to symptoms of pain in or around the joints, the muscles of head and neck, headaches, dizziness, and other symptoms sometimes remote from the jaw joints. More specifically symptoms (that can be made worse at times of stress) may include ear ache, joint noise eg. clicking, headaches, off bite, swelling on the side of the face, ringing in the ears, dizziness and trouble sleeping. Every person responds differently to the treatment however the vast majority will experience improvement in the TMJ symptoms. It is possible to go through life without any symptoms from a misaligned jaw but unfortunately some adults suffer from chronic pain. Symptoms can range from low grade nagging pain in the jaws, temples, neck, shoulders and low back to excruciating agony. The body’s adaptive capacity is affected by numerous general health and lifestyle factors, stress in the form of muscle tension causing grinding and clenching being the most common.
Diagnosis and treatment of chronic derangements of the joints frequently requires the combined effort of several practitioners in order to stabilise the joints, reduce muscle hypertension and enable the rest of the body to “decompensate”. The close association between the cranial bone imbalance and compromised jaw relationships means that dental orthopaedics need to be carried out with cranial work. Complex problems require a broad knowledge of all aspects of dentistry as well as an understanding of the relationship of the jaw to the rest of the body. The primary objective is to establish normal healthy function, to establish optimal relationship of maxilla/mandible, to correct condyle/disc/fossa relationship, to move teeth and alveolar bone in order to stimulate development of arches to accommodate teeth, and finally to rearrange the teeth to support the maxilla/mandible relationship (orthodontics).
Underlying jaw misalignment and muscle, joint pain is frequently seen. These symptoms can affect other musculoskeletal groups.
BRUXISM can lead to headaches, migraines and aching muscles (can also cause toothache, jaw, neck ache, morning headaches, broken teeth, wear of restorations and teeth, tooth sensitivity) as this habit overworks the muscles and restricts the cranial bones to which they are attached.
Bite appliances can alleviate the symptoms of pain from the masticatory muscles and can be worn at night when bruxism is more prevalent. Significant improvements sometimes take as little as a few days. In some more complex cases where internal derangements of the joints are suspected, appliances are designed to be worn full time. One example of an appliance is the Nti-tss splint: a small device covering just the front teeth and is usually just worn for sleep. It is proven to reduce muscle hyperactivity thereby preventing you from clenching the teeth together.
“Bruxism affects over 10 million adults in the UK”
“Patients who grind and clench their teeth chronically exert between 6 and 20 times more pressure due to their well trained muscles”
“With repeated intense contraction, these powerful muscles become painful and the forces generated cause pain to the surrounding tissues, joints, and other muscles”
“Early recognition of misalignments and early treatment is necessary”
The majority of patients with protruding upper teeth are tongue thrusters. It is an abnormal habit where the patients place their tongue between their teeth before and during the act of swallowing.
Thumb sulking can also distort the bone and cause the teeth to protrude, in some cases this can lead to an open bite anteriorly or laterally. Both habits can move the teeth into an abnormal position and can cause growth distortions of the face and teeth.
Treatment may involve use of removable dental appliances to block the tongue away from the front teeth and it can also break the thumb sulking habit.