Over the last 10-15 years, the use of clear aligners has found a place, favored by many patients, amidst other traditional orthodontic techniques. When directed by an orthodontist or a trained dentist, tooth movement accomplished by the use of aligners can lead to better dental hygiene and periodontal health, create more stable bite relationships, and boost self-confidence as a result of improved smile esthetics. All of these are positive outcomes.
As a TMJ specialist, however, I see many patients who are in the midst of aligner therapy to straighten their teeth experiencing a variety of jaw symptoms. Some are receiving their care from a trained orthodontist or dentist, and some have opted for self-directed care using mail-order aligners. Either way, their complaints are typically the same: after wearing their aligners for several weeks or months, they have difficulty opening their mouths, their jaw joints are clicking and popping, and most often, they have jaw pain. If this sounds like you, I’d like to offer you some tips on how to reduce jaw problems from aligners.
But first, it’s essential to understand that aligner therapy is a form of orthodontic treatment, the same as old-fashioned metal braces. In fact, anything designed to move teeth is a form of orthodontic treatment. Over the past few years, I’ve identified some reasons why some people experience jaw problems from aligners, whether they’re under professional care or are wearing mail-order aligners. It all has to do with the posture and position of your jaw while your aligners are in place…
Jaw Problems – During The Day
When you wear your aligners during the majority of the daytime hours, there’s a pretty good chance that the aligners are in contact with each other. This may seem ok, but in reality, once the aligners are in contact the jaw is no longer at rest. In fact, the normal rest position of your jaw is hanging in a loose way with the lips relaxed and teeth apart. So, when your aligners are in contact, your jaw is not at rest but is in a braced and tense muscle posture.
As a result of the top and bottom aligners being in contact for hours on end, your jaw muscles can fatigue and the jaw joints are put in a braced position. As a result of being overworked, injury can occur, in a fashion common to all joints in your body. Injury leads to symptoms of soreness and pain in the muscles and the onset of joint clicking and popping. At times jaw motion can become restricted as a result of the joint and muscle injuries. This is often called lockjaw.
Unfortunately, there are times when a new aligner tray doesn’t seat fully on the teeth when first used. At these times, patients are often provided what are called ‘chewies’ and instructed to bite on them to help engage the trays fully onto the teeth, so that the planned tooth movement can occur. Though this may be an important step, it can’t possibly be good for the jaw joints and muscles!!
Jaw Problems – While You’re Asleep
Since aligners are always used during the sleeping hours, some patients notice that they are clenching their teeth (often for the first time in their lives). Others who recognized that they were always night clenchers without morning symptoms prior to the aligners being used, now experience jaw soreness and pain as the result of the aligners and wonder why. One reason may be that the top of the aligners are not commonly adjusted to make sure that when they do come together, the right and left sides hit evenly. For some patients, this imbalance is all that is needed to start an injury process. This imbalance can be overlooked even if you’re under the professional supervision of an orthodontist or dentist. So, if you’ve opted for mail-order aligners, this concern will definitely be overlooked. The bottom line, however, is that contact of the trays in any way for a sustained period of time increases the risk for jaw muscle and joint injuries to occur.
So, if you’re in the midst of treatment or are considering it, here are some tips I’ve put together that can reduce the risk of a jaw problem developing
3 Tips To Help Reduce Jaw Problems From Aligners
During the day, try to keep your upper and lower aligners separated. Your lower jaw should hang like a hammock in the breeze. If you find this difficult, try some breathing exercises to help you relax. My patients get great results from Buteyko breathing and techniques like those found online on Headspace, Calm, and Buddhify (links below).
If you’re under the care of an orthodontist or dentist and suspect that you have been clenching while you’re asleep, make an appointment to have your aligners adjusted. If you are indeed clenching, at least you’ll be clenching evenly on the right and the left sides. For those of you who’ve chosen self-directed mail-order aligner therapy, this is one of the risks.
If you suspect jaw problems from aligners are developing as a result of what is happening during your sleeping hours, speak to whoever is guiding your care and consider giving your jaw a rest, and don’t wear them for a week or so. Or, wear only one aligner at a time at night for a short period of time as long as contact against the teeth on the other arch is even.
Clear aligners are here to stay and clearly, patients will benefit on many levels from pursuing this innovative form of tooth movement. However, if you’re having jaw problems since starting with aligners, and are under the care of an orthodontist or dentist, make an appointment right to address your concerns, If you’ve opted to “fly on your own” with mail-order aligners and have noticed jaw pain, that your jaw is clicking or popping, or if you’re having trouble opening your mouth all the way, I strongly advise you to discontinue treatment and seek professional advice.