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TMJ problems during Invisalign, TMJ, donald tanenbaum, tmj doctor, invisalign

TMJ Problems During Invisalign Treatment

Author: Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain

Date: May 16, 2016

Modern technology has changed nearly every aspect of dentistry during the past ten years. The world of orthodontics, in particular, has seen incredible advances that allow teeth to be moved in a revolutionary way. Because of software technology dentists can now simulate the tooth movement steps that are necessary to go from starting point to end point before treatment has even begun. This remarkable technology is known to most of us as Invisalign.

Invisalign has not only changed the way teeth are moved, it enables many more dentists than before to offer tooth movement services. This is a huge shift in the way orthodontic treatment is delivered. And for millions of people, Invisalign is more desirable than traditional braces. However, despite the wonderful outcomes, many patients experience TMJ problems during Invisalign

More Patients Experiencing TMJ Problems During Invisalign Treatment

My practice is made up mostly of patients that suffer from disorders of the temporomandibular joint, most commonly referred to as TMJ. One of the significant risk factors that may initiate a TMJ problem is the presence of frequent and aggressive tooth contact during the day and at night. These tendencies are called awake bruxism and sleep bruxism respectively. Before the popularity of Invisalign, I normally saw a small proportion of patients every year that were actively involved with orthodontic treatment.

But recently I have seen an influx of patients with TMJ problems during Invisalign treatment. They represent all ages: teens, adolescents and adults. And they arrive with a combination of jaw muscle problems and jaw joint-related problems. From treating these patients I have begun to see a pattern emerge. Let me explain:

Patients in Invisalign treatment must wear their upper and lower aligner trays on a nearly full-time basis. The only exception is while eating. These clear aligners are made from a very rigid material that is relatively thick. Consequently, they take up a considerable amount of the free space between the upper and lower teeth, even when the jaw is in a relaxed position. For some patients, the upper and lower aligner trays are always in contact, which means their jaw muscles are always contracted in braced state. Over time these contracted muscles can become sore, painful and tight. In some cases, the jaw joint gets involved as well with symptoms such as popping, clicking and locking. And that’s what happened to Paula.

Paula is a 56-year-old who arrived at my office in a state of panic. Her jaw had locked and she was in considerable pain. Paula told me that only two months into her Invisalign treatment she had begun to experience jaw tightness and jaw joint noise upon arising every morning. Reporting it to her dentist, he assured her that her problem was likely not related to Invisalign, as he had “never seen this before.”

Although concerned, Paula pushed ahead with Invisalign until one morning she woke up in tremendous pain with a locked jaw. During our consultation, it became apparent to me that her Invisalign trays had prompted her to her jaw in a braced jaw position during the day and a clenched position at night. Because Paula’s history revealed no other risk factors, it is likely that her jaw muscles and jaw joints were compromised due to repetitive overuse.

Paula is not the only patient I’ve seen in the past few weeks with TMJ problems during Invisalign treatment. Take into consideration Nicole, who is 13-years old. Nicole had a minor jaw click before starting Invisalign. She wore her aligners for only a short period of time before her minor click became out of control and she was in tremendous pain. During her consult, I recognized that with the aligners in place, Nicole could not maintain a relaxed jaw posture. It is, therefore, easy to understand why her previously minor jaw problem had escalated during Invisalign treatment.

Many people have a history of tooth clenching or consistent teeth contact before they ever enter into Invisalign treatment. And some people don’t even know they do it because they don’t experience the typical symptoms. For these folks the introduction of Invisalign trays makes it very hard to maintain a neutral and restful jaw position and the risk of TMJ problems is very real.

How To Prevent TMJ Problems During Invisalign Treatment

The best way to prevent TMJ problems during Invisalign treatment is to ask your dentist some very specific questions before you make the decision to go ahead. Here are some sample questions:

  • YOU’VE HAD TMJ PROBLEMS IN THE PAST: “I have had jaw problems in the past. Is Invisalign the best choice for me?”
  • YOU DON’T KNOW IF YOU CLENCH OR GRIND YOUR TEETH: “I don’t know if I clench or grind my teeth during the night. Can you check for signs before I decide to start Invisalign?”
  • YOU’RE ENTERING INTO A STRESSFUL PERIOD IN YOUR LIFE, such as moving or a divorce: “I’m going to be under a lot of stress in the near future. Should I wait until life is calmer to begin the Invisalign treatment?”
  •  YOU’RE ON A MEDICATION THAT COULD CAUSE MUSCLE TENSION such as Adderall. “I am currently taking Adderall. Could that impact my treatment?”

You may have your heart set on Invisalign, but it’s best to know for sure that it’s right for you before starting. If you are in the midst of treatment I recommend that you make great efforts to be as mindful as you can to keep your trays apart during the day. Report your concerns about night clenching to your dentist immediately if you suspect you are doing it. TMJ problems during Invisalign treatment can negatively affect the outcome.

More than anything else: choose a dentist that you trust and who listens to you and addresses your concerns. It’s better to be safe than sorry.

Dr. Donald Tanenbaum is a dentist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat problems associated with facial painTMJ and sleep apnea. To find an orofacial pain expert in your area, link to the American Academy of Orofacial Pain here: http://www.aaop.org/

Live or work in New York City or on Long Island? You can schedule a consultation with me here or call 212-265-0110

DISCLAIMER: The advice offered in response to your questions is intended to be informational only and generic in nature. Namely, we in no way offer a definitive diagnosis or specific treatment recommendation for your particular situation. Our intent is solely educational and our responses to your actual questions serve as a springboard to discussion of a variety of dental topics that come up in a day-to-day dental practice. Any advice offered is no substitute for proper evaluation and care by a qualified professional.

20 replies on “TMJ Problems During Invisalign Treatment”

Thank you for this. I just reported this exact problem to my dentist this week. She did say it was from my Invisalign trays and that it’s from the change in my bite. This makes more sense though. I had a mild pop before I started my trays. Now, when I wake up every morning, I have to stretch out my mouth for a good 2 or 3 hours before it stops hurting and “catching” on the right side. This seems to have helped some. Thanks again for this article.

Hello,
I used a night/bite guard for several years that my DDS custom made for me. The idea was to protect my teeth against grinding and clenching. I am 68 and had already cracked a couple crowns & my front teeth are separating and are thin. QUICK MED HISTORY: I had breast cancer-surgery-chemo 11 years ago. I have osteoporosis, chemical sensitivity/allergies & sleep apnea.
I had mild TMJ at the start of night guard treatments. Now my TMJ is very bad on the right with cracking, popping, constant soreness and a need for stretching (which doesn’t look good). Occasionally/briefly it gets stuck open (scary).
I have a new DDS now. Invisalign has been suggested by her to solve my problems.. My question to you as an expert is… Will it likely do more harm that good as a TMJ correction & tooth protection cure? Your input and suggestions will be very much appreciated. Thank You 🙂

Hi Renee,

I think that at the moment you should have the TMJ problem assessed by a “specialist” in your area before considering Invisalign. You need a diagnosis first to understand why the joint is now unstable. Moving your teeth around may not be the best option. Go to AAOP.org and in the member directory see if you can find a Diplomate in your area.

Good Luck,

Dr. Tanenbaum

Hello,
I do not have a history of TMJ or jaw popping. I’ve had Invisalign for 16 months and am on my final 2 months. I got new trays based on a new scan 1 week ago. By Friday of that week I was having what I thought was ear pain. The next day (Saturday), I realized it was more like my lymph nodes were swollen and getting worse -only on one side. I went to the doctor and they did several tests to check for a bacteria infection but everything looked good. I also don’t have a fever or anything like that. But in researching the pain I was having – I keep coming up with possible TMJ. My question is can TMJ cause swollen lymph nodes around the ear/neck? If so it seems like these latest Invisalign trays may be an issue because I haven’t had this problem with any of my other trays.
Thank you for your help.

Hi Rachel,

Are your lymph nodes truly swollen based on the physician’s exam or is there soreness in the neck muscles? In the absence of any accompanying jaw pain, limited motion, or joint noises it would be hard to assume that you now have a TMJ problem. You could try the last set of trays for 7-10 days and see what happens.

Good luck,

Dr. T.

Dr. Tanenbaum,

Thank you so much for writing this article and for your willingness to respond to comments. I desperately need advice. I would like to have my teeth straightened. I have suffered with severe bilateral TMD for over ten years and have tried every treatment methods, excluding surgery. I clench during the day and night. My orthodontist recommended Invisalign for its potential to keep my teeth spaced during the day and night. The TMD specialist I recently began seeing here in MD was unfamiliar with recommendations for orthodontic treatment as it is related to TMD and therefore deferred to the orthodontist. However, I have read several articles like yours and recalled that the orthodontist only recommended Invisalign because I could not where a nightguard with metal braces. What do you think? How would you advice a patient to proceed? I expect to wear braces from 6 month to a year or Invisalign for 12 months to 2 years. Any insight or advice would be greatly appreciated. Clench management has been my best method of pain management.

Dear Ria, There is no perfect answer to your questions. I often recommend that my patients lean towards traditional braces which can get the job done more efficiently and with a high degree of accuracy based on the skill of the orthodontist. Often, the soreness as teeth move and this can discourage daytime clenching. At night, some studies show that, as the teeth move, the ever-changing bite may diminish the intensity of sleep bruxism. You could also purchase loosely fitting over the counter devices and or try an Aqualizer Dental Splint that your dentist could order for you to use when sleeping.

Hope this helps,

Dr. T

Dear Dr T,

I have suffered with TMJ pain and migraine for years and seems to have increased with Invisalign. My trays definitely do touch at all times but separating them feels abnormal. I only have 5 weeks left of treatment. My question is, is it likely the TMJ pain will last the length of treatment and ease off once the trays are out? Or could the severe pain last beyond that now? I’m hoping the pain is due to the movement/clenching of the teeth during treatment. I have been referred to a TMJ clinic at a dental hospital. Many thanks!

I would ask your dentist if it is ok for you to only wear one tray at a time during the day for a couple of weeks to see if that helps. If that doesn’t work ask him or her if you can complete your treatment a bit earlier than planned. In my experience, the pain usually goes away after treatment is completed.

Good luck!

Dr. Tanenbaum

I’m just finishing three years of Invisalign. Within the first two months I began noticing someone awry with my jaw, as if it was moving out of place and tilting.
My dentist kept assuring me it would go away as we progressed, but it kept getting worse. On each visit, I complained about it.
Three years and $9,000 later…the entire shape of my face and jaw is uneven, my chewing mechanics are totally askew, and my bite is way off. When I try to eat, my jaw moves in figure 8 zigzags, and I can barely find a spot where upper and lower teeth meet.
My dentist seems to think this is fine and says I “might have TMJ” and should simply find someone for physio.

Does all this sound kosher to you?

I feel I need a specialist to RE-ALIGN my entire jaw, but I have no idea where to start or who to go to and I don’t trust my dentist anymore.
Do I need an orthodontist? A surgeon? A jaw specialist? A brace?
I’m at my wit’s end.

One of the main reasons I got Invisalign was because this dentist told me it would IMPROVE my mouth mechanics. Now, everything is a thousand times worse.

So upset…:-(

Any advice you could give would be most helpful…
Many thanks,

Hello,

I’ve recently begun Invisalign treatment, and everything was going well for the first two sets of aligners. However, with the third set, I’ve been experiencing headaches on both sides of my head, pain in the lower back of my head, and tightness in my head, along with neck pain. Could this be related to TMJ or some other problem?
Any guidance you could provide would be greatly appreciated. Thank you!

Hi Harsh,

My advice is to make an appointment with the doctor who’s providing your care. And, perhaps take a couple of days off from the aligners.

Good luck!

Dr. Tanenbaum

Hi, I have been wearing my Invisalign for about 2 months now, I was on my 4th trey when I started having a fever for 3 days with headache. Then the fever stopped, but the headache continued in my head,jaw,ear,neck. sometimes the pain would come from my bottom of my right neck side to my forehead and temples and sometimes it would be from the left side. I did CT everything was fine, I did covid test came out negative. I’m taking antibiotics incase i have sinus infection but I don’t have runny nose or sore throat. It’s been 16 days the headache is still there I feel pressure in my head and my jaws. Should I completely stop Invisalign treatment? Side note, I always had jaw clicking and pain in my jaw if I ate fast then after the Invisalign, now this headache. PLEASE ADVISE.

Ivy, your story is a bit unusual, but anything is possible! I’m glad to hear you had a medical consultation to rule out a serious underlying cause, but at this juncture you might want to speak to your dentist about stopping aligner therapy for a short period of time. If your symptoms go away, great. If they don’t, you might think about having someone in the medical community assess your neck.

I hope this is helpful. Best of luck.

Donald R Tanenbaum DDS MPH

THANK YOU SO MUCH FOR POSTING THIS! I am in soooo much pain, I was in Invisalign for 6 years! I’ve been getting botox in my jaws and face for years now since this started. I had no idea this could be creating my pain.
My jaw is now off, when I open and close it now feels like the grinding has created a disc issue. Do you think I need to see a TMJ doctor for surgery.
If I had known this I would have never gotten Invisalign, I would have gotten braces.

Dear Laura,

I’m very sorry to hear about your jaw problems, and you’re not alone. My best advice is to see an Orofacial Pain specialist as soon as possible. If you’re not located near one of our offices (NYC and surrounding areas), a comprehensive list of specialists in the U.S. can be found here: https://www.aboms.org/diplomates/find-diplomate

Best of luck,

Dr. Tanenbaum

Thank you so much for this article! I’m wearing my last set of trays, and am scheduled for my retainer in 3 days from now. The problem is my jaw feels very tight since wearing the aligners for the past 3-4 sets. I knew I had TMJ from the start. I’ve always had a sort of crooked mouth and jaw popping. After breaking my front teeth a few years ago, and the repairs to them, I could no longer make contact with my front teeth, and only a couple of molars would make contact. Biting and chewing was getting very difficult. A prosthodontist suggested I go to an orthodontist to get braces before attempting to get another bit adjustment which might make things worse. Problem is that now, my mouth is even more crooked, with my chin sliding to the left and my facial muscles feel very fatigued. I am scared that the orthodontist will tell me that it isn’t from the aligners, or that there is nothing she could do. I also keep biting my tongue on the left when I chew my food. Is this something that will be able to be fixed? I’m frightened!

Dear Syrena,

I’m sorry to hear about your troubles. I can’t ascertain from your note whether you’ve been to an orthodontist yet. If you have, perhaps get a second opinion from someone else. If you haven’t, then an orthodontist may be your next step.

Good luck,

Dr. Tanenbaum

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