One of the most common questions people ask me is when they should bring their child for an orthodontic consultation. The American Association of Orthodontists recommends that children should be seen for a consultation at age 7. The reason for this is that most children begin to get their first few permanent teeth by age 7, and so should be seen at that time to make sure they are coming in properly.
Having said that, I do not believe that most children need to be seen by an orthodontist at age 7 unless either a parent or the general dentist suspects a problem exists. I generally recommend that kids be seen by age 9. Frankly, there are few orthodontic problems that cannot be treated as effectively at age 9 as age 7, and there is generally a big difference in psychological and emotional maturity between those ages.
Now, the fact that I recommend children be seen at age 9 does not mean that I generally treat most kids at that age. Many orthodontic problems are best treated once all of the permanent teeth have come in, which may not be until age 12-14. However, there are some problems that are best treated early so as to avoid worse problems down the road. These include crossbites, underbites, and habits damaging to the teeth (such as thumb sucking).
I generally tell parents that our consultation appointments are free of charge, so bringing their child to see me won’t cost them anything. I may tell them that no work needs to be done and that they should return in a year, or I may identify a problem that requires immediate attention. Either way, it is to the child’s benefit to know.
It is never too late for orthodontic treatment – I treat many mature adults in my practice. But treating at earlier ages often makes the treatment faster and easier. So bring your child for a consultation by age 9, or even as early as age 7 if you or your dentist suspect something might be wrong.
The joint that connects the jaw with the skull is called the Temporomandibular Joint (TMJ). The initials refer to the joint itself, and do not refer to a diagnosis. (Everyone has two “TMJs” but no one has “TMJ”).
Like any joint (hip, shoulder, and wrist), the TMJ can be strained or injured. The injury can be the result of a specific trauma to the jaw or can result from prolonged low level trauma from oral habits such as night-time tooth grinding. Stresses (physical or psychological) can also result in tensing of the joint, which can result in jaw pain or clicking.
Once a joint or muscle is strained, it can be easily re-injured – like a sprained ankle which is subsequently more prone to injury. Because we use the jaw for so many activities including talking, eating, yawning, and laughing, the joint and the muscles are constantly moving. Therefore, TOTAL relaxation of the jaw joint and surrounding muscles is difficult. However, allowing the jaw muscles and joints to be in a relaxed position is very manageable with practice. Regular attempts to relax the jaw muscles, and avoidance of activities that would overwork the area, will be helpful to reduce the pain and prevent additional strain to the area. The following suggestions should help:
- Eat a PAIN-FREE diet. Do not chew gum – the repetitive chewing motion involved with gum chewing places a great deal of activity on the TMJ(s). Avoid hard foods, such as French bread or bagels. Avoid chewy foods, such as steak or candy. Cut fruits into small pieces and steam vegetables. Cut up food with a fork and knife if biting into food hurts. Chew with your back teeth. Eat anything you want as long as it does not cause pain or locking in your jaw. If “soft” foods cause pain, put any food you like into a blender and start on a grind setting. Blend the food into the chewiest consistency that does not cause pain or locking in your jaw. Do not stay on a soft diet too long by periodically increasing the consistency of your diet as tolerated. Discuss the details of your diet with your doctor periodically.
- Apply moist heat for 15-20 minutes two to four times each day to the painful area. For example, microwave a gel pack or hot water bottle and a wet towel until they are very warm. Wrap the towel around the gel pack/hot water bottle and put it on both sides of your jaw going under your chin, or treat one side and then the other side of your jaw. This heat treatment should feel very warm but comfortable. Some people respond better to cold treatments. Try using ice wrapped in a very thin cloth (or no cloth) for 5-10 minutes two to four times each day over the painful areas of your jaw muscles and/or TMJ(s). The ice may initially give you a “burning” sensation – this is normal. Keep the ice on the painful area only until you first feel some numbness, and then remove it. Heat or ice can reduce joint or muscle pains and relaxes the muscles. You may also find that cold followed by heat is useful. Experiment.
- Chew your food on both sides at the same time to reduce strain on one side. Specifically, cut your food into its normal size and cut that piece in half. Then put one piece on both sides of your mouth and chew. This will take practice.
- Avoid caffeine. Caffeine is a “muscle tensing” drug and can make your muscles feel tighter. Caffeine or caffeine-like drugs are in coffee, tea, soda, chocolate, and some aspirins. Decaffeinated coffee typically has half as much caffeine as regular.
- Avoid oral habits that put strain on the jaw muscles and joints. These include teeth clenching, teeth grinding, touching or holding the teeth gently together, biting cheeks/lips, pushing your tongue against teeth, or jaw muscle tensing. Also avoid biting on objects like pens or pencils. DO NOT CHEW GUM.
- Avoid resting your jaw on your hand.
- Avoid activities which involve wide opening of the jaw such as yawning. When you feel like yawning, put the tip of your tongue hard against the top of your mouth and let your mouth open as far as it can without letting your tongue off the top of your mouth. You can also put your hand under your jaw to limit the opening. Prolonged dental treatments with your mouth open should be avoided, if possible, until the pain has been reduced or eliminated.
- Avoid stomach sleeping since this puts strain on the jaw and neck muscles. Sleeping on your side is ok as long as you do not put a force on your jaw. Sleeping on your back is best.
- Use anti-inflammatory and pain-reducing medications like ibuprofen, Tylenol, and aspirin (without caffeine) to reduce joint and muscle pain as per your doctor’s suggestions.
- Calcium is very important for the healing and health of your TMJs and jaw muscles. Calcium comes in many sources including dairy products and certain vegetables. Supplements can be used in the 1200 mg per day range.
- Tongue up on your palate, teeth apart and jaw muscles relaxed.
The teeth should not be touching/resting together except occasionally they would touch lightly with swallowing. We suggest that you closely monitor your jaw position during your waking hours so that you maintain your jaw in a relaxed, comfortable position. This involves placing the tongue lightly on the top of your mouth wherever it is most comfortable while allowing the teeth to come apart, relaxing the jaw muscles. Often putting your tongue gently on the top of your mouth where you softly say “n” is a comfortable position.
** RECOGNIZE THAT THIS IS NOT A LIFE-THREATENING SITUATION, EVEN THOUGH IT CAN BE VERY UNCOMFORTABLE. INJURY TO THE TMJ AND JAW MUSCLES IS EXTREMELY COMMON, AND LOCKING OF THE JAW IS NOT UNCOMMON. MOST OFTEN THESE SYMPTOMS WILL IMPROVE OVER TIME. CHANGING HABITS, RELAXING THE AREA, AVOIDING ADDITIONAL STRAIN OR INJURY, AND DOING THE ABOVE SHOULD SPEED UP YOUR RECOVERY CONSIDERABLY.