Frank E. Cordray D.D.S., M.S.
Board Certified Orthodontic Specialist

Recipient, Distinguished Service Award
Dawson Center for the Advancement of Dentistry

TMJ Appliances

The temporomandibular joints, or TMJs, connect your lower jaw to your skull. Misalignment of your bite can cause pain in these joints. For some people, that misalignment can cause pain in the ears, muscle aches, headaches, and other issues. TMJ appliances are a range of orthodontic devices that can relieve or eliminate TMJ issues due to jaw misalignment. If you have questions about appropriate appliances, please contact our office.

Frequently Asked Questions

What is TMJ?
TMJ is your jaw joint. TMJ stands for Temporomandibular Joint. Think of it as your elbow for your jaw. If your elbow were out of alignment, it would cause stress on your joint, your muscles, and likely cause pain and discomfort. TMJ can cause similar symptoms and can be an indication that your top and lower jaws are misaligned. Jaw misalignment can cause problems with your jaw joint (TMJ), but it also can cause your teeth to not last as long as they should.

If my bite were misaligned, by now wouldn’t my dentist have already told me?
Perhaps, but after being in the dental industry for 30 years, I have found it to be unlikely. Most dentists do not adequately check for their patient’s misaligned bite. Partly it is the fault of dental schools not providing sufficient training on how to reliably assess a patient’s bite. But it is also due to the way our society thinks about dentistry: most of us only go to a dentist when there is a problem. Accordingly, most dentists are only comfortable talking about immediate problems. A misaligned bite, in all but the rarest situations, is rarely an immediate crisis. However, it is something that over the years can cause teeth to wear faster and as a result you can lose them prematurely

Is it expensive to see if my bite is misaligned?
No. I have spent my career developing cost effective in-office techniques to assess a patient’s bite. I have conducted and published research papers on how to do it and to do so cost effectively.

If I am ok with the moderate discomfort from TMJ, is it ok to just live with it?
If your discomfort is minimal, you can choose to live with it. However, the trade-off is that you risk that the cause of your discomfort is a misaligned bite and a misaligned bite can cause your teeth to age prematurely.

Isn’t it somewhat rare for people to have a misaligned bite? And wouldn’t I be able to tell?
Unfortunately, a misaligned bite is not rare. Some studies report that 75% of adults have a misaligned bite. My own research shows that even a higher percentage of people in Ohio have a misaligned bite. Also unfortunately, except in rare cases, a patient is completely unaware that their bite is misaligned. And your bite can be misaligned even when you have straight teeth. A misaligned bite means that your upper and lower teeth are not aligned to connect in the right way. And being off just a little can add up over a lifetime to premature wear and tear on the teeth resulting in premature teeth problems as we age.

I had braces earlier in life, so how can my bite be misaligned?
Good question. There are two reasons for this. One reason is that most orthodontists do not adequately assess a patient’s bite. In published research that I and others have done, it has been found that most orthodontists either don’t assess the bite or use techniques that provide unreliable results. Consequently, their patients will have straight teeth but may have misalignments in their bite. And why don’t most orthodontists pay more attention to their patient’s bites? It is because very few patients ask for it. Once patients start requesting it, our industry will do a better job of consistently providing good bite assessments.

A second reason is that our teeth move throughout our lives. Accordingly, having a properly aligned bite in our youth doesn’t prevent us from having a misaligned bite when we are older. And unless you have been using a retainer faithfully ever since your braces were removed, you are at risk.

How does a misaligned bite cause my teeth to “give out” prematurely?
When the bite is misaligned, it means that the upper teeth and bottom teeth are not hitting evenly. The result is that some teeth bear too much of the pressure that comes from eating or grinding your teeth at night. Those teeth with too much pressure wear out faster as we age. And this process accelerates once we start losing teeth. Restored teeth via techniques such as bridges, crowns, veneers are unable to “carry their weight” when it comes to supporting surrounding teeth. As a result, having restored teeth puts extra strain on the remaining healthy teeth. The consequence is that the remaining teeth wear even faster leading to additional premature tooth loss. However, having a properly aligned bite will distribute the chewing pressure evenly throughout the mouth which enables your teeth to last longer.

If I already have bridges or other similar dental work, is it too late to fix my bite?
Fortunately, it is not too late to have your bite aligned even if you already have restorative dental work like crowns and bridges. In fact, a growing part of orthodontics is using orthodontic techniques to extend the life of the remaining healthy teeth by making sure that the bite pressure is evenly distributed across all of your teeth in your mouth. The result will be that your remaining healthy teeth will be more likely to last longer than if your bite remained misaligned.

Further, we are learning as a profession that correcting a patient’s bite can make the restored teeth last longer too. So some patients are choosing to get braces as or right before having costly restorative work performed so they can minimize the amount of restorative work (lower their cost) and so that they can make their restorative dental work last longer.

If my teeth look straight, does that mean my bite is aligned?
Great question. Unfortunately, just looking in the mirror at your bite does not show you if your bite is misaligned. In fact, in a normal trip to the dentist, your dentist would be unable to determine if your teeth are misaligned. To assess if your bite is misaligned, I use reliable, but cost effective techniques, to see if your bite is properly aligned. However, even after practicing and teaching for 30 years, I can’t just “eye-ball” whether you teeth are aligned. It takes using special techniques to assess alignment.

I have been to several dentists, and none mentioned my bite was off. So I shouldn’t have a problem, right?
It is possible that your bite is just fine. However, some experts have estimated that 3/4ths of the U.S. population has a misaligned bite. And except in rare situations, most misaligned bites are not readily detected without using special techniques to assess bite alignment. And since most patients don’t ask their dentist whether their bite is aligned, most dentists don’t check. As a result, most people go through their entire life without their bad bite ever being detected. My professional mission is to help change the dental profession so that everyone with a misaligned bite is detected (and done so early) so patients can have it corrected and have their teeth last as long as they should.

What is the difference between having straight teeth and a bite that is aligned properly? Aren’t they the same?
Having straight teeth means that all of your teeth on your upper (or lower) jaw are aligned with each other. However, the bite is when your upper AND lower jaw come together. So if your teeth are “straight” but the upper and lower jaws come together a little unevenly, it puts too much pressure on some teeth and not enough on others. The result is that even though your teeth are “straight”, they don’t strike together properly resulting in some teeth failing over the course of your life before they otherwise should.