TMJ and other problems after braces.

[hansca]

I had braces put on when i was 13 years old. Had my two upper first premolars extracted and then had my upper teeth braced first. It was probably a month or two later before i had my bottom teeth braced.

The orthodontist had originally said i would have my bottom first premolars removed as well, but I came in one day for treatment and he just said "Okay, I'm going to be putting braces onto you bottom teeth today."

I said,"Don't I need to have the corresponding bottom teeth taken out first like you originally said?" He kind of hesitated a moment, then shook his head and said,"Nah, I don't think it will be necessary."

Being just a kid and happy I wouldn't have to have my mouth numbed again and listening to my teeth being yanked, I didn't complain.

I was hoping the braces would, apart from improving the aesthetics of my smile, would fix up a problem I had with my bite. After all my baby teeth fell out and the permanent teeth came through, I discovered I could only chew on the right side of my mouth as all the molars on my left side did not touch when I bite. Also, my top second molars had come erupted when I was 13 with no problems, but the bottom second molars had only been able to erupt half way and had flaps of gum over the back half of the teeth. The dentist (separate from the orthodontist) told me it would come through all the way in time.

So, about eight months into the treatment, I go in for a tightening. Nothing special. After it's finished, I'm in my mum's car when I bite down and discover my top front teeth are right on top of my bottom front teeth. I couldn't bite with my molars. I wondered if it was because I'd only had my top premolars taken out and now that the gap was gone my top front teeth been pulled inwards so much they were now directly opposed to my bottom front teeth. I managed (and still manage to eat) by forcing my jaw backwards when I need to chew. Otherwise, when I'm resting, I don't bite down at all, I just leave my jaw open and keep my lips closed. I didn't complain to the dentist or my parents, as after a while I seemed to get used to it. I regret now that I didn't...

Anyway, at the next appointment, the orthodontist took a look around in my mouth and decided it was time to put elastic bands onto my first molars to try and fix the outward jut they had. I thought "at last, I'm going to be able to chew with my left side!" It didn't work out that way though. The bands kept snapping and I found it really hard putting them onto the hooks. By the next appointment, there wasn't any improvement at all.

So I was shocked to hear the orthodontist say I was ready to have my bottom braces removed. I'd had them on for a little over 9 months, while all my friends had them for at least two years. I finally complained, saying my bite still wasn't fixed and that I thought half a year wasn't long enough at all. He tried to assuage my fears by saying different people required different lengths of time, and that my teeth hadn't finished growing yet and would eventually touch when they had. He gave me these invisible retainers for the bottom front teeth afterwards.

I got my top braces taken off about two months later, so I'd only had them for a total of a year. The relief of having those metal things off of my teeth and the sensation of being able to run my tongue over them distracted me at the time from the fact that the result wasn't very good at all. My mum noted that the top second molars seemed to jut out behind my canines when I smiled. My bite was still screwed up. But (i put it down to being a stupid kid) I didn't say anything.

As the years went on, my jaw seemed to pop and crack a lot more and would tire out from eating, to the point where I often had to stop eating before my appetite was actually satisfied. I always wore my retainers. I found if i didn't wear them for about an hour they would feel incredibly tight when I tried to put them back in, so I wore them diligently day and night for four years until the bottom ones broke and the top ones became too chipped and worn to have any use.

My bottom second molars still hadn't fully erupted. My dentist thought it was strange, but maintained they would come through eventually since I didn't have any wisdom teeth that could possibly be impacting them. Well, two years ago, I had an x-ray taken while I was overseas and, lo and behold, had to two impacted wisdom teeth sitting on top of the back of my second molars!

So, now, I'm going to have my bottom wisdom teeth pulled out. They say I'm going to have to be put to sleep since they are going to have to crack open the bone to get them out, and it's possible that I may end up losing my second molars in the process as well. This still doesn't fix my bite or my jaw pain. Should I have had my bottom second premolars extracted as well back when I had my braces done to keep the bottom and top teeth in symmetry, and would this have prevented my bite problems? Does anyone have similar experiences?

I'm sorry about the extremely long post. There's just so much information that I've been turning over in my head. I really should have spoken out back then. I suppose it's better to be called a whining kid then to keep your mouth shut and get screwed up teeth.

[Sunny]

Hi Hansca and I'm sorry to read about the outcome of your treatment.

Having two teeth removed is often what's best if the the teeth in that jaw are jutting out and need to be pulled back in to make the bite a class I. Your ortho may indeed have done the right thing ... there's no way of knowing, without you getting your x-rays from back then and having them checked by someone else. Plus I'm not that would help you now. Also your ortho was right about the difference in treatment times etc. It's a very individual thing.

I think you need to let go of the past and instead decide what you want to do now. What is going to be best for your bite and your comfort? Are you prepared to have orthodontic treatment again to have your bite corrected? If you are, please make appointments to see a few orthodontist's and listen to what they recommend as the best option for your treatment.

It's good you're having your impacted wisdom teeth out, as they're never going to be any use to you while they won't come through. I don't recommend having any more teeth removed, unless an orthodontist recommends this.

I am a tooth short on my upper right and lower left ... so my bite is never going to be 'spot on'. My upper tooth is an impacted canine that is bonded to the bone, so it won't come down and can't be removed. My lower left first canine was removed when I was a teenager ... why I've no idea. My orthodontist is doing his best with what he has, but I was well informed at the beginning of my treatment about what to expect ... and what not to expect. My main reason for treatment is to help my bite, but during treatment it started to open, which has made chewing a challenge on my left side and front. This is not something that my ortho was able to predict ... and so my treatment continues to change.

Good luck with your decisions.

[hansca]

Thank you for your reply Sunny. I think I do need to let go of the past, and retrospection is a bad trait of mine. It's terrible to hear about the problems with you canine teeth as I understand they are vital to face structure.

I did go to one other orthodontist for an opinion before my parents decided on the guy that ultimately did the work (because he was cheaper). The first orthodontist was pretty sure I would need both the top and bottom premolars extracted, and he did all these speech tests to check for lisps (I do have a lisp, and still have it now) and took a few photos of my mouth, profile and portrait, and said I would need at least 18 months treatment.

The orthodontist we settled on didn't do any of these things and only used the OPG xray for reference. Doing a Google search now, it turns out he was recently brought before a dental practice tribunal over sub-standard treatment of a patient and possible malpractice. In the end he was fined $4000 AUD along with a reprimand. They couldn't really pin the malpractice on him since it was "a matter of opinion" as to what was the correct method of treatment, but the tribunal agreed some of the methods and equipment he was using was dated.

Thanks again for your support.