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 pain, TMJ 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
Chari Lyn Bolejack says
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.
Renee Guzlas says
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 🙂
Dr. Tanenbaum says
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.
Rachel Lalley says
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.
Dr. Tanenbaum says
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.
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.
Dr. Tanenbaum says
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,
Jazz B says
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!
Dr. Tanenbaum says
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.
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.
Any advice you could give would be most helpful…
Dr. Tanenbaum says
At this point, I would recommend you see a board-certified orthodontist and an. orofacial pain specialist. To find an orofacial specialist, go to this website and look for a “diplomate” in your area: https://aaop.clubexpress.com/content.aspx?page_id=2720&club_id=508439 Best of luck, Dr. Tanenbaum
Natasha, I have been having the same symptoms (with clear aligners of a different brand name). I’m wondering if you were able to start resolving yours and if you could share advice. Thank you!
cecilia chan says
Hi Dr. Tanenbaum,
I am three months into my Invisalign treatment and I have been unable to fully open my jaw for three weeks. I have tried seeing my chiropractor and just started acupuncture in hopes that I can find some relief. Although it’s helped a tiny bit, I don’t think it will get better. I also have RA and am worried that this is a joint flare aggravated by the Invisalign to which the traditional braces will not help. Is there long term damage that can occur if I continue this way? Will traditional braces prevent this from happening? Thank you in advance!
Lady with the tight jaw
Dr. Tanenbaum says
Dear Lady with the Tight Jaw,
Without examining you, I can’t give you medical advice. But many people have the same problem from biting on the aligners or if they are touching each other all day long. That would create jaw tension. Check with your dentist to see what they suggest. Some people find that wearing the upper or lower, one at a time for a week, can help. But, do this ONLY if you have the OK from your dentist.
Jane kostadinoski says
Hi Dr. Tannenbaum
I had started invisalign in October 2001 within 2 months I was complaining about loud popping and the invisalign not fitting properly 4 months In the dentist agreed about invisalign not fitting properly and scanned my mouth to get a better fit even then I was complaining about the loud popping and tightness and was told that’s normal well at the 6 month mark all of a sudden I could not open my mouth all the way and my dentist sends me to another dentist currently I have alot of pain with pulling like someone in pulling my head foward, ear ringing, migraines (but I have always had migraines prior to this) dizziness etc. So I got sent to have a MRI done and this is what the report says Narrative & Impression
MRI OF THE TEMPOROMANDIBULAR JOINTS
CLINICAL INFORMATION: Limited mouth opening, articular disc disorder of left TMJ without reduction
TECHNIQUE: MRI of the temporomandibular joints was performed per routine
protocol. No intravenous contrast was administered.
1. Left: There is a small to moderate joint effusion. Mild degenerative
changes of the mandibular condyle. In the closed mouth position there is
complete dislocation of the articular disc anteriorly with thickening
and high signal of the disc. No recapture in the open mouth position.
Limited anterior translation of the condyle.
2. Right: Small joint effusion. Mild degenerative changes of the
mandibular condyle. There is near complete dislocation of the articular
disc in the closed mouth position with recapture in the open mouth
position. Mild signal abnormality and irregularity of the disc. Somewhat
limited anterior translation of the condyle in open mouth position,
although greater compared to the left.
So now I do go to physical therapy and tens does seem to help and I stopped using the invisalign the day I could not open my mouth all the way so my question is I have asked the dentist should I go back and finish invisalign will that make my situation worse and the only answer I get is that’s up to this is very frustrating to me can you give me some advice on should I re start invisalign or would that make my situation worse or should I do traditional braces or would that make it worse I don’t want to do anything that will make it my jaw position worse then what it is or would invisalign or traditional braces improve my situation
Someone in desperate help
Dr. Tanenbaum says
Jane, I recommend you see an Orofacial Pain specialist. You can find one in your area on the website of the American Academy of Orofacial Pain here https://aaop.clubexpress.com/content.aspx?page_id=2720&club_id=508439. Best of luck. Dr. T.