What should I do if my patient’s TMJ pops when she uses Chewies?
It's possible that the Chewies could be creating a fulcrum point in the patient's occlusal plane, resulting in joint stress and positional changes.
A conservative joint management approach is recommended:
- Discontinue Chewies and ask the patient to help seat the trays by pushing up/down with fingers instead.
- Ensure the clinical TMJ exam is complete including joint films (CBCT) and a radiologist report. (You need to rule out degenerative joint disease and pathology.)
- Continue to clinically monitor the patient's TMJ signs and symptoms at every visit. If pain or limitation of jaw movement is noted, consider pausing treatment and remaining in the previous step until symptoms resolve with conservative therapy (Motrin, no gum chewing, soft diet, limit wide openings, etc.).
- Consider a one-year TMJ radiographic examination—if there are no changes from baseline, consider a 3-5 year radiographic follow-up.
Hopefully the patient's joint popping or pain will diminish. If they do, continue on with the patient's aligner treatment. (Steps #2-4 above could also apply to aligner patients who suffer from TMD.)
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