Sleep Apnea and TMJ – The Relationship
Alive Magazine—September 2013
by Dr. Robert Brown
As many of my readers know, I have been practicing in the field of TMJ (the joint that attaches the lower jaw, mandible, to the temporal bone of your head) for 35 years. Over those years I have seen the usual fads come and go from simple little splints that attach only to the front teeth to full coverage splints. Anything will work occasionally because most TMJ is simply because it is not natural to hold the teeth together. Just put ting something in that interrupts this habit can sometimes work.
There is no “one size fits all” orthotic (splint) that works for everyone. One of my goals in treatment is to diagnose the underlying cause of why each patient has destructive oral habits and work on the factors causing the dysfunction. Over the years,working as a team with other specialists, I was getting very good results. Some patients, though, did not respond well or would have the symptoms come and go.
It was when medicine brought sleep apnea to the forefront and developed ways to diagnose and treat this problem that I got to the “root” of the problem. One finding was that during one’s waking hours, pressure when clenching reach forces in the area of 200 pounds per square inch. During sleep, by contrast, forces can reach over 700 pounds per square inch. Those that add grinding to their bad habits can literally grind their teeth to the gum line. These heavy forces can seriously exacerbate dam age to the joints and disks.
A major factor causing this is that obstructive sleep apnea (OSA) has an effect on the brain, not letting it go into deep sleep mode in order to be awake enough to prevent suffocation. Part of my initial exam questionnaire contains a test that is quite good at seeing the need for a sleep study. Most people go in for a study because of their friends that are kept awake with their snoring. I have found non snoring patients with acute OSA because the obstruction is below the tongue and palate where snoring occurs.
Treatment of the OSA using a dental appliance can not only bring the apnea under control, but help prevent any further damage to the teeth and joints. One comment I get from my OSA patients is that before the appliance they rarely dreamed and could not remember their dreams. “Now my dreams are much better, they are in color and I remember a lot of detail.” One very important factor in the treatment of TMJ is that treatment of the bite by reconstructive dentistry, surgery, orthodontics or endodontics should not be attempted until a complete diagnosis has been made. I do not feel a diagnosis is possible unless obvious causes, like trauma and its accompanying symptoms are gone. Then the practitioner can register the bite, mounting the patient’s dental models on an accurate articulator in the pain free position.
I have seen cases with root canals on many of the posterior teeth, none of which was necessary. In most severe TMJ cases, the chief complaint is pain in the muscles associated with the jaws. The same nerves that supply these muscles also supply the teeth. The muscle pain can imitate a toothache. The dentist treats the “tooth ache” by killing the nerve of the tooth, but the pain persists, so the dentist goes on to the next tooth and even the next. If pain persists after treatment, it never hurts to seek a second or third opinion.
Surgery has been used for TMJ but with mixed results. Properly diagnosed and with a team approach, wonderful results can be achieved. In a small number of cases surgery to correct the bite could also correct the airway. The results have been phenomenal giving the patients, in their own words, “a new life.” Most of this type of patient displays a severely reced ing jaw. This “new life” surgery is usually a “new face” surgery and can do wonders for the appearance and personality of the lucky patient.
My initial exam is with no charge in order that the patient can get another opinion.