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Consult us for comprehensive evaluation and management of temporomandibular disorders, headaches, trigeminal neuralgia, snoring, and sleep apnea.
Temporomandibular Joint (TMJ)
TMJ is a common term that is used to designate a problem with the jaw joint, although it truly is just the name of the joint. The TMJ is a rotating and sliding joint with a fibrocartilage covered, football shaped ball (condyle), fibrous pad (disc), fibrocartilage lined socket (fossa), ligaments, tendons, blood vessels and nerves. The disc functions as a moving shock absorber and stabilizer between the condyle and fossa. THE MUSCLES OF MASTICATION (jaw muscles) attach to the mandible (lower jaw), maxilla (upper jaw), skull and neck. The muscles of mastication open, close, protrude and laterally move the jaw, enabling you to talk, chew, and swallow. The supporting muscles of mastication (neck and shoulder girdle muscles) stabilize the skull on the neck during jaw function.
Temporomandibular Disorders (TMD)
TMD implies a disorder of the TM joint or dysfunction of the jaw muscles. It is unclear as to why TMD occurs. TMD is believed to result from several factors acting together, including jaw injuries (trauma), and joint disease (arthritis). Tooth clenching and grinding (bruxism) and head and neck muscle tension, while not scientifically proven to be a cause of TMD, may perpetuate TMD symptoms and often need to be controlled to reduce and manage TMD. It is important for the TMD patient to understand that the disorder can be chronic in nature and highly dependent upon multiple factors, several of which are beyond the control of a person and unpredictable at times. There is no “quick fix” or immediate cure for TMD, the most successful and scientifically supported treatments tend to be conservative in nature in most cases. Self-management techniques and control of the aggravating factors tend to be keys to success in management of this problem.
Common symptoms can include:
- Jaw pain, jaw noises (clicking, popping) and/or locking
- Trouble moving the jaw or trouble eating
- Ear pain, stuffiness or ringing
- Face pain
- Neck pain
- Sleep problems, fatigue and low energy
Do you have TMD? If yes, do you need treatment?
Often at times, there is episodic occurrence of one of the above symptom. It does not mean that you require treatment for it.
You could try soft foods, using ice packs and avoiding extreme jaw movements, like wide yawning and gum chewing. Short-term use of over-the-counter or prescription pain medicines may also provide relief. Also remember, having jaw clicking (or noises) without any pain or locking, does not indicate a real problem which needs to be treated.
You need to seek treatment from an orofacial pain professional if pain is consistent and the above mentioned techniques are not helping. Typical treatments range from orthotic occlusal appliances, cold spray and stretch, trigger point injections, physical therapy, acupuncture, biobehavioral therapy and drug therapy.
As a general rule, avoid treatments that cause permanent changes in the bite or jaw. This includes crown work, bridge work or orthodontics to change the bite, or grinding down teeth (occlusal adjustment). Another general rule is to avoid surgery. There are exceptions to these rules at times.
SLEEP DISORDERED BREATHING
Sleep disordered breathing encompasses snoring and sleep apnea syndrome.
Snoring is the sound of partially obstructed breathing during sleep. Snoring is an annoying problem and may harm your sleep and the sleep of your bed partner. Snoring can make relationships stressful, but snoring can also be the first sign of sleep apnea, a much more serious health problem. When Obstructive Sleep Apnea occurs, the tongue and soft palate collapse onto the back of the throat and completely block the airway, which restricts the flow of oxygen.
Dental appliances can be custom made to help prevent the collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep and promoting adequate air intake.
Obstructive Sleep Apnea
Sleep apnea often goes undiagnosed. Doctors usually can't detect the condition during routine office visits. Also, there are no blood tests for the condition. Most people who have sleep apnea don't know they have it because it only occurs during sleep. A family member and/or bed partner may first notice the signs of sleep apnea. The most common type of sleep apnea is obstructive sleep apnea. This most often means that the airway has collapsed or is blocked during sleep. The blockage may cause shallow breathing or breathing pauses.
When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Obstructive sleep apnea is more common in people who are overweight, but it can affect anyone. For example, small children may have enlarged tonsil tissues in their throats, which can lead to obstructive sleep apnea.
Untreated sleep apnea can:
• Increase the risk of high blood pressure, heart attack, stroke, obesity, and diabetes
• Increase the risk of, or worsen, heart failure
• Make arrhythmias, or irregular heartbeats, more likely
• Increase the chance of having work-related or driving accidents
Getting a specific assessment/diagnosis that is accurate is very important because it will have a major influence on matching your treatment plan to the type of your pain disorder and severity of illness.
Diagnosis influences the treatment plan by directing the type of medical tests that are run, type of treatments recommended and long-term management goals you and your practitioner select. Diagnoses and treatment plans are made on the basis of:
- Frequency of the problem (daily and monthly) with or without treatment.
- Pain characteristics such as location, severity, pain quality, and response to routine physical activity.
- Associated symptoms like sensitivity to noise (phonophobia), visual changes, and light sensitivity (photophobia).
- History of the illness (that is, when it started, how it has changed, and how long it takes to reach peak or worst pain/ disability).
- Physical (especially exam of your head and neck muscles) and neurological exams.
An understanding of the specific causes or contributing factors that lead to progression, and then reversing them, is key to
Dental appliances will be selected based on the initial evaluation and then are usually custom fabricated, fit, and adjusted. These devices, which look like mouth guards, to help patients breathe freely during sleep.
Follow-up visits and post-adjustment sleep studies help dentists determine if oral appliance therapy is effectively treating their patients’ sleep apnea.
Diagnosis of sleep apnea should be done at an accredited sleep center (www.sleepcenters.org) or with your primary physician.