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TMJ and Sleep Therapy

TMJ

Have you noticed a clicking, grating or popping noise while opening or closing your mouth? Do you experience discomfort or soreness while biting down, chewing or speaking? Are you suffering from headaches? Do your ears ache or feel full? Have you been dealing with lower energy levels or found yourself to be more fatigued or tired? If so, these problems may be a sign of TMJ or TMD.

The condition is often interchangeably referred to as TMJ, TMD or TMJD.

To add to the complexity of it all, TMD presents with many various signs and symptoms, of different combinations, leading the sufferer to seek help from doctors of different specialties. For example, a patient may see a neurologist, chiropractor, gastroenterologist and dentist for their headaches, dizziness, back or shoulder pain, acid reflux, irritable bowel, difficulty swallowing and jaw pain. TMD has been termed the “Great Imposter” because sufferers don’t associate the symptoms with the jaw joint.

TMD, left untreated, can potentially have devastating effects on your overall health and well-being. Some patients destroy their teeth because of constant clenching or grinding, while others may suffer from debilitating headaches. Furthermore, any patients experiencing TMD may also be suffering from sleep apnea. If you do not seek treatment from an experienced TMJ dentist, like Dr. Dalton, your symptoms may only worsen with time.  Lack of proper treatment often leads to increased inflammation, further damage to the joint and teeth; significant head, neck and facial pain; and even sleep apnea later in life.

It is estimated that over half of Americans suffer from a varying degree of TMD. Fortunately, it can be treated with neuromuscular dentistry.  The TMJ dentist, or doctor, at Rock Family Dental offers a variety of procedures and services that can be used to provide TMD treatment, or TMJ therapy, that is customized to your specific needs.

About Neuromuscular Dentistry

Rock Family Dental of Little Rock, Arkansas is a leader in treating TMD and craniofacial pain quickly and successfully. Rock Family Dental’s team consists of a top-rated, highly credentialed dentist who devotes his experience and refined skills to the treatment of TMJ disorders.  Some of the treatment options offered by Rock Family Dental are:

Advanced Diagnostics:

  • i-CAT – cone beam CT scan that produces high definition 3D diagnostic images for optimum treatment efficiency.  Allows focused visualization of the temporomandibular joints and 3D data enhanced views for detection of airway restrictions.
  • T-Scan – technology that identifies any imbalance in the bite or how the teeth fit together.
  • K7 Evaluation System – measures and records mandibular function and masticatory (chewing) muscle status via jaw tracking, electromyography, and sonography.
  • Computerized Range of Motion Measurement System – measures cervical spine movement.

Joint Stabilization and Splinting – careful repositioning of a dislocated, locked or poorly positioned jaw joint into the proper anatomical position with the placement of a splint to hold the jaw in place to allow healing to occur.

TMJ Oral Appliances:

  • TMJ Daytime Appliance – facilitates healing, calms overactive muscles, stabilizes the jaw, and achieves neuromuscular reeducation.  These mandibular, or lower arch, appliances are easily worn while eating, speaking, singing and playing musical instruments.
  • TMJ Nighttime Appliance – reposition the mandible in a forward position while allowing the disc assembly to resume a more normal position in relation to the condyle and fossa. The maxillary, or upper appliance, is generally worn at night as it interferes with eating and can make speaking difficult.
  • TMJ/OSA Appliance – reduces airway restriction caused by breathing related disorders by preventing jaw and/or tongue retrusion and maintaining an open airway.  TMD patients have a high propensity for sleep disorders.

TMJ Physical Therapy:

  • Low Level Laser Therapy – reduces pain and stimulates healing by reducing inflammation and increasing circulation or blood flow.
  • Therapeutic Ultrasound – helps relax tight muscles and provides deep heat to the muscles, joints, ligaments and tendons resulting in increased circulation or blood flow to aid in the process of healing.
  • Manual Trigger Point Therapy – application of continual pressure to release the buildup of lactic acid in the muscles thereby alleviated discomfort.
  • Microcurrent Stimulation – induces muscle relaxation, reduces pain and decreases muscle spasm.

Trigger Point Injection Therapy – injection of a local anesthetic into trigger points or tender areas to provide immediate relieve discomfort and break the pain cycle.

The purpose of TMJ treatment is to improve your quality of life by eliminating or significantly reducing symptoms and stabilizing the entire system.  Treatment length is approximately three to six months and success directly correlates with compliance.  Rock Family Dental achieves this by providing non-surgical, conservative treatment in a relaxed and professional atmosphere.

Sleep Therapy

Another uncomfortable condition involving the head area, sleep apnea is a serious condition wherein a person experiences abnormal pauses in breathing while asleep, which may last from several seconds to a minute.

Not everyone knows that this is a potentially life-threatening condition. Obstructive sleep apnea is the most common type of sleep apnea. It is caused by a blockage in the airway, which can be due to excess tissue in the nasal passages or behind the tongue. About 15 million Americans suffer from this disorder.

Typical symptoms include snoring, choking or gasping for air during sleep, daytime sleepiness, and fatigue. What makes the condition so dangerous is that it can cause high blood pressure, irregular heartbeat, stroke, heart attack, heart failure, diabetes, and depression.

Sleep Apnea Treatment Option

The good news is that there are several sleep apnea appliances that may help solve this problem. We offer several options to help patients suffering from sleep apnea, including oral appliance therapy (OAT) and a mandibular advancement device (MAD).

The oral appliance therapy procedure uses a device similar to a mouth guard which is placed inside the patient’s mouth and keeps the airway free from obstruction. A mandibular advancement device is used to slightly adjust the position of the lower jaw in order to keep the airway open more consistently during sleep. It is important to note that these sleep apnea appliances are adjustable. Since patients experience varying degrees of the condition, adjusting the devices is important in achieving the necessary comfort. TMJ and sleep apnea should never be a problem when you know the right appliance or therapy to use.

About Oral Sleep Appliance & Therapy

Many of our patients suffering from the troublesome symptoms of temporomandibular disorder (TMD) also sleep poorly. Although, some have already been diagnosed with breathing-related sleep disorders by the time they visit our office others remain alarmingly unaware. The most common complaints from our patients suffering from sleep disorders are snoring, disturbance of their bed partner’s sleep, witnessed episodes of not breathing, excessive daytime sleepiness and poor concentration. These episodes of not breathing are known as sleep apneas. The most common form of sleep apnea is obstructive sleep apnea (OSA).

Some other symptoms of sleep disorders are:

  • snoring
  • morning headaches
  • unrefreshing sleep
  • a dry mouth upon awakening
  • chest retraction during sleep in young children (chest pulls in)
  • high blood pressure
  • obesity or overweight (rapid weight gain)
  • irritability
  • change in personality
  • depression
  • difficulty concentrating
  • excessive perspiring or sweating during sleep
  • heartburn
  • reduced libido or decreased desire for intimacy
  • insomnia or sleeplessness (inability to fall asleep/stay asleep)
  • frequent nighttime urination (nocturia)
  • restless sleep
  • nocturnal snorting, gasping, choking (may even wake the sufferer)
  • confusion or disorientation upon awakening

The National Center on Sleep Disorder Research estimates that approximately 70 million people in the United States have a sleep disorder. It is estimated that sleep disorders, sleep deprivation, and sleepiness add $15.9 billion to the national health care bill each year. These calculations do not include related health problems, lost worker productivity, interpersonal relationship issues, and accidents. Those with untreated sleep apnea are two to three times more likely to be in motor vehicle accidents.

Relapse of the tongue into the airway is one of the primary causes of snoring and obstructive sleep apnea. Some other causes are retrusion of the mandible (a lower jaw that is further back that it should be), facial deformities such as micrognathia (a lower jaw that is smaller than it should be), obesity, enlarged tongue or tonsils, throat muscle and tongue relax more than normal and the aging process.

Undiagnosed or untreated obstructive sleep apnea can potentially lead to heart attacks, strokes, impotence, irregular heartbeat, high blood pressure and heart disease. The symptoms become progressively worse with time and severity range from mild to severe. The quality of life can be greatly affected if left untreated so the condition should not be taken lightly.

Sleep Apnea Recommendations

Common recommendations for those suffering from obstructive sleep apnea are a weight loss program, sleeping on one’s side, CPAP (Continuous Positive Airway Pressure) for those with mild to moderate symptoms and BiPAP (Bilevel Positive Airway Pressure) for those with more severe symptoms. While CPAP is an effective form of treatment and has been the standard of care for most patients suffering from mild to moderate obstructive sleep apnea the effectiveness and success is greatly reduced due to patient intolerance. Many patients are unable to wear CPAP due to claustrophobia, noise disturbances, the mask causing jaw discomfort or applying pressure to the upper lip/anterior (front) teeth, a latex allergy, or and having an unconscious need to remove the device during the night. Others that have a career that requires frequent travel often find it cumbersome.

study conducted by the Department of Otolaryngology at the Henry Ford Medical Group in 2011 demonstrates a CPAP compliance rate of a mere 28.8%. In contrast, oral sleep appliances have proven to have up to an 88% compliance rate and are considered the first line of treatment for patients with mild to moderate sleep apnea according to reports published in the February 2006 Sleep Journal and the March 2010 Canadian Agency for Drugs and Technology in Health Journal. Although CPAP has a higher efficacy in a clinical study setting oral sleep appliances have proven to have higher effectiveness due to continual compliance and intolerance issues with CPAP.

Rock Family Dental offers effective and patient-friendly treatment alternatives for those who have been diagnosed with mild to moderate obstructive sleep apnea. If you think you have obstructive sleep apnea but have yet to be diagnosed, Rock Family Dental offers a convenient sleep test that can be taken in the comfort of your own home. Once your diagnosis is confirmed you can be fitted for a custom fabricated oral sleep appliance that is designed to reposition the lower jaw, soft palate and tongue to open the airway. Oral appliances are then titrated (adjusted) to an optimal position to alleviate snoring and reduce the number of shallow or non-breathing events while sleeping (apneas/hypopneas). Treatment length is indefinite and success directly correlates with compliance.

Dr. Dalton may also recommend a lingual frenulectomy/frenectomy to correct low tongue posture or tongue tie that is often found in patients with sleep apnea. This is a simple procedure that involves clipping the tissue underneath the tongue that binds it down. This procedure allows for free movement and advancement of the tongue out of the throat resulting in an increased opening of the airway.

*Dental Sleep Medicine is not an ADA recognized specialty.

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