Relationship Between Sleep Disorders and TMD
By Brock Rondeau, DDS. IBO, DABCP, D-ACSDD, DABDSM, DABCDSM
AS FEATURED IN THE BEST SLEEP MAGAZINEJulias-Mini-Best-Sleep-Magazine-Launch-Issue-compressed
I strongly believe that all members of the dental profession entered dentistry with a strong desire to help people achieve higher levels of health. However, dental school curriculums emphasize treating teeth and gums so dentists are not taught how to diagnose temporomandibular joint dysfunction (TMD), snoring, or obstructive sleep apnea (OSA).
This is a surprising omission, as the American Dental Association reports:
- 34% of the adult population has TMD, More than 50% of men snore after turning 50
- 25% of adults have life-threatening OSA
- Around 40% of women snore after their menopause
After 5 years of treating teeth and gums, like many other qualified dentists, I continued to expand my knowledge by taking courses on orthodontics and gained skills to treat bad bites (malocclusions) with functional orthopedic appliances that expand the upper and lower jaw (arches).
Panthera Appliance for Sleep
Much better than the alternative ‘tooth- and-gum-dentistry’ approach to making room for all the permanent teeth which is; to extract bicuspid teeth and to retract the 6 front teeth.
This flattens the face, significantly reduces the width of the smile, encloses the airway, moves the tongue back, and increases the future risk of snoring and obstructive sleep apnea.
“Untreated severe obstructive sleep apnea can also shorten patients’ lifespan by 10 years.”
– Brock Rondeau, DDS
Obstructive sleep apnea has a devastating effect on the health of our patients including; increasing the incidence of high blood pressure, heart attack, atrial fibrillation, stroke, type 2 diabetes, kidney problems, acid reflux, depression, anxiety, dementia, and Alzheimer’s, to name a few.
By changing the approach and expanding the palate, you also expand the nasal airway and now my patients were reporting that they could breathe better through their nose! Nasal breathing is far superior to mouth breathing with 20% more oxygenation. We must always be aware of the importance of promoting an open (patent) airway.
Mouth Breathing causes a constriction of the upper arch as the tongue does not expand the upper arch when the patient incorrectly swallows 2,000 times per day. This constriction of the upper arch causes the lower jaw to go back which causes two major health problems:
1. When the lower jaw goes back the tongue also retrudes and can obstruct the airway particularly when the patient sleeps on their back, increasing the severity of life-threatening obstructive sleep apnea.
2. When the lower jaw goes back due to mouth breathing this increases the incidence of jaw joint problems (Temporomandibular Joint Dysfunction). When the lower jaw retrudes (goes back) the top of the lower jaw (condyle) goes too far back and impinges on the nerves and blood vessels in front of the ear and causing headaches, neck problems, ringing in the ears (tinnitus), fainting, dizziness, and back problems
The treatment would be to fabricate a lower splint that moves the lower jaw forward away from the nerves and blood vessels. This lower splint is worn on the lower teeth all day long, even when eating. This treatment significantly reduces the painful symptoms of TMD.
It is important to remember whatever technique is being used to treat orthodontic problems, TMD or snoring, and sleep apnea you must be aware of the importance of increasing the size of the nasal and pharyngeal airway.
My observation is that patients with deep overbites (upper teeth overlap the lower teeth) frequently have TMD symptoms, particularly in females over age 20. Also, patients with underdeveloped lower jaws seem to have the majority of jaw joint (TMD) problems. I would urge readers to be aware of this and if TMD symptoms persist to get treatment as soon as possible because TMD is a progressive condition that frequently gets worse over time.
I strongly believe that all patients should be screened for obstructive sleep apnea and TMD and, if the dentist is not qualified to treat, should refer these patients to a dentist that is, because as I stated at the outset, we all went into practice with the strong desire to help improve the quality of the life of our patients.
“Due to the high prevalence of TMD, snoring, and sleep apnea I think it is important for ALL DENTISTS to screen patients for these health problems.” – Brock Rondeau, DDS