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TMJ & Sleep Apnea

Jaw Care and Temporomandibular Disorder Treatment

TMJ Treatment | Middlebury Dental Group | Dentist Southbury, CT
Temporomandibular disorders (TMD) occur as a result of problems with the jaw, jaw joint, and surrounding facial muscles that control chewing and moving the jaw. TMD is often incorrectly called TMJ, which is the temporomandibular joint. If you place your fingers just in front of your ears and open your mouth, the movement you feel is your TMJ. It is a small ball-an-socket joint with three parts:
  • The ball, called the condyle
  • The socket, called the glenoid fossa
  • There is a small, fibrous disk that sits between the condyle and the glenoid fossa

According to the National Institute of Dental and Craniofacial Research (NIDCR), part of the National Institutes of Health (NIH), between 5% and 15% of people in the United States experience pain associated with TMD.

Causes of TMD

  • Trauma to the jaw, either by a direct blow or prolonged clenching or grinding of the teeth (bruxism)
  • Tension or stress, which triggers muscle spasm
  • Poor alignment of the teeth (malocclusion)
  • Arthritis of the jaw joint
  • Tumors of the jaw joint.

Symptoms of TMD

  • Pain or tenderness of your jaw in the area in front of your ear, especially when you chew, speak or open your mouth wide
  • An occasional feeling of the jaw being stuck open or closed
  • Facial muscle spasms that make it difficult to open your mouth, or that make it feel as though your teeth don’t meet normally
  • Clicking, popping or cracking sounds or a grating sensation in the jaw when you open or close your mouth
  • Headaches that tend to start in the front of the ear and spread to the rest of the head or neck

How is TMD diagnosed?

We take a careful and comprehensive approach to diagnosing TMD. Dr. Smith and Dr. Mandava will:

  •  Go over your medical history, including how long you have experienced pain, whether you have had an injury to your jaw, and if you have had recent dental treatment
  • Listen to and feel your jaw when you open and close your mouth
  • Observe the range of motion in your jaw
  • Examine your bite to check for abnormalities in the alignment of the jaws
  • Check for conditions that can cause misalignment of your jaw, incl. such as a high filling, a tipped tooth, teeth displaced due to earlier loss of other teeth or certain inherited characteristics
  • Examine your teeth for wear patterns that would indicate chronic grinding
  • Press on areas around your jaw to identify sites of pain or discomfort
  • Ask questions about your level of stress or anxiety and how you are coping

We may also take a panoramic or “full face” x-ray. In some instances, other imaging tests such as MRI (Magnetic Resonance Imaging) or CT scan (Computer Tomography) are needed. The MRI shows the soft tissue, such as the TMJ disc, to see if it is in the proper position as the jaw moves. A CT scan helps view the bony detail of the joint.

Treatments for TMD

Treatments for TMD range from simple self-care practices and conservative treatments to injections and surgery. Most experts agree that treatment should begin with conservative, non-surgical therapies first, with surgery left as the last resort.

The treatments listed below often work best when used in combination.

  • Heat or Cold. Applying warm, moist heat or ice to the side of your face may help you relax your muscles or alleviate pain.
  • Soft diet. Eat soft foods such as yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans and grains. Cut foods into small pieces to decrease the amount of chewing required. Avoid hard and crunchy foods (i.e. hard rolls, pretzels, and raw carrots), chewy foods (i.e. caramels and taffy) and thick and large foods that require your mouth to open wide to fit.
  • Medication. To relieve muscle pain and swelling, try over-the-counter nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin, Aleve). Dr. Smith  and Dr. Mandava may prescribe higher doses of these or other drugs if deemed necessary. Muscle relaxants, especially for people who grind or clench their teeth, can help relax tight jaw muscles, and are only available by prescription.
  • Splints or night guards. These are plastic mouth pieces that fit over the upper and lower teeth. They prevent the upper and lower teeth from coming together, lessening the effects of clenching or grinding the teeth. They also correct the bite by positioning the teeth in their most correct and least traumatic position. The main difference between night guards and splints is that night guards are only worn at night and splints are worn 24/7.
  • Dr. Smith and Dr. Mandava will discuss with you what type of mouth guard appliance you may need.
  • Corrective dental treatments. Replacement of missing teeth and bite (occlusal) adjustments and orthodontic therapy will help balance the biting surfaces of your teeth or to correct a bite problem.
  • Avoid extreme jaw movements. Keep yawning and chewing (especially gum or ice) to a minimum and avoid extreme jaw movements such as yelling or singing.
  • Practice good posture. Don’t rest your chin in your hand or hold the telephone between your shoulder and ear.
  •  Keep teeth slightly apart. This will relieve pressure on the jaw. To control clenching or grinding during the day, place your tongue between your teeth.
  • Relaxation Techniques. This will help control muscle tension in the jaw. Dr. Smith and Dr. Mandava may also recommend physical therapy or massage. Consider stress reduction therapy.

When To Seek Treatment

  • Headaches occur with local trigger points
  • Your jaw movement is limited
  • You have injured your jaw and are taking over-the-counter pain medication, but the pain does not go away after several days
  • You have swelling in the area of your TMJ
  • Jaw pain keeps you up at night or makes eating difficult

With proper care and control of habits, the symptoms should go away. Some cases may subside in less than a month. In other cases, such as those involving arthritis or people with long-standing or severe bruxism, it may take longer for symptoms to subside. The longer you have experienced symptoms, the longer it takes to resolve the discomfort.

Snoring & Sleep Apnea Treatment

Sleep Apnea and Snoring | Middlebury Dentist
Most of us, if not all of us, may have already encountered a person who has significant snoring problems, or have experienced them firsthand at some point. When a person snores, it may be something that could be just as trivial as being too tired that they fall right to snoring as soon as they sleep, or something more serious like a symptom of sleep apnea that the person may not know about. We have been helping patients with snoring problems get sleep apnea treatment once we establish that snoring was indeed a manifestation of this disorder.

Unlike regular bouts of snoring, obstructive sleep apnea is a serious condition that needs to be addressed immediately because it could lead to more serious medical conditions if left untreated. The symptoms of sleep apnea are common and this may be the reason why most people would not even know that they are already suffering from this disorder. Some of the most outstanding symptoms include excessive snoring and breath holding during sleep, choking during sleep, restless sleep that does not give the patient the intended relaxation that follows, drowsiness and chronic headaches in the daytime even after a full nights sleep, inability to focus or concentrate, high blood pressure, chest pains, or even frequent bathroom trips at night. If you experience one or more of these symptoms, it would be wise to seek professional advice and get diagnosed for sleep apnea if possible.

Based on whether a patient has mild, moderate, or severe sleep apnea, sleep apnea treatment will be tailored to the individual needs of the patient and also highly dependent on the various symptoms that they exhibit. Mild sleep apnea would usually just require a behavioral modification that may include a recommendation to lose weight, avoiding heavy meals right before bedtime, changing sleeping positions, or avoiding sedatives to try and alleviate the snoring. More moderate symptoms may require a slightly more aggressive form of sleep apnea treatment, which may include an oral appliance that is similar to a nightguard that is essentially molded from the patient’s mouth and puts the lower jaw in a position that keeps the tongue forward during sleep. This has been found to significantly reduce the gravity of snoring, because keeping the jaw thrust forward in that position signals the muscles of the tongue to follow the suggestive motion and keep it from rolling to the back of the mouth and blocking airway passages during sleep as it usually does in sleep apnea patients.  A similar concept is used for sleep apnea treatment in patients with more severe symptoms, by using the Continuous Positive Airway Pressure, or C-PAP method, that makes use of an appliance that is fitted snugly on the patient’s nose to effectively deliver a steady, prescribed flow of pressurized air to keep the airways from collapsing during sleep.