TMJ (temporomandibular joint) disorders are a family of problems related to your complex jaw joint. If you have had symptoms like pain or a "clicking" sound, you'll be glad to know that these problems are more easily diagnosed and treated than they were in the past. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.
TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. Or, you may have a damaged jaw joint due to injury or disease. Whatever the cause, the results may include a misaligned bite, pain, clicking or grating noises when you open your mouth, or trouble opening your mouth wide.
- Do You Have a TMJ Disorder?
- Are you aware of grinding or clenching your teeth?
- Do you wake up with sore, stiff muscles around your jaws?
- Do you have frequent headaches or neck aches?
- Does the pain get worse when you clench your teeth?
- Does stress make your clenching and pain worse?
- Does your jaw click, pop, grate, catch, or lock when you open your mouth?
- Is it difficult or painful to open your mouth, eat or yawn?
- Have you ever injured your neck, head or jaws?
- Have you had problems (such as arthritis) with other joints?
- Do you have teeth that no longer touch when you bite?
- Do your teeth meet differently from time to time?
- Is it hard to use your front teeth to bite or tear food?
Since the teeth, jaw joints, and muscles can all be involved, treatment for this condition varies with the specific problems you have. Treatment will involve several phases.
The first goal is to relieve the muscle spasm and pain, and restore the dislocated disc with in the jaw joint to its normal anatomical position. Then, one of our dentists must correct the way the teeth fit together. Often a temporary device (known as an orthotic, or "splint") is worn over the lower teeth until the jaw joint is stabilized. Our doctors use various types of splints that are comfortably worn in the first stage of your treatment.
Once the jaw joint is fixed your treatment advances into the second stage of bite correction so the splint will no longer have to be worn. Permanent correction of your bite may involve selective re-shaping of the teeth, building crowns on the teeth, orthodontics, or a permanent appliance to lay over the teeth. If the jaw joint itself is damaged, it must be specifically treated. Though infrequent, surgery is sometimes required to correct a damaged joint.
Ultimately, Evergreen Dental will stabilize your bite so that the teeth, muscles, and joints all work together without strain. The important aim of correcting your bite is to insure optimal long-term health. If you have any of the signs or symptoms mentioned, discuss them with us. Your health is your most priceless possession. It is worth the investment!
A thorough history and examination appointment is necessary to properly diagnose this condition.
Various types of clear plastic splints can be used to treat TMJ syndrome.
A bruxism splint, worn mostly at night, keeps you from grinding your teeth and helps reduce muscle tension. It does not treat the cause of the TMJ symptoms but only allows you to grind against it at night instead of grinding against your base teeth. You wear down the appliance instead of your teeth. This is the common "night guard" made by most dentists and is a low level, minimal treatment approach.
A repositioning appliance is worn 24 hours a day to move the dislocated parts of your jaw joint into alignment and allow the joints to heal in their normal anatomical position. A stabilization appliance, also worn 24 hours a day, relaxes your muscles around the jaw joints and attempts to stabilize shifting teeth and changing bite caused by the TMJ problem. It is effective only as long as it is worn and does not attempt to treat the cause of instability.
Your splint will be custom fitted from impressions of your teeth, to make it as comfortable as possible. The splint will not cover the front of your teeth, thus helping to make it invisible. You may need to wear a splint for three to twelve months or longer. During that time, we'll adjust the fit as your jaw posture changes.
OCCLUSAL TREATMENT (BITE MODIFICATION)
If an occlusal abnormality has been determined to be a portion of the cause of tooth mobility, excessive tooth wearing and types of head and neck pain bite modification therapy may be recommended. During this occlusal therapy the dentist will reshape the chewing surfaces of the teeth.
In order to properly restore a harmonious occlusion (bite) a minimal amount of tooth structure in selective areas must be removed. The doctor will identify those areas of tooth structure that prevent the oral muscles from closing the teeth into their proper position. Once noted, these high spots (interferences) are painlessly polished away. As only a minuscule amount of tooth is affected, there is no danger of these spots becoming decayed. Since the severity of the problem will vary with each patient, your dentist will discuss the number of treatments that you will require. In some cases, the tooth misalignment is so severe that orthodontic treatment might be necessary if greater improvement is necessary.
Following treatment, you will notice that your “bite” will feel more solid, each tooth touching at the same time with the same degree of force. Initially, you will notice that your teeth feel rough and some may notice sensitivity to cold. This may last until the settling in process is completed.
In addition, some people become more aware of their “bite”. This is a normal response which disappears with time.
One goal is to create a harmonious occlusion, with the teeth properly aligned, oral muscles relaxed and the jaw in its stable position. For those with head, neck and back pain, the degree of relief may depend on other contributing (not malocclusion) factors such as stress, previous injuries and posture.
The most important goal is to create a pain free, healthy and stable oral condition for you.
HOME CARE INSTRUCTIONS
- AVOID SLEEPING ON YOUR JAW. (the most important regimen) Sleeping on your back is the best position to enable your jaw to relax. A small pillow or rolled up towel to support the neck curvature and elevation of knees with pillows may be helpful.
- Application of moist heat with a hot towel at least twice a day for approximately 20 minutes, more often if possible.
- AVOID CHEWY FOODS AND BITING ANYTHING WITH YOUR FRONT TEETH. Soft diet is recommended.
- LIMIT THE INTAKE OF SUGAR AND CAFFEINE as both are stimulants to the nervous system.
- AVOID CLENCHING YOUR TEETH. Lips together, teeth apart.
- The time it will take to gain comfort and success in our treatment will depend in large part upon the way you follow the above instructions.
SYMPTOMS, CAUSES AND EFFECTS
Obstructive Sleep Apnea affects 1 in 10 people moderately and 1 in 100 severely.
WHAT CAUSES SNORING?
Snoring occurs when the structures in the throat are large and when muscles relax enough to cause the airway to narrow and partially obstruct the flow of air. As the air passes through these obstructions, these structures vibrate producing the snoring sound. Large tonsils, a long soft palate and uvula and excess fat deposits contribute to airway narrowing.
SYMPTOMS AND EFFECTS:
- Occasional snoring
- Disrupted sleep
- Low blood/oxygen levels
- Momentary loss of breathing
- Can lead to high blood pressure
- Excessive daytime drowsiness
- Cardiovascular problems- heart attack, stroke, death
WHAT CAUSES SLEEP APNEA?
Narrowing airway passages can cause Obstructive Sleep Apnea. Muscles relax during sleep. When the muscles used to breathe relax too much, the tongue is sucked against the back of the throat causing airflow to stop. The oxygen level in the brain becomes low enough to awaken the sleeper partially. The obstruction in the throat clears and the flow of air starts again (usually with a loud gasp). This is called apnea. The most common cause of airway constriction during sleep apnea is the tongue. The tongue relaxes excessively during sleep and falls back into the airway with each breath. Air travels faster through a slender tube, this rapidly moving air causes the soft tissue in the throat to vibrate, which produces the loud sound of snoring and compromises the ability to breath. Some patients experience up to 300 apnea episodes each night. Severe cases may have up to 700 per night and possibly develop serious health issues.
THE SLEEP APNEA/SNORING APPLIANCE
Oral appliances have several advantages over other forms of therapy. They are relatively comfortable to wear, and easy to care for. Treatment is reversible and non-invasive. This appliance has been proven 85% effective in treating sleep apnea. Patients have expressed their satisfaction in using this appliance. Clinical studies have shown that the appliance is effective in reducing or eliminating symptoms of Obstructive Sleep Apnea in the majority of cases.
The Sleep Apnea/Snoring Appliance is made up of 2 small custom-made plastic devices that look similar to orthodontic retainers or athletic mouthguards. They fit over the teeth and are worn while sleeping. The device works by moving the lower jaw and tongue forward and opening the airway in the back of the throat to let air flow.
Many medical insurance policies will cover the cost of this appliance when the patient is diagnosed with Obstructive Sleep Apnea by a certified sleep disorder center. Dr. Steidl has treated many patients using custom appliances and night guards. We work closely with physicians and sleep centers to determine a diagnosis and develop the best treatment protocol for each patient.
DENTAL TREATMENT FOR SNORING AND/OR OBSTRUCTIVE SLEEP APNEA
Although snoring is commonly thought to be funny and annoying, it can be part of a more serious medical condition called obstructive sleep apnea. Snoring by it self may be relieved by changing sleep position, losing weight, decongestants or palatal surgery.
Apnea, a more serious medical problem, is a Greek word that means "Want of breath." A person is considered to be a sleep apnea sufferer when he or she stops breathing for at least 10 seconds up to thirty times or more a night. Because of the lowering of oxygen and other factors, a strain is placed on the cardiovascular system which can increase the risk of heart attack, stroke and gastric reflux.
THERE ARE FOUR DIFFERENT TREATMENTS AVAILABLE FOR OBSTRUCTIVE SLEEP APNEA (OSA):
- Continuous positive Airway Pressure (CPAP).
- Palatal Surgery
- Lower jaw surgery
- Oral appliance approach.
Generally, the CPAP is the most effective. Your physician can discuss the CPAP and options. An ENT MD can discuss palatal surgery. An oral surgeon can discuss lower jaw surgery. We have the expertise to discuss an oral appliance approach.
When sleep apnea is suspected, a special test called a polysomnogram (PSM) is prescribed. This is a sleep study done either in a special lab or at home. The study monitors breathing and other factors. A sleep physician will discuss your options. Medical insurance requires a PSM indicating OSA before they will give approval for any type of treatment. Snoring by itself will not be covered by insurance. Before an oral appliance is prescribed a CPAP must be tried and /or refused.
The oral appliance is a conservative treatment involving the custom prescribed and fitted appliance made to wear during sleep which gently moves the lower jaw forward allowing more air to be utilized during sleep. These appliances are non invasive, easily accepted by most patients and are reversible. However, we can not guarantee that you will wear them. In only a few weeks, most patients are comfortable. A follow up sleep study may be necessary for insurance reimbursement.