Experience Restful Sleeps Again with TMJ and Sleep Apnea Solutions at Evergreen Dental

TMJ Disorders

What is TMJ Disorder?

TMJ (temporomandibular joint) disorders are a family of problems related to your jaw joint complex. They can stem from jaw muscles or the jaw bones themselves. They can present by many different signs and/or symptoms. These include jaw pain, joint pain, the feeling that your “bite is off”, difficulty opening your mouth, headaches/neck aches, multiple teeth that are sore and tender for no reason or clicking/grating of the joints themselves.

TMJ disorders develop for many reasons. Nowadays, people live a faster paced lifestyle with more stress around them. This leads to clenching and/or grinding of the teeth as a subconscious habit to cope. These two are risk factors for TMJ disorders and account for a large portion of patients in pain. TMJ disorders can also develop due to injury or disease. A significant hit to the face or jaw from an accident, fall or sports injury can result in TMJ pain. In some cases, it can be as serious as causing a misalignment in your bite and the feeling that your teeth don’t fit together properly.

Muscle Born TMJ Disorders

Many TMJ disorders stem from muscle overuse. Exercising hard at the gym causes muscle soreness in the same way overusing your jaw muscles causes soreness. This jaw pain can radiate to the neck, back and head to cause migraines. Although it is easier said than done, reducing stress levels can help resolve clenching and grinding thus leading to less muscle pain. Bruxism splints are another great non-invasive treatment option.

Generally, they are made of a hard or semi-hard material, fit on either the upper or lower teeth and can be worn during the day but mostly at night. There are two benefits that splints provide. One, they protect the teeth from wearing down. Two, biomechanically they provide a cushion between the teeth that helps decrease the total force that can be distributed. Many times, nightly use of a bruxism splint helps resolve symptoms. If symptoms persist, physiotherapy, neuromodulator injections (Botox/Dysport) and acupuncture can be used as adjuncts. Muscle release through physiotherapy and acupuncture provide similar benefits to splint therapy.

Neuromodulator injections
(Botox/Dysport) help relax overactive and tense muscles providing relief in those muscles of concern.

Joint and Bone TMJ Disorders

Joint and bone TMJ disorders are less common but can be trickier to resolve. They deal strictly with the joint space itself or the articulating bones of the joint. Degenerative joint conditions can occur with age or injury. Medical history of arthritis can also be a factor. Sometimes these conditions can be managed with non-invasive treatments as mentioned above.

Appliances made to reposition the jaw used in conjunction with small adjustments to the biting surfaces of the teeth to allow for a more “solid bite” and an anatomically happy joint are also treatment modalities under the right circumstances. If issues still persist and all options have been exhausted, a referral to a specialist may be recommended. Though infrequent, surgery is sometimes required to correct a damaged joint.

Regardless of the cause, the most important goal for our patients is to create a pain free, healthy and stable oral condition. Proper diagnosing is paramount to successfully helping our patients out of pain and functioning at their peak!


Since the teeth, jaw joints, and muscles can all be involved, treatment for this condition varies depending on the specific problem you have. Diagnosing the root of the TMJ disorder is key in determining the path of treatment. That is why it is so crucial to remember and document all the specific details about the injury.

These include:

  • When it started
  • How long does it last for
  • What provokes it
  • What makes it better
  • Has it happened in the past
  • Was there a specific incident that caused a lot of pain
  • Where specifically does it hurt
  • Are there restrictions in your jaw movement or noise in the joint

Once we have all the necessary info and a diagnosis is formulated, treatment alternatives can be discussed.


Sleep Apnea


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Sleep apnea is a common condition in which your breathing stops and restarts many times while you sleep. This can prevent your body from getting enough oxygen. 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. If the condition is not addressed, more serious systemic conditions can arise affecting your overall health. Several studies have shown an association between sleep apnea and problems like type 2 diabetes , strokes , heart attacks and even a shortened lifespan.

To make it simple, snoring occurs when there is not enough space in your airway to breathe smoothly. When tissues in the airway take up lots of space and when muscles in the neck relax enough, the airway narrows and the flow of air becomes partially obstructed. As the air passes through these obstructions, the tissues vibrate producing the snoring sound. Large tonsils, a long soft palate and uvula and excess fat deposits contribute to airway narrowing.

Symptoms and Side Effects:

  • Occasional or constant snoring
  • Disrupted sleep
  • Momentary loss of breathing
  • Excessive daytime drowsiness and low energy
  • Low blood/oxygen levels
  • Predisposition to high blood pressure
  • Cardiovascular problems- heart attack, stroke, death

Narrow airway passages can cause obstructive sleep apnea. Muscles relax during sleep. When the muscles used to breathe relax too much and there is limited space in the airway, 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 an apnea.

The most common cause of airway constriction during sleep apnea is the tongue. A proportionally very powerful muscle, the tongue relaxes during sleep and falls back into the airway with each breath. Some patients can experience up to 300 apnea episodes each night. Severe cases may have up to 700 per night. If left untreated, these cases lead to more serious health issues.

Treatments Available For Obstructive Sleep Apnea (OSA):

  • Continuous positive Airway Pressure (CPAP).
  • Palatal Surgery
  • Lower jaw surgery
  • Oral appliance approach.
Sleep Apnea Dentist Winnipeg

Generally, the CPAP is the most effective. Your physician can discuss the CPAP and options. An ear-nose-throat medical doctor can discuss palatal surgery. An oral surgeon can discuss lower jaw surgery. Dentists have the responsibility to discuss the 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 and results.

There are many different variations of sleep apnea appliances. However, they all perform the same function. They usually involve 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. These plastic devices are connected to each other which then in turn work by moving the lower jaw and tongue forward thus opening the airway in the back of the throat to let air flow.

Many dental insurance companies will provide coverage towards a sleep apnea appliance. In some cases, Manitoba Health will cover the cost of the appliance. Manitoba Health would require a sleep study indicating obstructive sleep apnea before they will give approval for any type of treatment. Snoring by itself will not be covered.