If you suffer from a temporomandibular joint dysfunction (TMD), chances are then you likely suffer from sleep apnea as well. There is a strong relationship between those who suffer from TMD and those who also suffer from sleep apnea. A 2013 study conducted in the Journal of Dental Research discovered that those who were more likely to have obstructive sleep apnea (OSA), were also three times more likely to suffer from chronic TMD. The same study showed that those who showed two or more signs of obstructive sleep apnea had a 73% greater incidence of TMD independent of their age, race/ethnicity, obesity, and smoking history. Although the two disorders are clinically diagnosed independently of each other, both are linked through similar deficiencies in proper form and function. It’ also because of these similarities that treatment for both can often be the same.
What is Temporomandibular Joint Dysfunction (TMD) and How Does it Relate to Sleep Apnea?
Temporomandibular disorders are classified as musculoskeletal disorders. It describes many different conditions involving the temporomandibular joint, chewing muscles, and all associated structures involved in the dental-alveolar process. Those who suffer from TMD often exhibit signs of clicking and popping joints, chronic headaches, pain to chewing, limited opening, and tooth pain. These conditions arise from problems in early childhood development or from trauma causing damage to the joint complex itself. Damaged joints cannot function at optimal capacity, and undesired stresses on the complex can cause the progression of the disorder. OSA can result in some of these undesired stresses.
How Does OSA Relate to TMD?
OSA occurs when your airway becomes closed and you are not able to breathe during sleep. When you’re unable to breathe, your body panics and undergoes a stressful response. Sleep bruxism, also known as “grinding your teeth”, it’s linked to this stress response. Sleep bruxism can unleash remarkable damage to the jaw joint, gums, and teeth themselves. If these conditions are not managed, long term consequences can be irreversible and devastating. Dentists often prescribe bite splints to help manage this problem. If you treat the airway however, often you also help improve the stability of the jaw joint because the sleep bruxism condition vanishes.
The conditions that cause OSA often exist at an early age and continue to worsen throughout life. Some would argue that the airway deficiencies that cause obstructive sleep apnea were present before the TMD exists, and even contribute to the onset and progression of the temporomandibular disorder. When a baby isn’t properly nursing, the jaw doesn’t develop and the airway immediately begins being compromised. If a child has enlarged tonsils that cause apneic events while sleeping, not only will their jaw development continue to be deficient, but they also often lose out on the essential growth hormone release that occurs during the deep N3 stage of sleep.
What Steps Should I Take?
If you recognize airway problems at an early age, solutions such as orthodontic treatment and tonsil removal can be enough to reverse the course and prevent the onset of OSA and TMD. When someone is currently suffering from TMD, the airway must be evaluated otherwise the treatment may not be successful. Oral appliance therapy can be a great tool in positioning the jaw joint in the healthier healing position as well as providing an adequate airway while asleep. Understanding the relationship between the two and how that can affect each other is critical to success in treatment.
Balasubramaniam R, Klasser GD, Cistulli PA, Lavigne GJ. The link between sleep bruxism, sleep disordered breathing, and temporomandibular disorders: An evidence based review. J Dental Sleep Med 2014;1:27-37
Sanders AE, Essick GK, Fillingim R, et al.. Journal of Dental Research. 2013; 92:S70-7.
Simmons, H. Clifton. Craniofacial Pain. A handbook for the assessment, diagnosis, and management. 199-227; 2009 Chroma Inc.