TMJ (jaw joint pain) and associated craniofacial pain syndrome can masquerade as so many other conditions; it often is difficult to diagnosis. Your "incurable" headache, ear or facial pain could be generated by your jaw joints, bite and spasm in the associated facial musculature.   Even swallowing difficulty and snoring can be related to TMJ disorders. It is interesting to note that some Fibromyalgia, Tinnitus and Migraine patients can also be helped with conservative treatment (see below). 

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Since the teeth, jaw joints and muscles can all be involved, conservative treatment for this condition varies. Typically, treatment will involve several phases. The first goal is to relieve the muscle spasm, pain, and inflammation. Then the specialist must correct the way the teeth fit together. This is accomplished by a removable device known as an orthotic/splint which is worn over the lower teeth until the bite is stabilized.

Along with the orthotic the specialist may also recommend:

• Exercise therapy
• Physical therapy
• Massage therapy
• Use of muscle relaxants
• Physical therapy modalities

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Therapeutic Appliances
All illustrated appliances are worn on the lower teeth and are constructed on an individual basis depending on the patient's symptoms and problems.  They are removable and adjustable.

The illustrated appliances are representative of the many variations of appliances that can be made.

Anodyne Bite Restorer	Brux-eze™ Splint
Farrar Splint	Gelb Splint
Pivotal Splint	Myotronic Splint
Pull Forward Splint	Sagittal Splint

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1. Oral Appliance Therapy for Obstructive Sleep Apnea Syndrome: Progressive Mandibular Advancement During Polysomnography (PDF*)
   
   
2. Obstructive Sleep Apnea
   
   
3. Photos of Sleep Apnea Orthotics
   

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Sleep disordered breathing encompasses several sleep disorders that are associated in varying degrees of an airway blockage due to large tonsils, long soft palate or uvula, excessive fleshy tissues, or over relaxed position of the tongue. In our practice we very often see some or all of these conditions that lead to snoring such as a small or retruded jaw and airway obstruction. Working together with your referring physician we are a valuable member of the ‘sleep team’ to provide our patients with an alternative, or adjunct to surgery or the use of a CPAP machine.
For many patients, snoring does not involve a serious medical disorder and can easily be treated successfully with an oral appliance that is used when sleeping. These appliances often are similar to orthodontic retainers or TMJ appliances and are usually made from clear acrylics and often have adjustment features.
Our screening process which identifies physiologic and behavioral predisposing factors will include:

ü      Complete medical/dental examination

ü      Intraoral exam and evaluation of the head, neck, facial area, teeth and supporting structures.

ü      Upper and lower dental impressions

ü      Specialized tomography x-rays to assess whether or not the patient is a sleep appliance candidate.

ü      A specialized instrument (pharyngometer/rhynometer is used to measure the throat and nasal airway.

All of the appliances attempt to dilate or open the airway, and the benefits include:
      Excellent patient compliance and acceptance
      Non-evasive, conservative treatment
      Repositioning of the soft palate, stabilizing the lower jaw, tongue, and uvula
      Increased muscle tone and muscle activity
      Moderate cost when compared to other more invasive treatment

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Sleep apnea is a multifactorial sleep disorder that is gaining greater recognition among physicians and the lay public. Stedman's Medical Dictionary defines apnea as the absence of breathing or the want of breath. Sleep apnea is defined as 30 or more apneic episodes(the cessation of airflow at the mouth or nose for more than 10 seconds) occurring during seven hours of nocturnal sleep.

Apnea severity is usually categorized by the frequency of apnea episodes:

• Mild
  
• Moderate
  
• Severe

These episodes can last anywhere between 10 to 120 seconds each, terminating with at least a partial wakening. Typically, a patient may have as many as 300 apneic episodes per night.

There are three basic classifications of sleep apnea:

• Central Sleep Apnea
  
• Obstructive Sleep Apnea
  
• Mixed Apnea

Because the etiology of obstructive sleep apnea is multifactorial and the treatment options are varied, proper diagnosis and treatment are best handled by a team approach. Members of the team may include a Sleep Specialist, an Internist, an Ear Nose and Throat Specialist, and a General Dentist who has specialty training in oral sleep appliances. A definitive diagnosis can only be accomplished by a sleep test called a Polosomnogram.

Most people with sleep apnea benefit from both general measures and specific treatments:

• Lose excess weight
  
• Get regular exercise
  
• Avoid alcohol, heavy meals and medication that make you drowsy

When these measures are more severe, and these measures don't solve the problem, other treatment options include:

• Dental Appliance Therapy
• Nasal CPAP (continuous, positive airway pressure)
• Surgery

In recent clinical studies, physicians and dentists have found that in the majority of patients, a well made, fitted dental appliance will effectively reduce or eliminate snoring and apnea.

<Back to Sleep Apnea and Snoring Index>
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Silencer	Napa
EMA-1 (Elastic Mandibular Advancement - 1)	EMA-2 (Elastic Mandibular Advancement - 2)

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If MPD goes untreated perhaps nothing might happen. Or, your symptoms might become much worse. It is a chronic degenerative disease and often takes years to develop.

It may be that you were not aware of any symptoms until you woke up one day with, for example, an excruciating headache. Many different lifestyle factors can combine which could aggravate MPD- such as structural imbalances, stress, fatigue ,certain foods and drinks and even chewing gum. Any one of these is a single drop in the bucket, but taken together, they precipitate into a full blown MPD condition.

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Why Do We Use It?
The ability to track the movements of the jaw allows us to very precisely determine the correct jaw to skull relationship. We then know how to adjust the bite to maintain this correct relationship.

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A group of symptoms, disorders, and discomforts, which center around the joint where the jawbone joins the skull. This area is a complex of muscles, nerves, tendons, ligaments, large and small blood vessels, and small but significant discs, all working in precise harmony with one another, to produce all natural movements of the jaw.

What Are The Symptoms?
The symptoms of the syndrome range in intensity and degree, depending on the degree of the involvement of the structures. Some of the symptoms include:

• Headache
• Ringing in ears-fullness, earache
• Backache, neck ache and tension
• Clicking and or popping in jaw joint
• Visual disorders
• Tiredness of facial muscles
• Painful opening of jaw-locked opened or closed
• Limitation of range of movement of the jaw with deviation from the center line
• Symptoms vary in individuals according to the severity of the disease and duration of the symptoms.

Possible Causes

• Accidents
• Malocclusion of the teeth-inherited or acquired
• Stress
• Bad posture; jaw habits (clenching and grinding)
• Long anesthetic medical or dental procedures
• Poor fitting dental prosthetics
• Diseases of the bone or joints

Treatment

Treatment varies from simple to extensive therapy. The most common treatment is a repositioning oral appliance which is used to change the patient's occlusion (bite) and restore proper function.

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