Temporomandibular joint disorders (called TMJ or TMD) and sleep apnea often occur in the same person. Since many people have both conditions, and we treat both conditions with oral appliances, patients often ask: can I get just one appliance for both my conditions?
Not really. The two treatments have different functions and different goals, so one treatment can’t work for both conditions. However, it’s important to work with a Denver sleep dentist like Dr. Kevin Berry, who understands both conditions. That’s because, if not properly utilized, an oral appliance for treating sleep apnea can worsen TMJ symptoms.
How Oral Appliances for Sleep Apnea Work
The most common type of sleep apnea is obstructive sleep apnea. In this type, your airway collapses when you sleep. Because your jaw (mandible) is the main bony support of your airway, an oral appliance repositions your jaw to help hold your airway open.
Most of the time, this means moving your mandible forward so that it pulls your airway more open. That’s why they’re called mandibular advancement devices (MADs) if you look at paperwork from your doctor, insurance company, or Denver sleep dentist.
How Oral Appliances for TMJ Work
An oral appliance for TMJ has a different function. This appliance is trying to reposition your jaw with respect to different features of your anatomy. A TMJ appliance, often called a bite splint, is trying to reposition your jaw with respect to your joints, muscles, teeth, nerves, and more. The goal is to find a relaxing, balanced position for your jaw.
While it isn’t specifically trying to close your airway, a bite splint isn’t necessarily trying to help it stay open, either. Unfortunately, a relaxed, balanced position for your jaw isn’t always the best one for keeping your airway open. In fact, it’s often the opposite, as the advancement of the jaw to hold the airway open can be a tense, potentially uncomfortable position for your jaw.
Do MADs Lead to TMJ?
If a position that holds your airway open might be uncomfortable for your jaw, does that mean that sleep apnea appliances can cause TMJ? Yes, they can.
If you look at the documentation for your MAD, you will find that TMJ (or TMD) is listed in the section on possible side effects.
The likelihood of developing TMJ after oral appliance therapy seems to be small. In a study comparing people using oral appliance therapy with those using CPAP for sleep apnea treatment, the oral appliance was more than twice as likely to cause jaw pain as CPAP. However, the study showed that TMJ pain was a short-term side effect and not a reason to recommend against oral appliance therapy.
In fact, some studies suggest that CPAP and oral appliances are essentially comparable when it comes to TMJ-related pain. Successfully deployed oral appliances are unlikely to lead to long-term bite problems.
However, poorly utilized oral appliances do have the potential to cause jaw pain and lead to long-term bite problems. The biggest danger here is over-the-counter (OTC) “snoring” appliances that people might buy and try to use at home. Sleep apnea is underdiagnosed, and many people with the condition might think that they are just a snorer. Their sleeping partner might report the loud noise, and they think that’s the problem. Self-treatment of snoring might stop snoring, but in the process, it might leave sleep apnea untreated, and it might cause TMJ.
Instead, it’s best to talk to a Denver sleep dentist before attempting to use any oral appliance for snoring or sleep apnea. At least you want to get a sleep test to see if you have sleep apnea. Then, make sure your sleep dentist understands potential side effects to reduce the risk of TMJ and other potential complications.
Can MADs Improve TMJ?
Although MADs can’t work exclusively as a TMJ treatment, they can sometimes still help with TMJ. Depending on the specific type of TMJ, treating sleep apnea with a MAD might reduce your pain. In fact, one study found that the prevalence of TMJ-related pain was reduced by about half over the first year of treatment. At the initial visit, 33 of 167 people seeking sleep apnea treatment had TMJ pain (20%). At the fourth visit, more than a year later, only 7 of 85 people had TMJ pain (8%). Although some people with TMJ pain might have dropped out of the study, it still suggests that there is a potential for some people’s TMJ to improve with MAD therapy.
There are two reasons a sleep apnea appliance might help TMJ. First, some people might find the advanced position more comfortable for their jaw. Certainly, a Denver sleep dentist who understands TMJ could take full advantage of this. Second, a MAD might reduce clenching and grinding during sleep (night bruxism). Sometimes a person might clench their jaw when their airway collapses. This can help hold the airway open, but it can be hard on the jaw muscles and joints. Keeping the airway open means fewer clenching instances.
Treatment for TMJ and Sleep Apnea in Denver
What if you have TMJ and sleep apnea? Well, in rare cases, we will treat your sleep apnea and TMJ at night with the same orthotic, but you’ll need a separate TMJ orthotic during the day.
If you’re looking for treatment for TMJ and/or sleep apnea in Denver, please contact the TMJ Therapy & Sleep Center of Colorado. Dentist Kevin Berry understands both conditions and knows how to optimize combined treatment to help you get the best possible results from both.
To learn more, please call (303) 691-0267 or use our online form today to request an appointment at our Denver office near the intersection of I-25 and Colorado Blvd.