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Understanding Sleep Disorders TMJ and Sleep Therapy of New England by Wendy Fachon Many people suffer from a disorder at the joints that connect their lower jaw to their skull, and a temporomandibular dysfunction (TMD) will often accompany a sleep disorder. People can fail to recognize the symptoms of TMD and may live a majority of their life suffering a treatable condition. In fact, most dental and medical practitioners fail to recognize the signs of TMD or sleep disorders. Dr. Amparo David, DMD, who practices in Bolton, Massachusetts, is one of few specialists that under-
stands TMD/sleep disorders and has been spending many years improving her treatment methods. The temporomandibular joint (TMJ), situated in front of the openings of both ear canals is a movable joint that connects the lower jaw to the skull. Each joint contains a soft cartilage that protects the bones from rubbing against each other. This cartilage contains nerve endings, allowing us to experience pain in the area when something is not working correctly. When people grind or clench
their teeth, they strain this joint, creating a dysfunction in its movement. People may experience different levels of discomfort or a clicking sound when they open and close their mouths. If the cartilage that protects the bone is displaced, bone-on-bone friction can occur, leading to longterm damage and pain. David treats patients with temporomandibular (TM) appliances, custom fit to the upper and lower teeth. This appliance is designed to keep the lower jaw in a position that alleviates pressure off of the TMJ joints. It is used at night time when the suspected grinding occurs during a patient’s sleeping hours. David will also have her patients wear a daytime appliance for a few months. The day time appliance is fabricated for the lower teeth only, to hold the jaw in a similar position to alleviate pressure from the TMJ. Plastic bands are used to connect the appliances to reinforce a favorable position of the jaw and to promote healing. The daytime appliance functions as a brace to give more healing time to the damaged joint(s). Ongoing use of the night-time appliance will maintain a healthy, healed TMJ. The quality of sleep is also important to TMJ health. If insufficient oxygen is absorbed while sleeping, the brain will recognize this and either force the body to wake up, or try to move the lower jaw forward in an attempt to open the airway while one is still in a subconscious state. For patients that do not present with symptomatic TMJ dysfunction or severe sleep apnea, a night orthotic
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