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By Peter Blais, RPSGT
Many different treatments are available for people suffering from temporomandibular joint (TMJ)-type pain, says Cameron A. Kuehne, DMD, MS, a dentist with The Center for Sleep Apnea and TMJ in Boise, Idaho.
People have two TMJs, Kuehne explains. It is a joint, like the elbow or knee. When somebody has a TMJ disorder, it is called temporomandibular disorder (TMD). This can include head and neck pain symptoms, pain upon opening or chewing, headaches, popping or locking of the jaw, arthritic changes to the joints, ear pain, and more.
Most dentists know how to do a basic TMJ screening, but not all problems may be caught by a general dentist. Referral to a dentist with special training in TMD is sometimes needed. A TMD-trained dentist may need special tools and x-ray imaging or MRI to help confirm a diagnosis related to TMD.
“We think that an underlying sleep apnea issue may cause TMJ-type pain in certain individuals,” Kuehne says. “Some studies suggest that as the airway closes off, some people subconsciously try to protect their airway by clenching or grinding their teeth. This type of microtrauma can cause TMJ-type pain or headaches in certain individuals.
“We feel it is important to screen all people, especially those with TMD, for an underlying sleep apnea issue. For some people, as we treat their sleep apnea problem and open their airway, that need to clench or brux goes away along with the TMJ pain or headaches.
“In cases where sleep apnea is not a concern, things such as ice/moist heat, anti-inflammatories, and a soft diet may be all that is needed. In tougher cases, splint therapy may be initiated along with physical therapy, chiropractic treatment, or other adjunctive therapies. Some people may need a permanent change made to correct their bite. In rare cases, surgical approaches may be considered.”
Kuehne notes in his area the medical community tends to send people with TMJ-type pain to dental professionals. “Physicians that tend to send the most TMD patients to my office are ENTs. ENTs see a lot of patients presenting with ear pain that ends up being pain due to a TMJ issue.”
Most insurance companies in his area are willing to pay for treatment for patients that have sleep apnea along with TMD. In some cases dental offices have to do some extra legwork to get these types of cases approved, though.
In cases where underlying sleep apnea is causing a TMJ problem, opening the airway with a dental appliance or CPAP machine is usually an effective treatment route in mild to moderate sleep apnea cases, Kuehne says. In more severe cases, CPAP tends to be the better approach in treating both condition. He adds, “Having said that, sometimes we still need to insert a TMD nightguard along with the CPAP treatment to have resolution of the TMD.”
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