In nearly every case of TMJ I have seen, there is some form of airway obstruction. Either a narrow airway in the throat, enlarged tonsils or adenoids, allergies, sinus problems, deviated septum or small mouth with limited tongue space. Many researchers believe that airway obstruction in one form or another is the underlying cause of TMD/TMJ. Why?
If the airway is compromised, the patient naturally alters their oral posture to ensure proper air flow for survival, usually by mouth breathing with the tongue and jaw forward. Ideal resting oral posture is for the lips to be together and for the tongue to be resting gently just behind the upper two front teeth. When the tongue is forward and the mouth is open on an ongoing basis, the tongue pushes the teeth forward, and the cheeks collapse inward, narrowing the jaw. In effect, the tongue and cheeks act as orthodontic appliances, moving the teeth to a position far from ideal. With the teeth out of proper alignment, the bite can become unbalanced, placing unbalanced force on the biting muscles, causing headaches, jaw pain, and other symptoms of TMD/TMJ.
What causes airway obstruction? According to Weston Price, it is our modern society's foods which, to many people, are allergens. The most common food allergens are wheat, dairy and chocolate--the things we all love to eat! Compounding the problem, when young patients get crowded teeth from this syndrome of mouth breathing and forward tongue posture, the orthodontic solution is often to extract the first bicuspid teeth to make more room. From a strictly orthodontic standpoint, this works nicely as the teeth can be moved so that they don't look crowded anymore. And if the patient wears their retainers, the teeth will stay that way. But what about the airway?
The tongue becomes more crowded with fewer teeth in a properly formed dental arch. The tongue then moves forward between the teeth, which can cause an open bite at the skeletal level, putting severe pressure on the rear-most teeth. Alternatively, the tongue is restricted by the retained teeth to the back in the throat, which can cause sleep apnea, a condition where the patient stops breathing many times during a night's sleep.
Obstructive Sleep Apnea (OSA) is often accompanied by snoring and is very common in modern civilization. OSA can cause death and is closely associated with an increase in cardiovascular disease, hypertension, and an average 20% decrease in lifespan. Many OSA experts believe that Tim Russert of "Meet the Press" and Billy Mays, TV pitchman, died because they had OSA. Not surprisingly, OSA patients commonly grind their teeth and have an un-ideal bite.
So what can be done for prevention and treatment of TMD/TMJ? Aside from raising your children in the Australian Outback where Weston Price found no patients with this problem, there are some solutions. Awareness of the nature of the problem is most important. Everyone should be able to breath freely through their nose. If that is not happening, look into the problem as early as possible with an ENT Physician.
If you are considering orthodontics for crowding, in my opinion, I would request the orthodontist to expand the jaws, rather than remove teeth, decreasing the intraoral volume for the tongue. Many orthodontists will say that this is not possible after a certain age, but it is being done by those orthodontists and dentists that know how to do it. Once a patient is in a TMD/TMJ syndrome, orthodontics is often an option but it becomes even more important to follow principles that support an increase in airway. Sometimes, orthodontists work in concert with oral surgeons to solve these problems permanently.
While these solutions may sound drastic, TMD/TMJ treatment is often as simple as making a small adjustment to a new filling or making an orthotic/nightguard that places the jaw into a relaxed position for the jaw muscles. If the teeth are severely worn or damaged, dental work can be made to allow the jaw to relax in the physiologically most restful posture for the muscles.
Most importantly, seek the services of an experienced professional to guide you in prevention and treatment of TMD/TMJ. If we can help, please call our office at 510-601-7645.
Josh Bernstein, DDS
Josh Bernstein, DDS
Founder and President, Dental Comfort Academy
http://www.allnewsmiles.com
http://www.sanfranciscosedationdentist.com
http://www.comfortacademy.org
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