Is treating Sleep Apnea can help TMJ dysorder?

Hi Everyone! My name is Sharon and after having anxiety and panic attack I suffered from TMD since 2015. I've been to a dentist August 2016 and suggested to have braces to correct my bite as my upper and lower teeth are not touching. My braces are scheduled to be removed by end of this month but my TMD symptoms haven't disappeared. So I decided to look for a TMJ specialist and she asked me to do the sleep test. The result is I have mild OSA which she advised me to wear the appliance every night for a year. She said she will check me every 3 months to see if the appliance is working with me. Then after a year she will see if I need to wear braces again as she found out that the way the other dentist put my braces was not right and actually did not help my TMJ issue. My question, is wearing the appliance for OSA can cure also my TMJ pain?

Oral appliances to treat sleep apnea put significant forces on your teeth and their major side-effect is tooth movement. If you have had braces after the age of 21 (it seems as you are still in braces) there is a 100 % chance of unwanted tooth movement with an oral appliance. This could lead to the back teeth not touching and significant problems. As a dentist who has treated sleep apnea for almost 30 years, I think you should not consider oral appliance therapy. As associate editor of the Journal of Dental Sleep Medicine, I know of no good literature that shows treating your sleep apnea will treat your TMD. I also know of no good literature that shows orthodontics is the appropriate treatment either. NIH suggests symptomatic treatment with NSAIDs, a soft diet and moist heat. That being said, there is anecdotal information that orthodontics and oral appliances can be helpful in a small highly selected group of patients. Treatment of your sleep apnea is recommended because there are good studies that show tired patients have a very low pain tolerance / threshold. There are many treatments for sleep apnea. You need to discuss your options with a Board certified sleep specialist and look at all your options. Oral appliance therapy will cause you more problems than you can imagine. B. Gail Demko,DMD

This is a very difficult question. First let's consider what we do know: We know that there is a strong association between untreated obstructive sleep apnea and nocturnal clenching and bruxing. Some literature that I have read puts the association as high as 50%, but that is not a settled issue and I shall not attempt to defend that figure. We also know that successful treatment of obstructive sleep apnea with CPAP, oral appliances, or other modalities will often lessen or totally eliminate the nocturnal clenching and bruxing. Again, that is not an absolute and there are many exceptions. There are many causes of TMD, but clenching and bruxing are probably the most common. If a person's TMJ pain is simply due to excessive muscular strain and tension on the muscles of mastication, it is possible to resolve those symptoms and proceed to oral appliance therapy for obstructive sleep apnea eventually in many cases. The problems that you describe, particularly the posterior open bite, indicate that your problems have progressed to the stage where you actually have structural problems within the TMJ itself. These are called intracapsular problems. I would agree that you should not undertake oral appliance therapy at this point because it would compound your problems. However, I would not agree that no one in that position has ever been treated well enough to ever be an eventual candidate for OAT. In some cases, dentists extremely skilled in TMJ therapy have been able to perform a procedure called disk recapture and do some other things that might make OAT possible, but again, I do agree that it is limited in scope to a small percentage of cases. Bottom line is that I would agree with Dr. Demko that CPAP or some other mode of treatment is a better bet for you than OAT at this time. Arthur B. Luisi, Jr., D.M.D