Do you Snore?
BEWARE
The number of people suffering from Temporomandibular Joint Disorder (TMJD) is much more than one can imagine, but identifying the problem takes a hit due to lack of knowledge on it. Its symptoms are what we generally brush aside, such as headaches, migraines, neck pains, aching facial pain or pain around the ears and clicking sounds while opening the mouth, to name a few.

What is Temporomandibular Joint Disorder (TMJD)?
TMJ comprises a list of condition that cause pain and dysfunction in the jaw joint and muscles that control jaw movement. What you need to note is that the way we chew, our jaw alignment and all are extremely important.

How are headaches, snoring and migraines associated to the way we chew?
Most of these headaches are myogenous in nature, which means it’s related to the muscles that control the position of our lower jaw. And that position is more often than not related to how our teeth are connected to each other, basically our ‘bite’. Our jaw’s position is decided based on how we chew. When we chew wrong, the jaw’s joint called the Temporomandibular Joint (TMJ) goes for a toss. Normally it starts with a ‘click’ sound in the joint when the mouth is opened and closed, but many ignore it, eventually leading to migraines and headaches. There’s a nerve that travels within the joint, which gets compressed once the joint space is lost. This excites all the muscles that the nerve caters to, which is almost the entire head and neck. This leads to headaches and migraines.

Can a Dentist identify a TMJ problem?
Unfortunately, this topic is only glanced through and not given much importance while being taught. So unless one specializes in it, getting into the intricacies will not be possible.

How do you treat people with TMJ disorder?
We relax the excited muscles with the help of a dent machine and find the actual position of the jaw. The patient, then, will be given a splint to be worn on the lower teeth for a period of time, till the jaw comes to the right place. And as far as headaches are concerned, they vanish in a fortnight’s time itself, once the treatments begins. It’s almost like magic! People suffering from headaches for years can be cured. In fact, a survey in the US says that 80% of headaches and migraines are TMJ disorders! It’s pretty common, but not many know, including several doctors!

Can Orthodontic negligence lead to TMJD?
Yes! Almost 90% of the population has a mal occlusion, which is the case where teeth do not meet together properly. People get braces done to correct it, but sadly, many do not complete the treatment. Such patients also end up with headaches over a period of time. An orthodontic treatment ought to be completed, particularly in children who get braces in the growing stage. If neglected, they could end up with neck pain. What one also needs to note is that a change in the position of the lower jaw could lead to a change in the position of the neck, eventually leading to a stoop.

What is Obstructive Sleep Apnoea and what are its symptoms?
The tongue is connected with the lower jaw and if the lower jaw is placed backward, the tongue goes backward. When we are sleeping it goes even more backward and hits the jaw palette. This is a huge reason for snoring; It’s called Obstructive Sleep Apnoea (OSA). Restless sleep, Disturbed sleep, snoring, breathlessness during physical activities or climbing stairs, feeling sleepy or tired during the day and neck’s pain are symptoms of Sleep Apnoea.

Does Sleep Apnoea and TMJD co-exist?
More than 90% of the TMJD patients have sleep issues. They go to a neurologist , who calls it a of psychological problem, but it actually could be an issue caused by the lower jaw. Around 80% of the patients suffering from TMJD have Sleep Apnoea, while only 20% Sleep Apnoea patients may have TMJD. The former will need to be given two appliances, one to be worn during the day to dealt with, while the other to be worn at night to help cure Sleep Apnoea.

Will wearing these appliances on a regular basis be painful?
Not at all! In fact, it will help you sleep better. There will be sleep study done to see if you’re getting back to normal or not. However, the concern here is, not many doctors know about TMJ disorders and the physiological approach to treating it in the same way as treating sleep apnoea.

If a person snores, does it mean he’s suffering from OSA?
No. Let me put it this way – if you have a snoring problem and a breathlessness issue when you climb stairs or while walking, then you could be suffering from OSA. And a word of caution – if you have a snoring issue and dyspnea, then in 15-20 years of time you could end up becoming a cardiac patient. This is the reason behind 95% of people suffering a cardiac arrest while sleeping. Snoring, please note, is NOT a joke!

How can one cure the problem of snoring and TMJ?
Preventive medicines isn’t as advanced in Asia as in other parts of the world. However, snoring can be prevented by wearing an appliance, thus, helping to bring your heart back to a healthy state. And treating TMJ starts by taking measurements. We use electromyographs, kinesiographic machines and other sophisticated equipment to find the jaw’s actual position and then get to correcting the flaw. Every person has a basic structure, based on which we work.

Are people born with no defects and eventually affected or is this problem innate?
It could be either ways. It could be a genetic disorder or it could be an acquired one due to pollution, stress, etc., which could eventually affect the jaw alignment. Every problem has a cause. Once a doctor arrives at the cause, a patient could be cured better.

Is the treatment expensive?
There are two kinds of treatment – one is expensive, while the other is not. The international way of treatment ranges between Rs. 75,000/- and Rs, 1,25,000/-. If you are skeptical to spend and wish to go for a cheaper option, you would need to shell out anything between Rs. 30,000/- and Rs. 35,000/-. The cheaper option’s results are around 85%. Many patients, in fact, start with the cheaper option, sense the immense difference and relief and switch to the costlier one.

Whats the association with TMJD and sports?
Have you seen many sports people wearing a mouth guard? Those are custom made. Once it’s worn, the jaw is aptly balanced. And once that happens, the jaw is pushed forward a little, the air way opens up, the body oxygenates better, giving you more balance, power and stamina. This will energize a person better, helping him perform well. Please keep in mind that posture, ALWAYS, is important! Do not ignore recurring symptoms.

Dr Rajesh Raveendranathan
Neuro-muscular Dentist
KIMS DENTAL, TRIVANDRUM