Approaches to TMJ ?

I have TMJ and had a dental appliance made that was supposed to be be for TMJ and jaw advancement!
$2000 later I am struggling worse with my apnea than ever and my jaw pain is unbearable!

I went back to cpap. Please be sure before you waste money like I did. Best of luck!

49er wrote:RogerSC,

Not to get this thread off topic but this citation, which I have posted many times on this board, indicates a much better success rate for dental appliance in getting the AHI below 5 , particularly if an adjustable one is used. As you will see from the statistics, they are more successful for folks with mild and moderate apnea although there were a few severe ranges that the success rate was around 55%

https://advancedbrainmonitoring.app.box ... 7pjn8s11y4

I do agree that there are alot of rip off artists out in the field but in my opinion, if you find someone really good, which is easier said than done, this could be very worthwhile treatment, particularly if you can't adjust to pap therapy. I actually think a good sleep medicine dentist who will go the extra mile to get a fitting correct may be even more key in the success rate.

Sorry, I don't mean to be anal retentive about this but since so many people struggle big time with pap therapy in spite of their best efforts, I wouldn't want to discourage them from trying an alternative even though there would be plenty of hoops to jump through to find a competent sleep medicine dentist and to make sure you were getting optimal treatment.

Finally, if anyone is seriously considering oral appliance therapy as an alternative, please go to http://www.apneasupport.org/sleep-apnea ... n-f20.html and read all posts by sleepdent and ask him any necessary questions. He is extremely knowledgeable and gives you straight answers in my opinion.

49er

Thanks for the reference. The study that you've referred to is much more encouraging than what I heard from my sleep doctor a couple of years ago. Personally, I'm not really searching for alternatives to CPAP unless they show a better success rate than CPAP when actually used *smile*. An OA is certainly something to look at if you can't use CPAP, or it doesn't work for you for some reason that can't be fixed. My wife's sister's husband is using an oral appliance, could not use CPAP for reasons unknown to me. He seems okay with it, not sure that he's had a sleep study using it. It was either that or nothing for him.

Anyways, thanks, I've forwarded the study to my sleep doctor, and asked him for comments. I don't think that this is OT for this thread, since the OP had asked for opinions about oral appliances *smile*. This looks to me like good information.

kaiasgram,

Something I noticed in your initial post is that your dentist said your bite has changed. As you probably know, I am in the process of orthodontic treatment because the high pressure I've been on for years moved my teeth. This caused all sorts of pain, TMJ included. Is it possible your TMJ and bite difference could be caused from your PAP therapy? If you have a change in your bite, perhaps your PAP therapy is moving the teeth, causing the TMJ aggravation along with the bite misalignment. Just a thought, but I've been through a lot because PAP therapy moved my teeth & if this is the cause in your situation, orthodontic treatment might permanently fix it. By permanently, I mean moving the teeth either braces, trays or nighttime retainers. Then keeping them correctly in alignment by using nighttime retainers permanently.

Perhaps this is just not the case for you & I'm missing the mark, just wanted to point out that this might be what's going on & the fix, while not cheap, can be permanent. I'm getting NO TMJ symptoms now that I'm more than 1/2 way thru my orthodontic treatment. My orthodontist pointed out that with all the movement in my mouth, the new alignment is alleviating the pain caused by the misalignment of my jaws at the temporal mandibular joint (I just know I spelled that wrong). I will wear a nighttime retainer for the rest of my life, but that's a small price to pay for keeping my teeth & getting some TMJ relief as a side effect. Just food for thought.

Jen

Thanks jencat -- Yes the primary issue from my dentist's perspective is that my bite has changed dramatically in the last year. What's unclear is why/how that has happened. I've been wearing a nightguard since well before cpap, a nightguard which has a hard exterior and thus acts as a retainer too. I wear it on my uppers. It's possible the lowers have moved since starting cpap (though I don't have a full face mask pushing on the lowers so not sure what would cause the lowers to shift).

The change in my bite is that my upper teeth no longer make contact with my lower teeth, on both sides. Basically I can't bite down all the way anymore. I don't know if that's a function of teeth shifting or TMJ changes. I'll be scheduling an eval.

Thanks to everyone for your comments.

I'm a bit late to this discussion...

My TMJ pain was caused by clenching & grinding my teeth from stress during the day at work. I had no issues with night-time grinding or clenching.

My dentist fitted me with a mouthpiece that helped me to stop clenching.

Essentially, it maintained a gap between the upper and lower teeth when I closed my mouth

I wore it for about 2-3 years every day and it helped me a lot with the pain!

I was also given some exercises to retrain myself to not clench and to open my mouth and relax my jaw every so often while at work.

I've been free of the mouthpiece for more than 5 years now.

Wearing a full face mask for my OSA/Sleep apnea for nearly 2 years now has not caused me any issues at all



Dave