TMD Could be Interrupting Our Patients’ Sleep

Approximately one in every four people who regularly visit their dentist has a condition called bruxism, which is an involuntary movement of the jaws when a person is sleeping. And, about 80% of those who do grind their teeth each night are unaware they are doing it. It can happen occasionally to some people without causing any severe damage, while others it can cause a lot of harm to their teeth. Unfortunately, though, those who experience regular teeth grinding face the possibility of dental problems and sleep disorders. One complication that can arise is temporomandibular joint disorder (TMD).

What is TMD?

TMD is a problem occurring within the jaw, jaw joint and the surrounding tissues. The TMJ is a hinge joint which attaches the lower jaw to the temporal bone of the skull found in front of the ear on the sides of the head, which allows for jaw movement and enables yawning, talking and chewing. When teeth grinding occurs at night, the TMJ can become damaged from the pressure causing a chain reaction to the surrounding tissues resulting in pain, injury and or joint degeneration.

The Sleep Apnea and TMD Connection

Approximately 75% of people with TMD have signs that suggest a sleep breathing disorder, such as sleep apnea. A narrow upper arch of teeth is 90% predictive of OSA and a retruded chin in 70% predictive of OSA.

In other words, teeth grinding and TMD can affect more than just the jaw–it can be an underlying cause for sleep apnea and other sleep disorders. The tongue which is attached to the lower jaw acts as a pad when the jaw is not aligned under normal circumstances. When TMD is present, it is possible for the jaw to move and for it to become misaligned, which affects the bite and general size of the mouth. This change in size can result in the inability of the mouth to properly accommodate the tongue.

When less space is available, the tendency is for the tongue to fall to the back of the mouth, which, in turn, creates a blockage in the air pathway. This obstruction then leads to episodes of pauses in breath or shallow breathing known as sleep apnea.

To learn more about TMD and the connection with sleep apnea, feel free to contact my office or attend an upcoming lecture.

Teaching Dental Sleep Medicine in Dental School at West Virginia University

Previously we have discussed the need to incorporate dental sleep medicine courses into the curriculum at dental schools. While this continues to be an area that we need to focus on, I have some exciting news to share with you all. To my knowledge, the first school where the dean is proactive in incorporating dental sleep medicine (DSM) education is West Virginia University School of Dentistry.

Beginning in the first year of dental school, Dean Borgia of West Virginia University ensures students can start receiving classes in DSM. And, to help keep students informed, I have joined forces to provide courses on DSM and other areas. Teaching

My Time Teaching at WVU

Topics are covered at West Virginia University as they cover sections in Basic Science. When students complete head and neck anatomy, I came in to visit and teach about Airway Anatomy as it relates to sleep apnea. Understanding the airway and how it can affect a patient’s sleeping patterns due to sleep apnea, and other sleep disordered breathing conditions, is vital in maintaining your patients’ health and improving service offerings.

Next, when students’ classes covered respiration in physiology, I came in again to discuss sleep physiology. There are two types of sleep, non-rapid eye movement (NREM) and rapid eye movement (REM). By understanding these types of sleep, and their role in sleep apnea, as well as other areas, students can continue to learn the importance of DSM and caring for their patients.

This occurs each time students reach a place in their learning where dental sleep medicine come into the picture. By providing these added courses, we can pave the way for our students to begin their dental careers with more knowledge than ever before. And, while they will still need to complete more education each year to remain up-to-date, the dean, a few of my colleagues  and myself are able to get them prepared for the future.

Providing advanced classes in dental sleep medicine at our Universities should be a requirement for all dental schools. I am glad West Virginia University’s School of Dentistry Dean has taken that next step in providing classes at each phase of learning. To learn more about my upcoming lectures, and where I might be next, please visit my Upcoming Lectures page.

Teamwork Between Dentists and Sleep Physicians is Essential

It’s time to create your team! Just like any sporting event, teamwork means success. While you won’t be choosing a whole roster, you will need to find  a sleep physician to work with. Collaboration with a sleep physician allows your office to generate a diagnosis for your patient while also receiving referrals.

A Diagnosis for Patients

To begin, dentists DO NOT diagnose–it is important to remember you need a diagnosis from a sleep physician before beginning treatment. By building a rapport with a sleep physician you can send your patients their way for a proper diagnosis. Begin now by introducing yourself, and providing information about what you know and services you offer your patients–the more they know the better.

Receiving Referrals

When patients are CPAP non-compliant, what other options do they have for treatment? Many are unaware of the availability of oral appliance therapy, which often is the same for many sleep physicians. By not only educating your patients, but sleep physicians, too, you can begin receiving referrals to your office. As you know, mild to moderate sleep apnea can often be treated with oral appliance therapy.

Physicians who understand oral appliance therapy can frequently refer patients to your office for proper care when CPAP therapy is not working or the patient doesn’t want to utilize a CPAP machine. It can also be beneficial for combination therapy with both the oral appliance and the CPAP machine.

To learn more about building a relationship with a sleep physician, sign up for an upcoming lecture, or schedule a consultation and shadowing options. Together we can improve your service offerings.

Searching for the Right Continuing Education Courses for Sleep Apnea

I recently read an article in Sleep Review about Dental Schools receiving a failing grade. While this might be accurate, I wouldn’t give the schools a failing grade. What dental schools do is educate dentists to provide general dentistry. However, we can change this failing grade to a passing grade with the availability of continuing education courses. Let’s take a stand and further advance ourselves and our practices by understanding how to take our dental education to a new level of success with continuing education courses.

What Research Says

According to researchers, there is an absence of sleep-disordered breathing education for dental school students. With the increase in a need for proper obstructive sleep apnea treatment, dentists remain in a unique opportunity to screen patients and recommend treatment. While dentists can’t diagnose, they maintain the ability to notice the first signs of sleep apnea, which allows them to refer to a sleep physician for proper diagnosis.

The issue that remains is that when dentists graduate from dental school, they are not prepared for the added services of dental sleep medicine. It has been shown that less than 3 hours are dedicated to OSA and other sleep-related disorders for dental students. And, only a handful of postdoctoral programs are available that include such courses to help improve the offering of dental sleep medicine.

What Needs to Change

In order to further improve dental students’ understanding of all areas of dentistry, we must provide our students with the education they need to better serve their patients. While I don’t have a set answer for how many hours are needed to be spend on the subject of obstructive sleep apnea, there is one thing we do know–continuing education is available.

The availability of continuing education courses in dental sleep medicine allow dentists to continue to advance their knowledge in dentistry. While many dentists will go on to remain in general dentistry, others search for ways to further their practice and services available. This is where continuing education comes into play.

Continuing Education

Are you ready to continue your education well past what you learned in dental school? While less than 3 hours are dedicated to dental sleep medicine in school, there are options out there to help dentists. The biggest advantage dentists have is the opportunity to advance their expertise with quality education seminars and courses from accredited associations such as Nierman Practice Management.

Lead by experienced dental sleep medicine specialists such as myself, we continue to help dentists and their teams advance their practices to offer sleep apnea services. And, while researchers has stated that “without such a component in their academic career, the researchers explain, dentists must rely on courses offered by manufacturers of oral appliances and information gleaned from medical literature and industry meetings,” there’s more out there.

Today, numerous courses are available through accredited associations and led by experienced dentists who are currently practicing within the field of dental sleep medicine. Visit my lectures page or Nierman Practice Management to learn more about your options for continuing education.