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Frequently Asked Questions

One of the first signs of TMJ problems is a noise when opening or closing the mouth. The noise can happen all the time or sporadically. In some people the noise is very quiet and hard to hear, in others it is loud enough to hear across the dinner table. The reason the jaw is making noise is that the ligament between two bones is dislocating and popping on or off the jawbone. This is not normal or healthy.
TMJ problems occasionally are associates with severe pain, but more than not, pain is a late effect. This means pain is not a predictable way to screen people for TMJ disorders. In most TMJ issues the bodies’ temporomandibular joint is resilient to the pain that people would expect when the bones and ligaments are being torn apart. Pain can occur in the joint space itself and in the muscles, that control the movement of the jaw and head and neck. Pain can come in the form of sharp shooting pains when opening and or closing and pain can also come in the form of dull unending ache in the muscle. It is not unusual to mistake TMJ pain for headaches and earaches.
The jaw can occasionally become stuck or locked when the ligament dislocates between two bones completely blocking the jaw from closing again or opening to its full range. Another cause of a lock is when the muscles that control the movement of the jaw spasm to such an extent as to prevent full range of motion. Both situations are bad and very dangerous if left untreated. TMJ disorders are progressive in nature, which means small problems will turn into bigger problems without treatment.
TMJ disorders are diagnosed by the use of physical examination, range of motion, joint sounds/vibrations, joint hard tissue images, patient history and interview and in some cases, sleep diagnostics and hospital based soft tissue diagnostics. Prior to any treatment suggestions a diagnosis of your condition will be made.

Routine dental x-rays such as a panoramic x-ray can give hints about what might be going on in the joint space, but alone are not diagnostic for the condition of the bones associated with the jaw joint. It will frequently be necessary to obtain a 3D image of the joint through the use of a technology not typically found in a dental office. This image is called a CBCT scan or Cone Beam. You may be referred to a diagnostic imaging center to have this completed.

Often, the action of clenching and or grinding of teeth can have a negative effect on the jaw joint. The jaw works best when plenty of lubrication is present. The act of clenching and grinding teeth puts stress on the joint space and causes a decrease in the quality of the lubrication.
Drugs can play an important role in the treatment of your TMJ issues. Drugs only will be used to improve the outcomes of more definitive treatments and therapies. Drugs alone cannot solve your TMJ issues. It may be necessary to prescribe analgesics, corticosteroid, muscle relaxants, anti-anxiety drugs, antidepressants, or local anesthetics.
It has been reported that greater than 60% of patients with TMJ issues suffer from Obstructive Sleep Apnea (OSA). OSA can only be diagnosed through the use of sleep study that is read and interpreted by a sleep physician. OSA has many presentations that can affect the mouth, the tongue, the teeth and the jaw joint. Because such a high correlation exists between the two disorders and the severity of consequences of living with undiagnosed sleep apnea it may be suggested during the course of TMJ therapy that a sleep study be obtained. One of the hallmark maintenance therapies for TMJ is a nighttime appliance. This appliance can cause patients with sleep apnea to double the severity of their sleep apnea, if not made to control sleep apnea.
It depends on the type of headache. Headaches are complicated and deserve to be evaluated carefully by a medical doctor. Headaches may result from issues within the skull, outside of the skull, the spine, blood pressure, medication and many other causes. We can never guarantee that TMJ appliances will solve headache issues, but we have found that frequently headache occurrence improves with therapy.
Unfortunately, the future is worse than the present. TMJ issues are progressive; they continue to get worse over time. The progression usually follows this pathway. Short term sharp pains, jaw inflammation resulting in muscle tenderness, jaw joint noises, limited range of motion and locking of jaw, changes in the bony makeup if the jaw joint, wear and destruction of teeth, loss of a portion of jaw joint resulting in a permanent change in the bite and ability to chew.
Sleep Apnea cannot be diagnosed from symptoms alone. There are only two ways to determine if you have sleep apnea. One is called a PSG which is an overnight visit to a facility that is designed to monitor all facets of sleep. The other is a home sleep study where you sleep with a monitor in the comfort of your own bed. Both options are good at detecting sleep apnea and with both tests, a boarded sleep physician will read and interpret the raw data collected by the sleep study. The at home sleep study is much less expensive to administer than the in-lab sleep study but sometimes can under diagnose the occurrence of sleep apnea. It is occasionally recommended that if you have severe symptoms and get a negative reading from a home sleep test that your test is followed up with an in-lab sleep study.
The American Academy of Sleep Medicine has created 3 classifications of obstructive sleep apnea. The difference between the classification center around the number of times you stop breathing in an hour of sleep. Mild is equal to 5-15 events per hour, moderate is 16-30 events, and severe being greater than 30. Obstructive sleep apnea is a progressive disorder; without treatment, it will get worse over time.

It depends. We will be able to run some simple tests to determine the amount of advancement required to prevent snoring. On occasion, it takes a period of time to adjust your appliance to the best possible position; one where you will wake feeling rested, minimize snoring noise and allow you a comfortable night’s sleep. We will do everything in our power to help you get into this position.

Nothing lasts forever. Your appliance is going to be used every night for 6-8 hours. We anticipate that your appliance will need to be replaces in 5-7 years. This could be sooner in people who are heavy bruxers and clenchers or those who do not take care of their appliance.

Generally, your subjective symptoms will improve within 30-60 days. We work with you to ensure that this happens as quickly as possible.

Sleep appliances typically last from 3 to 5 years or even longer under some circumstances. The actual duration depends on factors such as proper care, maintenance, and frequency of use. Comparable to any well-maintained possession, the better you attend to it, the longer it will serve its purpose. Regular cleaning and maintenance are essential for prolonging its lifespan.
If you obtain a diagnosis of obstructive sleep apnea, your insurance company should pay for your care. Obstructive Sleep Apnea is a medical condition treated with a dental device. Because it is a medical condition, only medical insurance will provide coverage. It is also subject to your annual medical insurance deductible. If you have met your deductible, they will generally cover more of the expenses. If you have not, your payment will apply to your deductible for other services you may need this year.
It depends. CPAP is the gold standard of treating obstructive sleep apnea, and its effectiveness should never be undervalued. The goal of treatment should always be to render the least invasive, least expensive treatment that is both effective and lends itself to patient compliance. Sometimes, an oral appliance does not meet these goals. When it does not, we will actively support your in obtaining other effective therapies. Both CPAP and oral appliances work by helping air get to your lungs. Occasionally, we will discover that the air is having difficulty in making the journey because of physical barriers in the pathway that CPAP and oral appliances are unable to help. In these situations, we will work with the appropriate physician to create a plan that gets you the best possible outcome.

Because you will be seeing a dentist with advanced training in treating sleep apnea, we can assure you that every possible precaution will be made to prevent any possible harm to your occlusion (the way your teeth come together) and your TMJ. But despite all care, it is possible to have some consequences in these areas.

Obstructive Sleep Apnea steals far more than sleep, it steals life. Few diseases have more consequences on your longevity and quality of life than sleep apnea. Of course, it is impossible to know for sure, but heart attack, stroke, type 2 diabetes, automobile accidents, poor performance at work, fatigue and negative social interactions are among the most common and problematic risks.
Home Sleep Tests are commonly used to diagnose sleep breathing disorders such as Obstructive Sleep Apnea as well as look for other physiologic data that can give us diagnostic information to use to determine what type of sleep problem you have and what options are available to treat you. A lot of our patients have already been diagnosed with OSA and have had a sleep study previously. If you have not or it has been over 2 years since your last study, please call our office and we will be happy to arrange a new sleep study before your consultation with us.
A home sleep study is equivalent to the quality of a sleep laboratory in the palm of the patients’ hand. The recorder contains sensors for body position, pulse oximetry, and a pressure transducer. Each sensor includes the same high-quality and reliable biosensors that are used in a sleep laboratory. These sensors monitor airflow, respiratory effort, and blood oxygenation as well as movement patterns and snoring. The snore microphone records every single snore and will offer precise audio playback for your sleep physician. When played back, it sounds as if you were in the room during the patient’s snoring
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If jaw pain, facial pain, or sleep disorders plague you, let us help! The Pain And Sleep Therapy Center has a treatment that will provide relief. From laser therapy and physical therapy to airway pressure machines and orthotic appliances, we will find a way to help you live your best life.
For more information, please call 302-239-1757

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Pain & Sleep Therapy Center
(Newark, DE)

620 Churchmans Road, Suite 203
Newark, DE 19702
(302)239-1757

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Pain & Sleep Therapy Center
– Main Line (Bryn Mawr, PA)

1149 Lancaster Avenue, Unit 5
Bryn Mawr, PA 19010
(610)973-6595

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