#104 TMD/TMJ and OSA, Why All the Confusion?

TMD/TMJ is the acronym for Temporomandibular Joint Disorder/Temporomandibular Joint, and OSA is the acronym for Obstructive Sleep Apnea.  

 TMD/TMJ is a disease seen most often in women and defined by its symptoms, including frequent and/or recurring headaches, earaches, neck pain, jaw pain, ringing in the ears, a feeling of fullness in the ears, vertigo, upper back and shoulder pain, arm/hand/finger tinging and numbness, and various kinds of jaw locking. TMD/TMJ is caused by chronic inflammation within the joint.   

OSA is a disease with symptoms which include: 

• Loud persistent snoring                                           

• Excessive daytime fatigue 

• Poor concentration 

• Sleepiness during routine activities 

• Early morning headaches 

• Depression or irritability 

• Restless sleep 

• Witnessed pauses in breathing 

• Choking or gasping for air during sleep 

• Frequent visits to the bathroom 

Furthermore, OSA Has been proven to be associated with increased incidence of heart disease, diabetes, lung disease, and sudden death.  

OSA is created by obstruction of the upper airway behind the tongue.  OSA is seen most often in males and exacerbated by weight gain and increased body mass, ingestion of alcohol and other highly refined carbohydrates, and various kinds of jaw growth problems. 

The airway behind the tongue is a flattened tube.  In a normal patient this tube is big enough so that it doesn’t completely collapse when a person falls asleep and the muscles of the throat and tongue relax.  In a patient with OSA, the tube is narrow.  When the person falls asleep, the surrounding muscles relax, and the airway collapses and air cannot be inhaled into the lungs unless the person wakes up.  OSA can be demonstrated by monitoring the patient while sleeping and counting the number of times per hour the person stops breathing and for how long they stop. A person has mild OSA if they stop breathing between 5 and 15 times per hour, moderate OSA if they stop breathing between 15 and 30 times per hour, and severe OSA if they stop breathing more than 30 times per hour. 

The confusion between these two diseases begins with the fact that both can be treated with an oral device.  The science demonstrating the success of each device has been proven.  Both the TMD/TMJ device and the OSA device move the lower jaw.  But that is where the similarity ends.  The TMJ/TMJ device allows the lower jaw to move rearward or posteriorly so the jaw joints are in their most restful position allowing the chronic inflammation to dissipate and the symptoms decrease.  The OSA device does the opposite.  It pulls the jaw (mandible) forward or anteriorly increasing the airway behind the tongue and therefore allowing air to move easily into the lungs while sleeping. 

Besides confusing the devices as to what they do, some doctors try to make the case that patients who have TMD/TMJ are more likely to have OSA, and similarly, patients with OSA are more likely to have TMD/TMJ.  There is no scientific evidence that one causes the other.  They are not related at all except for the fact that both disorders have been proven to be successfully treated using oral devices.  One device, the Urbanek Device and Protocol, allows the jaw to slide posterior to its most comfortable position, and the OSA device pulls the jaw forward to increase the size of the airway behind the tongue. 

Not only does each device do something diametrically opposed to the other, they do not look similar to each other in any way.  One would not confuse a picture of an OSA device for a TMD/TMJ device. 

It might surprise you to find out that not only patients confuse OSA devices with TMD/TMJ devices but many physicians and dentists exhibit this confusion.   

Most confusions are simple to sort out once you define your terms.