#122 I Discovered Why There is Confusion about TMD and OSA

TMD is a list of disparate symptoms including recurring headaches, earaches, jaw pain, neck pain, ringing in the ears, a feeling of fullness in the ears, dizziness/vertigo, upper back and shoulder pain and tightness, arm/hand/finger tingling and numbness, and various kinds of jaw locking.  OSA is airway obstruction in the back of the throat while sleeping which over time can create dire consequences including, heart and lung disease leading to death. 

There is no way for me to sugar coat my discovery about the reason that so many TMD/TMJ, so called, “expert/specialists” in dentistry tell patients that Obstructive Sleep Apnea, OSA is caused by Temporomandibular Joint Disorder, TMD, and vise versa, TMD is caused by OSA.  Several months ago, I identified this problem and described the confusion among both doctors and patients in a previous blog article.  At the time, I commented there is absolutely no causal relationship of one to the other.  I cited the fact that this issue was even addressed and found to be false in the standard, and most widely authoritative textbook on Sleep Apnea, “Sleep Medicine”.  The fact that some of my colleagues were trying to make the case that OSA and TMD cause each other made no sense to me.  As both a dentist, DDS and physician, MD with additional degrees in anatomy and cell biology I was certain of my position.  TMD and OSA are two separate and distinct diseases and the only thing they have in common is both create their symptoms and effects while patients are sleeping, and both are successfully treated with oral devices worn primarily at night. 

This weekend I was in Chicago attending one of the largest dental conventions in the United States and had a very interesting conversation with one of the other female attendees who shared with me the following story.  Her story led me to figure out WHY this group of so called “expert/specialists” have been trying to make the case that OSA and TMD cause one another. 

This woman, who I will call Mary, told me her sister had been plagued by the devastating symptoms of TMD for 20 years and the symptoms were ruining her quality of life.  She lost her job because of frequent painful episodes so, severe at times, she could not get out of bed. She was also suffering from many of the side effects of the drugs that had been prescribed.  Mary’s sister had been seen in consultation with doctors and clinics in several states including large institutions that are common household names. She had been seen by dentists and physicians of many varietie., None were able to offer any treatment or care with any long term relief.  Mary’s sister was desperate. Eventually Mary’s sister was referred to a dentist in St. Louis who held himself out to be an expert/specialist in treating TMD, Temporomandibular Joint Disorder.  After an evaluation, this dentist told Mary’s sister that the reason no-one else could help her was because her TMD symptoms were caused by her OSA, Obstructive Sleep Apnea. He said he could help her as soon as her insurance company approved his treatment with an OSA device.  This dentist wanted to put in a claim to the medical insurance company to cover the OSA device. OSA devices are usually a covered expense when patients cannot tolerate CPAP masks for treatment. 

But Maty’s sister had absolutely no history of sleep apnea, or any of the common symptoms of sleep apnea confirmed by everyone in Mary’s sister’s immediate family. 

Listening to this story from my fellow convention attendee, I blurted out, “OMG, now I know why there is such a push for these so called “expert/specialist dentists to try to connect OSA with TMD.  They are just trying to game the medical insurance companies to pay for TMD treatment that is routinely denied by medical insurance.   

I am disgusted to find out the reason for the push to connect TMD with OSA.  

 The only association between OSA and TMD is both are treated successfully with oral devices and both are treated primarily during sleep.   

There is a very old adage in medicine.  “Association Does Not Prove Causation”.   This definitely applies to OSA and TMD and Mary’s Sister.