About TMD, Orofacial Pain and Dental Sleep Medicine Clinic

Dental Sleep Medicine involves the use of oral appliances for the treatment of sleep-related breathing disorders (SBD) such as obstructive sleep apnea and snoring.

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by multiple apnea events, due to short-duration blockages of the upper airway during sleep, resulting in decreased airflow to the lungs. OSA in general decreases the quality of life of the affected adults. In fact, it is a life threatening condition and has been reported as a risk factor for depression, hypertension, cardiovascular diseases, reduced vitality, impotence, diabetes, obesity, and occupational and motor vehicle accidents.

Classic symptoms of OSA include loud snoring and arousal/awakening from sleep, daytime sleepiness, tiredness and lack of concentration. However, patients with OSA may not present clinically with these symptoms. Since, there are three types of apnea — central, mixed, and OSA — an accurate medical history and an overnight polysomnography studying at a sleep clinic are necessary to diagnose the condition.

Among the non-surgical treatment options for OSA are: behavioral modification, CPAP, medication, and intraoral mandibular advancement appliances. The scientific literature reports that mandibular advancement appliances have been successfully used as an alternative option for treating mild-to-moderate OSA in adults who do not tolerate the continuous positive airway pressure (CPAP) therapy. Most intraoral appliances hold the jaw forward which opens the airway.

Our dental team treats patients referred by sleep specialists and diagnosed with OSA by fabricating intraoral appliances. In our opinion, when appropriately used, the custom made intraoral appliance is effective in treating snoring and mild-to-moderate OSA. Patients report a decrease of their symptoms and experience an improvement in the quality of sleep.

• Comprehensive orofacial evaluation (head and neck examination, intraoral evaluation, joint examination and radiographs, dental screening).
• Splint (occlusal devices) therapy, sleep apnea intraoral devices, medication management, occlusal consultation and adjustment.

• Comprehensive musculoskeletal evaluation of the jaw and neck including measurements of mobility, strength, coordination and postural alignment.
• Physical therapy treatment includes interventions such as therapeutic modalities and procedures to rehabilitate the TMJs and masticatory system. It involves self-care management, joint protection techniques, therapeutic exercises, postural correction and manual therapy.

• Behavioral and psychological evaluation (health styles, pacing, stress, coping mechanisms, emotional distress).
• Instruction in oral habit management, stress management and pain coping strategies, brief cognitive therapy regarding life style change, general health habit changes and mood, relaxation, hypnosis, biofeedback.
• Health and lifestyle evaluation (diet and sleep).

• Consultative relationships with oral surgery, neurology, otolaryngology, sleep physicians, physical medicine & rehabilitation, rheumatology and chronic pain management.