Research has demonstrated that poor sleep quality plays a significant role in pain management, especially in the context of orofacial pain. For example, sleep disturbances have been shown to increase pain sensitivity in temporomandibular disorders (TMD). This connection underscores the importance of addressing sleep-related issues in patients with chronic pain because improving sleep may help alleviate pain and improve overall treatment outcomes.
TMD is notably more prevalent in women than in men, with reported ratios as high as 9 to 1. Although obstructive sleep apnea (OSA) is generally more prevalent in men that in women, as women age, their risk of developing OSA increases, especially after the age of 50, when hormonal changes during menopause contribute to the disease's progression. In contrast to men, who typically experience symptoms such as excessive daytime sleepiness and loud snoring, women with OSA are more likely to report headaches, anxiety, depression, and even post-traumatic stress disorder (PTSD). In addition, women often manifest OSA symptoms at lower levels of the apnea-hypopnea index, which can result in underdiagnosis or misdiagnosis.
TMD pain may serve as an early indicator of airway dysfunction. TMD pain is often linked to dysfunction of the masticatory muscles, including those responsible for chewing and jaw movement. Sleep-disordered breathing, including OSA, can exacerbate this dysfunction by promoting abnormal muscle activity, such as teeth grinding and clenching, during sleep. These behaviors increase tension in the jaw muscles, which can worsen TMD and its associated pain. The relationship between sleep disorders and TMD-related pain is substantial. Studies have shown that continuous positive airway pressure (CPAP) therapy can lead to a reduction in both TMD pain and the frequency of headaches. This improvement occurred even though the CPAP treatment did not directly target TMD symptoms, suggesting that resolving sleep-disordered breathing can alleviate the pain of conditions such as TMD.
Dentists play a critical role in identifying potential sleep-related breathing disorders, which are often linked to TMD and related symptoms. Integrating an airway questionnaire into routine evaluations is an effective strategy for screening. By identifying early signs of compromised breathing patterns, dentists can address the underlying factors that contribute to both TMD and OSA. If a patient presents with poor sleep and muscular dysfunction, it is essential to consider whether these problems are related to a sleep-related breathing disorder.
Once a sleep-related breathing disorder is identified, there are various dental treatments that can help manage both OSA and TMD. Mandibular advancement devices are commonly used to treat OSA by repositioning the lower jaw forward, which improves airway volume and airflow during sleep. Mandibular advancement devices have also been shown to reduce sleep bruxism and alleviate TMD-related pain. For severe cases of OSA, maxillomandibular advancement surgery may be considered. The concept of "airway aware" dentistry, pioneered by Jeff Rouse, DDS, integrates facial, skeletal, and muscular dentistry to optimize airway function and health. Treatments may include palatal expansion, splint therapy, and the creation of a comprehensive, harmonious occlusion that not only optimizes respiration but also ensures stable joints.
Given the higher prevalence of TMD in women and the strong connection between airway dysfunction and orofacial pain, it is crucial to screen women with TMD for potential underlying airway issues. By integrating airway screening tools, dentists can provide more comprehensive care and potentially reduce the long-term health risks associated with untreated airway dysfunction in women. For many, effective management of the underlying breathing dysfunction can alleviate TMD pain, improve sleep quality, and reduce other related symptoms.
About the Author
Tracey Nguyen, DDS, is an accredited member of the American Academy of Cosmetic Dentistry and a diplomate of the American Academy of Dental Sleep Medicine. She is the cofounder of ASAP Pathway Education, a scientific advisor at the Kois Center, and a private practitioner in Lansdowne, Virginia.
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Tracey Nguyen, DDS
