Possible Association between TMD and OSA
Materials and Methods: This study was performed retrospectively in a group of patients who sought out treatment, surgical or non-surgical, for temporomandibular joint dysfunction, but were identified as having OSA during evaluation. Patients were evaluated both subjectively and objectively. A TMD workup was performed on the these patients, including onset of dysfunction associated pain, ROM, MIO, oral health, mechanical attrition, missing teeth, panorex, MRI when appropriate and previous treatment regimen. OSA workup involved the Epworth Sleepiness Scale, history of loud snoring, choking at night, witnessed apneas, etc. Patients were also evaluated objectively in clinic by taking their height, weight, BMI, cephalometric x-ray, neck diameter, and CBCT when appropriate.
Results: In the year 2012, there were a total of 162 patients treated for TMD. 8 (4.9%) of the 162 TMD patients were also associated with OSA. 18 patients in the same year were evaluated and treated for OSA. Of those 18 patients, 8 of them (44%) were evaluated and treated for TMD.
Conclusion: Obstructive sleep apnea has a significant correlation to temporomandibular joint dysfunction. This study showed that 4.9% of TMD patients had some form of OSA. It has also been found that 44% of the OSA patients had some form of TMD. Patients with OSA have to posture their mandible forward and hold their mouth open in order to maintain a patent airway. This constant strain on the muscles of mastication, especially the lateral pterygoid in translating the condyle forward in the fossa, is most likely the cause. Subsequently sleep apnea as well as CPAP itself can exacerbate TMD.
Reference:
1. Merrill Robert L, DDS, MS. Temporomandibular Disorder Pain and Dental Treatment of Obstructive Sleep Apnea. Dent Clin North Am. 2012 Apr;56(2):415-31.
2. Collesano V, Segu M, Masseroli C, Manni R. Temporomandibular disorders and sleep disorders: which relationship? Minerva Tomatol. 2004 Nov-Dec;53(11-12):661-8.