Doctors

Dr. Rajesh Raveendranathan. BDS, Dip. N.Ortho( Italy), Dip. Sleep Medicine (USA)

Treatment for sleep disorders, Snoring etc.

Dr: Navin Jayaraj BDS. Dip. N Ortho Consultant TMJ, Sleep Medicine.

Dr. Asheeda .A.M. BDS.

Dr. Jisha .O BDS.

TMJ DISORDERS

The Temperomandibular joint known as the TMJ, joint that connects the maxilla or upper jaw and the mandible or lower jaw situates at the base of skull in front of the ear. The joint has a round protrusion of the lower jaw that rests on an indentation in the skull & disc like structure which is made of a soft bone known as cartilage is found in between the two bones. There known as ARTICULAR DISC. Ligaments that arise from various parts of the temperomandible joint to support the jaw and helps in its movements. Several muscles that are connected to their ligaments, also helps in the movement of the jaw. Temperomandibular joint disorder can be referred to as any problem that occurs in the joints & movements

TMJ can be fractured or become sore. Fracture is rarely seen, but the articular disc displacement is commonly seen.

SYMPTOMS

◉ Severe pain & swelling.
◉ Limited movement of the lower jaw
◉ Radiating pain to the neck & head region
◉ Severe headache which resembles migraine pain
◉ Sharp ear ache
◉ Clicking & popping sensation while opening or closing the mouth
◉ Strong pain when tried to open mouth wide, to eat or to yawn
◉ Locking of the jaws

IMPROPER ALIGNMENT OF TEETH OR JAWS AND GRINDING OF TEETH ARE THE COMMON CAUSES OF TMD ( TEMPERO MANDIBULAR DISORDERS )

In addition, the other symptoms of TMD includes
◉ Pain or tenderness in the face
◉ Snoring and disturbed sleep
◉ Pain around neck and shoulders
◉ Popping sound in ears
◉ Sleep APNEA
◉ Hearingproblem
◉ Tooth aches
◉ Restless Legs
◉ Dizziness
◉ Over all lethargy
Each patient has to undergo a diagnostic set up .which includes

DIGITAL X-RAYS

◉ Lateral cephalograph
◉ Over all lethargy
◉ OPG
◉ TMJ view( left+right open &close)
◉ Airway CBCT volumetry
◉ 3D CT TMJ/ Airway

QUESTIONNAIRE
INTRA-ORAL &EXTRA ORAL EXAMINATION POSTURAL EXAMINATION SLEEP STUDY (HST-HOME SLEEP TEST OR PSG –POLY SOMNOGRAPH)

TREATMENT

Treatment involves applying the ULF TENS (J5 MYOMONITOR )M –SCAN AND K7/JT ,the TMJ specialist would register the perfect bite of the patient and a customized ANATOMIC ORTHOTIC ( ORAL APPLIANCE ) to maintain the new mandibular position which would relax the muscles and would repair the temperomandibular joint . The patient has to wear the appliance for 8-10 months which includes bi monthly visits to the doctor (if required) for orthotic (appliance) adjustments. The pain and the associated symptoms would reduce in one week to two weeks time and by the end of the treatment time, the patient will not have any of the symptoms associated with temperomandibular disorders ( TMD ) .This is the first phase of treatment The second phase of treatment includes ORTHODONTIC OR PROSTHODONTIC REHABILITATION to maintain the corrected bite and jaw position in the patient permanently to avoid the relapse of the pain.

SLEEP MEDICINE

We usually hear about sudden heart attacks and related deaths even in young people irrespective of age and sex, especially during sleep. These deaths are commonly labelled as Myocardial Infarctions but 75% of these unfortunate deaths could have been avoided if they were diagnosed from a fatal disease called OBSTRUCTIVE SLEEP APNEA (OSA).

What is OSA?s

It is the condition where the person is not able to breathe normally at sleep due to an airway obstruction. The obstruction can be Polyp, DNS (deviated nasal septum), Adenoids, Macroglossia, Posterior Mandibular positioning, Tonsillitis , long Uvula, even enlarged Neck circumference. When your body is at rest during sleep, mandible falls back pulling the tongue backward. When the tongue falls back, it vibrates hitting the small tongue (UVULA) creating a snoring sound. This could increase the load of the heart. A person having such a condition would feel breathless when they exert a little extra effort during a physical activity like climbing stairs. This could end up in a possible cardiac arrest if it’s continuous. Due to the persisting airway block by the oxygen will be at a lower level and the carbon dioxide level increases within the body. This situation is called HYPERCAPNEA and that is known as DESATURATION event. This is sensed by the brain as a dangerous event and it will respond by forcing the tongue to move forward . The tongue while moving forward pulls the lower jaw which will result in subsequent CLENCHING or BRUXISM. Clenching/bruxism while sleeping is virtually a physiological response of the human body to balance the ill effect of OSA . The TMJ would be further deteriorated due to the pressure exerted within the TMJ complex. 80% of the patients suffer from OSA related clenching / bruxism and they are not aware of it.

DIAGNOSIS OF OBSTRUCTIVE SLEEP APNEA (OSA)

◉ Physical examination and history
   (a)Examination of the back of throat, nose and mouth for extra tissue or abnormality, measurement of the neck and waist circumference, weight imbalance.
◉Radiographs- LATERAL CEPHALOGRAM for airway patency, AIRWAY CBCT VOLUMETRY, 3D CT TMJ/AIRWAY.
◉Extra oral and intra oral examination.
◉Questionnaire.
◉Postural examination
◉(HST – HOME SLEEP TEST OR POLYSOMNOGRAPHY)
Interpretation from the sleep report would be AHI (Apnea-Hypopnea Index) and the number of desaturations.
◉ Airflow, blood–oxygen level, breathing patterns electric activity of the brain , eye movements, heart rate ,muscle activity, snoring events .

TREATMENTS

◉Evaluvation of the AHI index
◉Elimination of pathological factors
◉Sleep appliance made with the help of J5 Myo-monitor in the right bite finding the perfect mandibular position