Craniofacial Pain, TMJ and Sleep of Oklahoma

448 36th Ave. N.W., Suite 103
Norman, Oklahoma 73072

Phone: 405.321.8030
Fax: 405.321.2108

Hours

Mon. - Thurs.
8:30 a.m. - 5 p.m.
Friday
8 a.m. - noon
(Business Office open only)

FAQ

When my treatment is completed, will I be cured?
There are 40+ different types of TMD. Some can be cured; others can be managed. For all TMD patients, the first stage of treatment involves controlling TMJ-related pain and dysfunction for a period of time sufficient to determine stability. The second stage involves EITHER correcting the problem (if it can respond to a cure) OR managing it. Our goal is to make each and every patient independent of us. And we prefer the least invasive, most simplistic approach possible to achieve maximum improvement and enhance your quality of life.

Can I postpone or delay my treatment?
TMD is often progressive. The earlier it is diagnosed, the greater the likelihood TMD can be treated conservatively, relatively inexpensively, and without surgery! Early treatment of TMD can also help to prevent further damage to your jaw joint and its related structures. Only you can make the decision that is right for you. To do so, we want you to know that waiting to begin treatment can have serious consequences, particularly if you are experiencing intermittent or continuous clicking and/or occasional locking. Once therapy has begun, delaying or canceling scheduled appointments can also compromise the success of your treatment. Before making any decision to postpone or delay treatment, we strongly urge you to discuss the risks and benefits with a qualified dentist or another trusted healthcare provider.

Why do I have to uncross my legs for you to mark and balance my appliance?
There are more than 2-dozen appliances available to treat TMD. To achieve maximum improvement, each appliance must be carefully customized and precision fit for each patient. When you cross your legs, it turns your pelvis, which, in turn, unbalances your entire skeletal and muscle alignment. To mark and balance your appliance correctly, your posture must be proper. (This is also why they ask you to uncross your legs whenever you get your hair cut!).

Will I have to wear my appliance forever?
There is often no single cause of TMD and no two patients are alike. Our goal is to wean patients off daytime appliances rather than having to wear them indefinitely. However, any decision to reduce or eliminate the use of a daytime appliance can only be made after 6-months of active treatment has been completed. We generally suggest that patients wear their nighttime appliance "forever," as a precautionary measure to prevent symptoms from reoccurring. This is because we all clench and grind our teeth to some extent when we sleep, which can put 2x - 3x the normal amount of pressure on your TMJ. Think of using your nighttime appliance like wearing a knee brace or taping your ankle when you play a sport. You do it to add stability and safeguard against further injury.

Do I have to eat with my appliance?
The answer depends on the stability of your TMJ and the type of appliance that has been prescribed for you. More specifically: If you are using a repositioner so that we can stabilize your joint and can control dysfunction, the answer is "Yes." Chewing puts tremendous stress on your TMJ, so it's important to wear your appliance whenever you eat. It may take a few days for you to get used it. However, eating with your repositioning appliance in place is critical to a successful outcome at this stage of your treatment. If you are using a deprogrammer to manage your TMD, the answer is "No." You should not eat with a deprogramming appliance in place.

Why is it important to do self-care at home while I'm undergoing treatment?
Patients spend significantly more time away from our office than they do with us. That's why the diet and exercises we outline for our patients under "self-care" are so important. Self-care is an essential part of rehabilitating your jaw joint (just as it would be if you needed to rehabilitate your knee, your ankle or any other joint in your body). Through self-care, you'll learn about things you can things you can do (and things you should avoid) throughout your normal day to facilitate "healing." More specifically, self-care will help to enhance the effectiveness of therapies you receive at our office, so that you can regain mobility of a compromised jaw joint and restore full range of motion. Self-care also helps to establish a "healing and wellness pattern," which will pave the way for you to manage your TMJ-related pain and dysfunction -- and sustain the results of treatment once completed - without having to continue to visit our office. Since I've been wearing my appliance, my teeth don't touch like they used to. Is this normal? Yes, that is very normal but it's only temporary. The reason it happens is because of the changes in your jaw position that take place during treatment. In brief, your appliance teaches your muscles to close your jaw in a new position - a position that may not be aligned with your bite. After you complete your treatment, we will slowly reduce the amount of time you use your day appliance and your bite will return to normal. In some cases, orthodontics may be needed but this is not true for the vast majority of our patients.

Why is sleep so important?
Sleep is more than a time out from daily activities. It is an active state, essential for physical and mental restoration. Individuals who do not get sufficient amounts of restful sleep each night put themselves at increased risk for hypertension, heart attack, stroke, diabetes, plus workplace accidents and injuries. In addition, the National Highway Traffic Safety Administration (NHTSA) conservatively estimates that 100,000 police-reported crashes are the direct result of driver fatigue each year. This results in an estimated 1,500 deaths, 71,000 injuries and $12.5 billion in monetary losses. The good news is that much can be done, through technology and advances in dental sleep medicine, to enable patients who suffer from sleep disorders find relief.

Who is at risk of developing a sleep disorder?
Men suffer most often from non-restful sleep. In addition, according to both the National Institutes of Health and the American Academy of Family Practice, the rates of obstructive sleep apnea (OSA) and other airway-related sleep disorders are 2x-4x higher after the age of 50. Since the health of women and children may also be affected by sleep-disordered breathing problems, we urge anyone who does not wake in the morning feeling rested and relaxed after a full night's sleep to discuss their sleep concerns with their family physician, a dentist with expertise in dental sleep medicine or another trusted health provider. More than 40 million Americans consult their physicians about sleep complaints each year, making sleep-related problems the THIRD most common complaint heard in the physician's office (behind colds and headaches).

How many hours of sleep should I get each night?
Sleep is as important as diet and exercise to good health. Despite this, there appears to be an epidemic of daytime sleepiness in this country. In fact, recent National Sleep Foundation (NSF) polls have shown that more than one-third of Americans say that they are so sleepy during the day that it interferes with their daytime activities a few days a month. Don't be one of them!

Age GroupRecommended SleepNational Average
Infants (3-11 months old)14-15 hours12.7 hours
Toddlers (12-35 months old)12-14 hours11.7 hours
Preschoolers (3-5 years old)11-13 hours10.4 hours
School-aged Children10-11 hours9.5 hours
Parents/caregivers7-9 hours6.8 hours
*Source: National Sleep Foundation, 2004 Sleep in America Poll

Why should I consult a dentist about my sleep concerns?
Mild to moderate sleep apnea patients are among largest groups of patients that are not screened. However, dentists with advanced training in dental sleep medicine can be patients' first-line of defense against the potentially devastating cardiovascular, neurologic and interpersonal consequences of undiagnosed and untreated sleep-disordered breathing problems. In our office, we use a state-of-the-art pharyngometer/rhinometer to measure your airway volume, determine whether or not your airway collapses, and evaluate your nasal turbinates (small, bony structures covered by mucous membranes that protrude into the nasal airway and help to warm, humidify and cleanse air as it is inhaled and before it reaches the lungs). Enlarged turbinates and nasal congestion can contribute to headaches and sleep disorders such as snoring and obstructive sleep apnea, as the nasal airway is the normal breathing route during sleep. In addition to screening for sleep disorders, qualified dentists can provide dental sleep medicine therapies to patients that suffer from snoring, sleep apnea and other sleep-disordered breathing problems. These therapies can often enable sleep patients to find effective alternative or adjunct therapies to traditional treatments for sleep disorders, including CPAP or surgery.  What can I do to give myself the best chance of getting good, restful sleep? In addition to making time for sleep, here are some sleep tips from the National Sleep Foundation (NSF) that may help you improve the quality of your sleep: Maintain a regular bed and wake time schedule including weekends. Establish a regular, relaxing bedtime routine such as soaking in a hot bath or hot tub and then reading a book or listening to music. Create a sleep-conducive environment that is dark, quiet, cool and comfortable. Sleep on your side, on a comfortable mattress and pillows. Use your bedroom only for sleep and sex, and take work materials, computers and televisions out of your sleeping environment. Finish eating at least 2-3 hours before your regular bedtime. Exercise regularly and complete your workout routine at least a few hours before bedtime. Avoid nicotine (e.g., cigarettes, tobacco products). Used close to bedtime, nicotine can lead to poor sleep. Avoid caffeine (e.g., coffee, tea, soft drinks, chocolate) close to bedtime. It can keep you awake. Avoid alcohol close to bedtime. It can lead to disrupted sleep later in the night.

If I snore, does that mean I have obstructive sleep apnea?
Snoring is no laughing matter. Although often depicted comically, snoring should be taken seriously. It can disrupt your sleep as well as your partner's sleep. Snoring can also lead to sleep apnea by changing the structure of tissues. However, not everyone who snores has sleep apnea. If you've been told that you snore, or you suffer from excessive daytime sleepiness or shortness of breath upon awakening, consult your doctor. Today, patients with mild to moderate sleep apnea are among the largest groups of patients not screened. That said, the only way to determine with certainty if you have sleep apnea is by referral to an overnight sleep lab for a diagnostic polysomnographic (sleep) study. We are happy to you with names of sleep physicians and sleep labs that we work with upon request.

Can a dental appliance stop snoring?
For simple snoring and mild to moderate obstructive sleep apnea (OSA), oral appliance therapy is an excellent alternative to CPAP and/or surgery. Both the American Academy of Sleep Medicine and the Academy of Dental Sleep Medicine endorse it. When they are well made and used as directed by a qualified health professional, dental sleep appliances can put an end to snoring in the majority of patients. However, the success of these splint-like devices for any given patient cannot be determined without a complete dental sleep examination. In our practice, we use six (6) different FDA-approved oral appliances to successfully treat snoring as well as other types of sleep-disordered breathing problems. To achieve maximum results, each of these splint-like devices must be customized and precision-fit to each patient. One size does not fit all, which is why you should be evaluated and treated for snoring by a dentist with advanced training and expertise in dental sleep medicine.

Can a dental sleep appliance replace my CPAP machine?
At their annual meeting in 1995, the American Sleep Disorders Association adopted a resolution, which formally accepted dental appliance therapy for treatment of snoring and mild sleep apnea. They also extended the recommendation to include dental appliance therapy for treatment of moderate and severe cases of sleep apnea. This is especially encouraging news, since nationally only 45% of patients using CPAP machines continue to use them. We cannot determine with certainty whether or not you are a candidate for dental sleep appliance without a comprehensive sleep evaluation by our office. However, we can tell you that increasing numbers of patients are successfully using oral sleep appliances as both alternatives and adjuncts to standard therapies, including CPAP and surgery.

Is there a connection between my TMJ-related pain and my sleep-disordered breathing problem?
We cannot answer this question without your being fully evaluated by one of our doctors. However, we do know that development of your airway can be diminished by improper development of your jaws and/or an inability to breath through your nose. This explains, in brief, why we carefully examine the airway of every patient we see as a routine part of every new patient examination.

Will wearing a nighttime sleep appliance cause a TMJ problem?
No! Nighttime repositioning devices that are properly customized to help maintain your airway during sleep rarely ever cause TMD problems. The same is true of appliances that are worn to prevent "bruxism" (that is, grinding of your teeth during sleep). If you are experiencing jaw-joint pain or dysfunction and you are using a nighttime sleep appliance, we recommend that you make an appointment to see a dentist with expertise in TMD, craniofacial pain and dental sleep medicine immediately.

How can I know for sure if I have a sleep disorder?
The only way to determine with certainty if you have sleep apnea is by getting a referral from your physician to an overnight sleep lab for a diagnostic polysomnographic (sleep) study. We are happy to assist you in that process by providing you with names of sleep physicians and sleep labs that we work with upon request.