The testing that is done for sleep apnea is through a test called a Polysomnogram. This entails hooking you up to a bunch of wires that will analyze sleep quality and snoring as well. It also measures how much desaturation of oxygen occurs and how often. The problem with the Polysomnogram (PSG) is this; let’s say you slow or stop breathing perhaps five times each hour of the night, yet that slowing, or cessation, lasts for several minutes, not just 20 or 30 seconds. Your apnea index will be the same, regardless of whether you stop breathing for 10 seconds or 10 minutes! In other words, you need to look at how long the breathing ceased or slowed to understand how serious the problem is.

When a person performs the PSG, a number called the Apnea Hypopnea Index (AHI), is generated. If that number is 0-5, it is considered mild apnea, and no treatment is indicated. If that number is 5-15, the apnea is moderate, and a CPAP is usually prescribed as the gold standard of treatment. If the apnea index is above 15, then the apnea is considered severe and most definitely the CPAP is required. In many cases, people who have a hard time wearing the CPAP can benefit greatly by wearing a dental appliance that opens and brings the jaw forward. Studies indicate that 93% of the people prefer this over the CPAP. It is easier to wear and much more portable. Carrying that bulky CPAP machine is hard to do when you travel.

Another interesting aspect of sleep apnea is that it often correlates with TMJ  disorder. When the jaw joint discs are slipped off, i.e. displaced, this creates chronic inflammation that can tighten up the throat and make the apnea worse. It is my belief that if you are going to go through all the trouble of the PSG and sleep analysis, you really should look at any underlying issues with the TM joints. As it turns out, most people with TMD (TMJ Disorder) also have underlying distortions to their cranial bones (the bones in the skull) and this can cause the neck to turn or twist. The twisting of the neck can then impede the airway. These are all the things we need to look at.

Just to add more to the mix, a critical aspect of sleep involves knowing what your Vitamin D₃ levels are. This is important because D₃ is actually not a vitamin, it is a hormone, and it controls aspects of your sleep. A simple blood test will reveal your D₃ levels. In most people, the D₃ is well below the bare bones minimum of  30 ng/ml. This is not healthy, and you simply will not sleep. Your D₃ needs to be around 60-80 ng/ml yet most doctors are not really aware of this.

As you can see, dealing with sleep apnea means we need to look at more than just what the PSG tells us. You need to talk to the doctor, then look at the numbers. The more information you gain, the more likely you can get improvements in sleep and overall health!

Getting Help

Dr. Jeffery Brown can help you with your sleep apnea symptoms.  Please call our team in Falls Church, Virginia to schedule your consultation. Please call 703-821-1103 today!

The post Breathing in the Night: Understanding Sleep Apnea and Its Fundamentals first appeared on Sleep & TMJ Therapy.

AHI- Apnea-Hypopnea Index

The Apnea-Hypopnea Index (AHI) is a diagnostic tool used to assess the severity of sleep apnea, a sleep disorder characterized by pauses in breathing or periods of shallow breathing during sleep. The AHI measures the number of apnea (complete pauses in breathing) and hypopnea (partial reductions in breathing) episodes that occur per hour of sleep. It is calculated based on data collected during a sleep study, known as polysomnography.

Here’s how the AHI is categorized in terms of sleep apnea severity:

-0-5 is considered none to mild.
-5-15 is moderate.
-15+ is considered severe apnea.
-UAR: Upper Airway Resistance – blockage in the upper airway.
-MSLT- Multiple Sleep Latency Test – naps to see sleep efficiency.
-OSA: This is obstructive sleep apnea.
-PSG: Polysomnograph – the sleep apnea test.
-Multiple leads are placed over various muscles to see how they react while asleep.

Visible and Audio Symptoms for Adults and Children

If a spouse or parent sees or hears a person snoring, gasping or waking up a lot, then the HST, Home Sleep Test, is indicated to determine if apnea is present. Look for big circles under the eyes. Subjective symptoms include the following:

-Tiredness during the day and daytime drowsiness.
-Overwhelming urge to take naps.
-Difficulty falling or staying asleep.
-Unusual breathing patterns and movement patterns while falling or during sleep.

Epworth Sleepiness Scale Questionnaire

The Epworth Sleepiness Scale (ESS) is a questionnaire used to assess daytime sleepiness. It provides a measure of a person’s general level of daytime sleepiness or their average sleep propensity in daily life. The scale was introduced by Dr. Murray Johns in 1991 as a simple, self-administered questionnaire.

The ESS consists of eight questions, each asking the respondent to rate, on a scale from 0 to 3, their likelihood of dozing off or falling asleep in different common situations that vary in terms of their somnolence-inducing potential. The situations include passive activities such as sitting and reading, watching TV, sitting inactive in a public place, being a passenger in a car for an hour without a break, lying down to rest in the afternoon, sitting and talking to someone, sitting quietly after a lunch without alcohol, and being in a car while stopped for a few minutes in traffic.

-0-7 is unlikely abnormally sleepy.
-8-9 is the average daytime sleepiness.
-10-15 is excessively sleepy, depending on the situation.
-16-24 is continual, excessive sleepiness.

The Breathing Triangle?

The “Breathing Triangle” refers to three key areas of the face that are essential for optimal breathing: the two nostrils and the mouth. This concept is often discussed in the context of health and wellness, specifically in relation to sleep and breathing disorders such as obstructive sleep apnea (OSA). This involves both nostrils and the throat and the two points make up the inverted triangle. If the top of the triangle is blocked (the nostrils) then the breathing is compromised.

(MSLT) Multiple Sleep Latency Test

The Multiple Sleep Latency Test (MSLT) is a diagnostic tool used in sleep medicine to measure the speed at which a person falls asleep in quiet daytime situations. It is often used to diagnose narcolepsy and other disorders associated with excessive daytime sleepiness.

Your Sleep Visit

We take your vitals, note neck measurements, etc. At the initial visit, the vitals are the same as TMD: BP, Oxygenation, Pulse, Neck measurement, BMI, and pH. At each visit, the ROM (range of motion) is measured, discuss your symptoms, mostly subjective on how you feel you are sleeping with the appliance. If your spouse is present, we will ask if snoring still occurs.

At the 3-12 Month Markers From Delivery

At three months we run a new HST (home sleep test) and titer the appliance forward by 0.5mm and Dr. Jeffrey Brown will adjust the strap. The HST will be performed again six months after the last visit until no more apnea or snoring is reflected. The 12-month check after the last visit will be more of a review, then once each year thereafter with a new sleep test every 2-3 years.

As you can see, Dr. Brown and our team take your sleep health seriously. If you would like to read more, check out our Sleep Apnea Therapy page. If you would like to schedule an appointment, please call 703-821-1103 to speak with a friendly member of our team!

The post What You Should Know About Your Sleep Numbers first appeared on Sleep & TMJ Therapy.

As we all know, a smile makes everyone feel better. But do you know why? There are several reasons. First of all, a smile relaxes the muscles of the face and calms the nervous system. There is a nerve called the vagus nerve and when you smile, the vagus nerve is activated, and the body relaxes more. Laughing actually sends more oxygen to the brain which helps the whole body feel better. As more oxygen circulates, it helps to flush the byproducts of the cells in the body and  effectively you are doing a cleanse.

During a smile, the neurons in your body release dopamine, endorphins and serotonin which are the neurotransmitters that reduce depression and aggression. These are the ‘feel good’ neurotransmitters. Think of it like a runner’s high, you feel really good, really light and airy when on a good run and things are clear and bright. The best thing about smiling may be that it is free and easy to do.

Along with increasing the ‘feel good’ hormones being produced, there is a reduction in the stress-enhancing hormones. These hormones are cortisol and adrenaline. Cortisol and adrenaline are great hormones when we are being chased by a sabretooth tiger that is intent on eating us, as our muscles go into a high-stress mode so we can basically run away faster. However, the lactic acid will build up and make those muscles very sore later on. This is why smiling helps, less of the stress hormones and more of the calming neurotransmitters.

Another reason for a big smile is that when you show those pearly whites, you are opening yourself up to others. You are telling other people that you are happy to see them and want to be around them. We are all creatures who crave companionship and when other people want to be around you, it makes you feel wanted and cared for. Just this feeling of companionship has its own healing power. When we open up to others, we stimulate endorphins to be produced, and this is certainly a great way to improve our health. And when the other person smiles back at you, they are now producing endorphins as well. So, make someone happy, smile at them, get their endorphins going and make it a better day for everybody!

Call Today

If you would like to learn more, please call our experienced team in Falls Church, Virginia to schedule a visit with Dr. Jeffrey, Brown. Call 703-821-1103 today.

The post How Does Your Smile Make You Better? first appeared on Sleep & TMJ Therapy.

Back when I was the guy who stood at Gold’s Gym at 05:00 hours.  That’s 5 am for anyone who is not familiar with the 24-hour time clock. Then one day I was driving home, and it was a dark and rainy night (sounds like a good beginning to a horror story, and as it turns out, it was). There was a jaywalker in the middle of the road, so I hit the brakes hard and stopped, but so did the bus to my right. Unfortunately, the guy behind me did not stop and slammed hard into the back of my car, doing around 40 mph. My neck snapped pretty hard, and my beautiful car was crunched up quite badly. (Sure, it was already 15 years old, but it was my baby :)). I took down the name of the guy who nailed me, went home and went to bed. The next morning my neck hurt so bad I could not move, could not get out of bed and could only call for help.

This was the beginning of a 20-year nightmare of neck pain and back pain that would never cease. I felt like I was living on Advil. My neck, traps, back, shoulders, everything had been in pain for so long that it felt like there was no solution. And then, I slowly began to notice that I was having difficulty swallowing my vitamins and eventually even food was tough to get down my throat. It was like I had to really ‘work it’ to force down my food and people were noticing that I had lots of issues, they actually asked if I was choking. Well, it turns out that I was indeed having swallowing problems sounding like choking!

As the years progressed, I sought countless physical therapy appointments, osteopath visits and any other doctor to help with the pain.  Some of them were really good, others not so much. The problem with all this treatment was that nothing would really alleviate the pain or swallowing problems for any length of time. It was all ‘palliative’ treatment, as they call it.

So, I already knew that I had a severely deviated nasal septum that would greatly affect breathing and healing, obviously. As a member of the ALF Academy, I learned more about my own problems. I learned that when the body incurs trauma, like I did, the ligaments that exist from the mastoid bone behind the ear and go to the hyoid in the throat will often calcify into bone. This calcification is our body’s way to help open up the airway and reduce spinal compression, both of which I had going for me. If you can imagine having long pieces of bone stuck in your throat on both sides and these darned things are blocking both your airway and your ability to swallow, then you can understand what I have been through, and many of my patients have experienced. Was this diagnosed as Eagle’s Syndrome? No, not really, but some of my doctors did suggest it. And what do you do about Eagle’s? You generally watch it and keep an eye on it. So that’s what I did until recently.

In my practice, we have always watched for this, and appliance therapy slows down the calcification process tremendously. To be clear it does not get rid of the problem.  The concern is the compromised airway and continued pressure placed on the carotid artery. Obviously, this is a concern that can lead to a stroke. This is why we have a CBCT X-ray completed from the neck up.

Now, back to my story. There came a time in middle to late 2022 when I was choking on most foods and literally gave up on all the vitamins and supplements that my doctor wanted me to take. I knew my hyoid ligaments were very calcified at this time. I took a good long look at my own X-rays and said, ‘That’s enough XXXX’, I need to deal with this problem. I made the call to the most wonderful ENT doctor that I have known for years. He and I discussed treatment and he explained he has dealt with these issues for many years now and knew exactly what to do. Needless to say, I knew I had to deal with this, so I scheduled a surgical intervention. His surgery involved correcting the deviated septum and removing the calcification from either side of my throat.

The next three days of my life were really rough. All I could do was to choke down the oxycontin and cry for the next five minutes or so. The oxy would kick in for a while and it was three days later before I could even think of consuming chicken broth or anything similar. So, for the next week, I would choke down my broth, and sometimes there was a bit of noodle in there as well.

At 12 days post-surgery, I am at the computer typing away with a very sore throat and just taking Tylenol as needed for the pain. Last night, I was able to choke down some noodles and sauce and it was a bit less difficult than the night before. No more oxycontin is needed. My nasal passages are also popping out lots of scabs these days and if I blow my nose, lots of junk comes out. Overall, it is getting better, but ever so slowly. I have been sleeping up to 12 hours each day; not sure if this is recuperative sleep from losing so much sleep over the years or just from the lack of sleep post-surgery. I am still having problems with swallowing, but the throat is still quite swollen, so I guess that’s par for the course.

So, how would I rate doing this surgery? The jury is still out. I do admit that I believe I can breathe a little better through the nose and hope this continues to improve. Also, when I take Tylenol, it does not get stuck in my throat nearly as much. The neck pain is still there – I had no expectations about curing that. Sleep is much better and definitely more restful. My main reason for writing this very long blog was to set expectations if one ends up doing such a surgery. Expect a lot of pain. Expect difficult days and rough nights. But in the end, as long as it helps, it was worth it!

The post The Case of the Calcification and the Correction or How I Handled Eagle’s Syndrome first appeared on Sleep & TMJ Therapy.

There are so many issues involved with SDB that it would take pages to explain, so in this short blog, we will review some of the major players in the equation.

The symptoms of SDB include morning headaches, night terrors, teeth grinding, polyuria (lots of bathroom visits at night), mood changes (irritability during the day), cognitive difficulties, restless sleep, gasping/snorting while asleep, and periods of outright cessation of breathing. As you can see, SDB is a very serious matter and needs to be addressed.

Let’s start with how to measure SDB. To get somewhat of a handle on the problem, a fairly simple test called the PSG (Polysomnogram) can be done. The PSG produces a number that allows an assessment of how serious sleep apnea might be. It’s sort of similar to getting a blood pressure number. For sleep apnea, if the number goes above 5-15, the apnea is considered to be moderate. Anything over 15 is generally considered severe apnea and needs to be addressed right away. A CPAP is usually the first course of treatment, and if a patient cannot handle wearing the CPAP, a dental sleep appliance usually works quite well.

As part of a good sleep analysis, the Vitamin D3 level should be analyzed carefully. The reason for this is that D3 is not really a vitamin, it is actually a hormone that regulates your sleep. If the D3 number is around 30 ng/ml or below, you are running really low and should address the problem. The proper number for good healing and good sleep is around 60-80 ng/ml. If you maintain a very low D3 level over time, eventually your body stops the ability to process D3 and you will have lots of problems with sleep later in life.

Snoring is another SDB issue that is very common in our society. Snoring is created by a harsh sound that occurs when the tissue is vibrating as you breath. This can turn into a chronic problem causing a vibration of the carotid artery, and this can cause damage to the artery to the point where your body sends plaque to fill in the damaged areas. If a plaque loosens and goes to your heart, then a cardiovascular event, even death, can occur. Snoring can be caused by a condition having fat deposition in the throat and tongue, nasal congestion, deviated septum, or even enlarged tonsils and adenoids. These factors can lead to snoring and prevent a good night’s sleep.

Another important aspect of good sleep is a very much ignored thing called sleep hygiene. That’s right; how clean, how good is your sleep pattern? What this means is that if you can program your body into going to bed at a regular time each night, your body will get used to that pattern and sleep more effectively and efficiently. Good sleep can be prevented by other factors such as:

-Sleep Disturbance: This is mostly caused by stress, insomnia and even excessive screen time.

-Poor Diet: Food is obviously a very important part of fuel for our body. With a poor diet, nutritional deficiencies become present, like the vitamins and minerals your body needs.

-Dehydration: This affects the function of your body’s organs and blood volume. The effect makes you feel tired.

-Psychological: This could be stress from work or a traumatic event causing a considerable degree of uneasiness leading to your mental health and exhaustion.

As you can see, when sleep is poor, you will be tired. It’s as simple as that.

If you are experiencing any of these symptoms, Dr. Jeffrey Brown and our team are here to help. We offer sleep apnea therapy in Falls Church, VA. Please give us a call if you would like to learn more, or to schedule a consultation. Just call our office at 703-821-1103. Better sleep awaits you!

The post Why am I Always Tired? first appeared on Sleep & TMJ Therapy.

One of the best things, just for starters, is to consume enough water to keep your cells functioning as best as possible. The rule of thumb is that whatever your body weight is, cut that in half and that is how many ounces of water you need daily just to survive. For example: a 140-pound person needs at least 70 ounces of water per day. The water from your refrigerator filter is usually the best unless you can afford the fancy glass bottles at exorbitant rates.

Another factor in good sleep is getting enough Vitamin D3. You see, D3 is not a vitamin. It is actually a hormone that regulates your sleep. Vitamin D receptors, together with the activating enzymes (hydroxylase) control the activation and degradation (waste) being expressed during the sleep cycle. This is also an important item to help produce melatonin. This hormone is involved with the circadian rhythm, an important aspect of the sleep cycle. If your D is too low, you simply cannot sleep. The D level is determined by drawing blood and then the lab analysis is done. The results will tell you what level you have. Generally, 30 ng/ml is the bare bones minimum. Most people are either below or pretty close to that. If you are low then the recommendation is to take 5000 IUs of D-3 with K2 per day and then re-assess in three months.

Vitamin D3 and K2 are taken together for best absorption in the body. Vitamin K2 is generally not produced in sufficient amounts within our bodies. Achieving a healthy level of vitamin K2 will support our heart, blood circulation and bones. While vitamin D is well understood, the importance of K2 is not so known.

Sleep hygiene is a sort of new term that is in vogue these days. What this basically involves is your body’s ability to sleep efficiently. This involves your behavioral practices and environmental influences to obtain a healthy habit of falling asleep. Some sleep problems are caused by bad habits but to start the change a person needs to go to bed around the same time each day and wake up around the same time the next morning. If the bad habits have been reinforced over many years, then a better night’s sleep may take longer to be affected. Proper hygiene also means not drinking caffeine in the late afternoon and not consuming too much alcohol in the evening hours. A rule I tell my patients is to follow the 10,3,2,1 Rule:

-10 Hours Before Bed: No More Caffeine

-3 Hours Before Bed: No More Food or Alcohol

-2 Hours before Bed: No More Work

-1 Hour Before Bed: No More Screen Time (phones, TVs, Computers, etc)

As one leader of a campaign for sleep and mental well-being asserted, supported by the Mental Health Foundation, the author created the 5 principles of good sleep health: Value, Prioritize, Personalize, Trust and Protect one’s sleep.

In cases where the sleep apnea index (the AHI) is sky-high, the gold standard for treatment is the CPAP (Continuous Positive Airway Pressure). This is a device that forces the air down your throat and into the lungs to make sure you are breathing. It is quite effective in lowering the apnea index but can cause stomach bloating and even dry mouth or eyes. For most people, if they commit to wearing it, they can greatly benefit. For other folks, the CPAP is quite difficult to wear and since it really inhibits your movements at night, it can be a real bother.

A new device that just came on the market is the hypoglossal nerve stimulator. It basically involves a surgical procedure to embed a small shock wire into the hypoglossal muscle in your tongue and if and when the tongue falls back at night and closes your airway, it shocks the tongue into popping out of your mouth and thus opens the airway. Shocking, to say the least.

A much better approach to treating apnea is the Panthera device. It is made by a dentist and is an anti-snoring and opening airway device by bringing your chin forward (just like in doing CPR) to widen the breathing passage allowing for more air. This in turn reduces the potential of snoring. This appliance is customized to your mouth and is also adjustable. It is very effective and easy to wear. For most people, it does the job as well as a CPAP and, in some cases, even better.

There are many other ways to deal with apnea, and most of these are surgical, but the above ideas are simple and generally quite easy to implement for most people. If you would like to learn more about Sleep apnea and your oral health, please give our Sleep & TMJ Therapy team a call at 703-821-1103. Our dedicated dentist in Falls Church, Virginia, Dr. Jeffrey Brown, has been successfully helping patients with sleep apnea get a great night’s sleep!

The post What To Do About Lack of Sleep first appeared on Sleep & TMJ Therapy.

If you snore or wake up gasping in the middle of the night, you really should consider having at least a HST-Home Sleep Test- done to see if you are in the range of sleep apnea. In most cases, you would do the home test to get the basic indicators to see if there is more of a problem than meets the eye. The test will reveal a number called the AHI-Apnea Hypopnea Index. If that number is between 0 and 5, there is a very low risk of apnea. If the number is over 15, then it is usually labeled as moderate to severe apnea. AHI refers to how many times you either stopped or slowed breathing each hour of the night.

The problem with sleep apnea is that your brain does not get enough oxidation to function properly. Often this can manifest as a morning headache. Other manifestations of apnea include cardiovascular disease, high blood pressure, stroke, diabetes and even some cancers. When the brain and body do not receive proper oxygen supply, systems in the body begin to shut down. This is when disease processes can set in and now you have to deal with daily meds for diabetes or high blood pressure. Many times, some of these meds prevent the good, deep sleep that we need for better health. Painkillers are notorious for allowing us to fall asleep, yet they prevent the deeper, restorative sleep that is critical to good health.

So, what are some of the warning signs that you might have sleep apnea? One clear sign of potential OSA (Obstructive Sleep Apnea) is waking up with a headache regularly. This oftentimes means that your brain is not getting enough oxygen and it lets you know by making your head hurt when you first wake up. This is serious stuff – deal with it. Other indicators include restless legs and even gasping for air in the middle of the night. Your brain jolts you into waking up so that you can breathe and get some oxygen into the body. Other signs include waking with a dry mouth or even a sore throat.

A really strong sign of OSA is excessive daytime sleepiness. Again, your body is warning you of a potential problem and you really need to listen. Another symptom is trouble focusing during the day. As you can see, OSA is a serious problem and it’s wise to deal with it. Get the proper help you need from someone who understands sleep apnea. Please call our team in Falls Church, Virginia to schedule a visit with Dr. Brown. Call 703-821-1103 today!

The post Do You Have Sleep Apnea? first appeared on Sleep & TMJ Therapy.

One of our success stories that really stands out is the daughter of one of my friends. The friend and my wife go way back – about 20 years – and that friend sent her daughter to see me earlier this year. She told me that her daughter was in so much pain that when she came home at night, she could do little more than curl up in a ball and cry herself to sleep. This young woman had already been to dozens of doctors over the years and could not function much longer with so much head and neck pain. She was even thinking that life was not worth it. We were able to figure things out pretty quickly and within a month she was feeling better than she had in years. This is how debilitating TMJ disorders can be and how remarkable it is when they are fixed.

Of course, there are failures – unfortunately, most of those are with the people who have been in really bad shape for too many years. The goal is always to avoid surgery but sometimes no matter what we do (appliance therapy, massages, laser treatments, etc.) we cannot get the disc back in place or it is already perforated. The analogy that I tell patients is that they should imagine their car having an oil leak, loud muffler, brake fluid leak, smoke-belching, etc. and the mechanic trying to fix it all to restore your car. This is just too much for any mechanic to totally fix. All you can do is hope for the best. In most cases, there can be some degree of improvement. This is how TMJ treatment can be at times. You hope for the best in a bad situation. In almost all cases, however, improvement is seen, and I am thankful and grateful for that.

As we close out 2023, I am grateful for the support of our friends, families and team members who have made all of our efforts so successful. My core team members are well aware of how much I appreciate their hard work and going beyond what is expected of them. We are now in a position to further spread the word about what we can do to help people improve their lives. Our office will be expanding as many of you have already seen when you visit. We will have a bit more space to be able to prepare the treatment rooms in advance of your visit to make sure our ‘on-timeness’ is really top-notch!

So, we end this wonderful year with good friends and family all around us. May you all have a most excellent 2024 and God Bless.

Dr. Jeff Brown

The post The End of Another Year is Here first appeared on Sleep & TMJ Therapy.

Another approach, however, vastly different, is to use medications to calm the pain and at least get some degree of relief almost immediately. In some of these cases, the practitioner would prescribe Cymbalta to alleviate the anxiety often associated with the pain. Cymbalta is a well-known drug used to treat depression and anxiety. Admittedly, many TMD patients are hurting so badly that they become depressed, and anxiety sets in as they worry about how their future is looking. Unfortunately, this drug has a host of side effects that may make it not so worthwhile, but as a temporary measure, it might help for now. Some practitioners use Xanax along with the Cymbalta since it takes time for the Cymbalta to activate the desired response.

In other cases, something like Cymbalta is used in conjunction with injections into the muscles of the head and neck region to calm those muscles that have been irritated from the slipped discs. Injectables like Botox®, cortisone, prolotherapy and stem cell therapy have been documented to reduce muscular tension. This also provides some degree of temporary relief and may even help to ‘reset’ the muscles into a better pattern.

Of course, there are the surgical approach options. The least desired surgical treatment entails breaking the jaws and resetting them into a more ideal position, however, this approach may not work very well. Cutting apart the bones of the skull may be more risky than other modalities. A more conservative approach to dealing with the displaced discs in the jaw sockets entails simply putting the discs back on top of the condyles. A 20-minute surgery called plication. By far, this is more conservative and simpler than the other surgeries.

So as a patient, you have a choice: try to figure out the underlying issues and deal with them accordingly, or mask over the symptoms and hope things settle down. As I tell our people, it is up to you and I am simply here to guide you on the journey.

Read more about TMD.

The post The Case of the Confused Craniofacial Case first appeared on Sleep & TMJ Therapy.

In most cases, when the MRI is ordered of the TM joints, it is patently clear when there is cortical erosion of either the condyle or the fossa (socket for the condyle). The radiologist will most likely indicate that the articular disc (that protects the condyle) is displaced and thus the condyle is now exposed and is bone on bone in the fossa. This is not a good situation and can lead to all sorts of pain, asymmetry, and other problems in the head/neck region. Think of it like this: If the disc is slipped off the top of the condyle, it can no longer protect your condyle from banging into the socket bone-on-bone. Diagnosis: OUCH!

The cortical erosion of the condyles and fossas can also be diagnosed with the X-ray called CBCT (Cone-Beam Computed Tomography). The CBCT allows the dentist or the radiologist to look very precisely at the condyle and fossa and if erosion has begun it can be clearly seen in the images. Even though some people do not like taking the CBCT due to the radiation, it is really important to do these images every few years to follow up on the cortical erosions.

So, what does one do when cortical erosions are present? Well, in most cases it’s called ‘watchful waiting’ where the doctor checks the range of motion on a regular basis to make sure the erosions are not doing more obvious damage. You should wear your mouth appliance(s) accordingly to protect the joints. And every few years, just re-take the images and compare them to the previous images.

Unfortunately, if things worsen, surgery is sometimes all that is left to offer to a person with severely damaged joints. There are several types of surgery. The simplest surgery is called plication of the articular discs. This means just moving the slipped discs back into the proper position to reduce the risk of bone-on-bone damage to the condyle and fossa. The next level of surgery entails what is called menisectomy – removal of the damaged discs. If the discs are fully removed, this enhances the risk of bone-on-bone, condyle to fossa, banging or pounding. As long as the appliance (splint) is worn, this is not a problem. Unfortunately, if things get worse, then TJR (Total Joint Replacement) is indicated. This is a big surgery but very rarely indicated.

As with most health issues: Treat early and keep a careful watch on your health!

The post So, What Is Cortical Erosion? first appeared on Sleep & TMJ Therapy.