Frequently Asked Questions

Do you have questions about our treatments? Dr. Jeffrey Brown and the team at Sleep & TMJ Therapy have the answers you need. Take a look at some of our most frequently asked questions below. If you have any questions that are not answered on this page, we invite you to call our office at 703-821-1103 to learn more.

General Q&A About Our Office’s Best Practices and Your Visits

Is there an age where I can see early symptoms of TMD present in my child?

Although obstructive sleep apnea can develop in any person at any age, there are certain age groups that are at higher risk for sleep apnea as well as body types. Have yourself or your child screened if any of the symptoms are being experienced. Our office will evaluate and get you in touch with a sleep specialist.

How long is the first appointment and what is done?

The first appointment is about forty minutes. This step in your treatment planning process includes additional data gathering. The visit is set up to record your vitals, review your current dental and medical histories, symptoms reported, a complete head and neck exam, and measurements of range of motion. These are important beginning markers for progress in the treatment. In addition, based on the exam, two types of diagnostic imaging may be required. A CBCT x-ray which shows the neck and skull (bones) and can easily be done in the office. The other is an MRI which you will receive an order for the imaging center.

What do I do if I have an emergency?

With each treatment appliance, there is accompanying paper given for care and emergencies. Typically, most concerns can be handled without coming in. But if the emergency requires you to come into the office, we generally can schedule you within a 24-hour period. Keep in mind, we want to give you the time you need, and understand that the time may not be ideal. As always we thank you for your understanding and flexibility.

Why do I need both an MRI and a CBCT dental x-ray?

An MRI shows soft tissue, like the articular discs in the jaw joints. A CBCT X-ray shows bone and airway analysis. Both provide completely different information and are very valuable tools when diagnosing and treating TMD or sleep issues.

General Q&A About Our Treatment for TMJ Disorders (TMD)

What treatments do you offer for TMD?

With every patient, the type of treatment and duration will vary. In our practice we focus on orthotic oral appliances. The appliances most used are ALFs, Modified Gelbs and other adjunctive services are laser, laser and massage, and the Neubie.

What is an ALF appliance?

The ALF is a lightwire appliance that can be customized for the upper and lower arches. It hides behind the teeth and is removable. The appliance helps to gently expand the palate, level the cranial bones, reduce crowding, provide cranial support and much more. ALF appliances are manipulated by the doctor to achieve personalized treatment goals.

What is a modified splint or modified Gelb?

A modified Gelb appliance, or a modified splint, is a custom-made removable appliance that fits over your lower teeth. The goal is to take pressure off of the jaw joints and promote better breathing. When the pressure is taken off of the jaw joints, the discs are able to move freely, cranial nerves start to un-pinch and inflammation is reduced. All of these benefits help rid symptoms associated with TMD. Splints are modified based on your symptoms to achieve personalized treatment goals.

How does TMJ dysfunction cause migraines or chronic headaches?

When the jawbone is set back too far in the jaw joint, it “pinches” the nerves in that part of the joint. The resulting effect causes pain which manifests as headaches or migraines.

What does TMJ dysfunction have to do with my ears ringing?

The jawbone, when set too far back or forward in the joint, will pinch and irritate the nerve endings directly in front of the ear. This effect manifests as pain and possibly ringing in the ears.

What is causing my jaw joints to make clicking/popping sounds?

The sounds the jaw makes are largely caused by the dysfunction of the joint. The disc is pushed out of place. The act of overextending the jaw causes the disc to folds up on itself and make a “popping” sound when it slides around. The sound can also be caused by bone-to-bone contact. The hinged action is no longer buffered by the disc and the jawbones rub against the skull’s socket.

What could cause my face to be asymmetrical?

The term “asymmetric face” merely means that a person’s facial features are not 100% aligned: both sides of their face do not look exactly the same. Many people have a slight difference and find no effect from this. In many TMD cases, the patient may experience facial pain. Their eyes or ears are not level, and this may be in part due to a cranial bone distortion. This can often be felt by the doctor when palpating the bones of the skull, and X-rays often confirm this distortion. The causes can include congenital disorders, acquired diseases, a traumatic event or developmental deformities.

What could have caused my TMJ discs to be slipped in the first place?

The disc may have moved due to a muscle (lateral pterygoid muscle) pulling the articular disc out of place. The abnormal jaw mechanics could have been due to congenital or acquired asymmetries, trauma or arthritis. Most of the time, the cause of disc slippage can be traced back to some past trauma: from birth or a fall. Even a little bit of trauma can cause the jawbones to slip and push the discs out of place.

How does TMD affect other disorders like Dystonia and Tourette’s Syndrome?

The concept presented is the disc inside the jaw joint puts extraneous pressure on the nerves surrounding the joint causing tics. The pressure sends a noxious signal resulting in an involuntary repetitive movement or sound response relating to Tourette’s. The tics causing pulling or twisting movements of the muscles produce abnormal postures called Dystonia.

Why wear a splint instead of getting surgery immediately?

A splint must be worn at least four to six months before even considering surgery. The goal of the splint is to reduce the inflammation and allow for an easier surgical procedure with better results. The other possibility is that the discs may correct themselves, thus avoiding the surgical procedure.

Is the material used with the splints safe for me?

All our acrylic materials used in-house or at our outsourced laboratory are FDA approved and safe. The lab uses surgical grade materials, and our acrylics are orthodontic acrylic.

General Q&A About Symptoms and TMJ Dysfunction

How does TMJ dysfunction cause migraines or chronic headaches?

What does TMJ dysfunction have to do with my ears ringing?

What is causing my jaw joints to make clicking/popping sounds?

What could cause my face to be asymmetrical?

What could have caused my TMJ discs to be slipped in the first place?

How does TMD affect other disorders like Dystonia and Tourette’s Syndrome?

General Q&A About Our Treatment for Obstructive Sleep Apnea (OSA)

What is sleep apnea?

This is a condition during sleep in which you have a brief but repetitive interruption in your breathing. This is referred to as apneic events. There are two most noted types: obstructive sleep apnea (most common) and central sleep apnea (CSA). OSA is where your upper airway gets partially or completely blocked while you sleep. During sleep, the tongue falls back against the soft palate, and in turn, the soft palate and uvula fall back against the back of the throat, effectively closing the airway. This is the collapse of the pharyngeal airway. CSA is a cessation or lack of breathing. This type of apnea is where your brain does not tell your muscles to breathe.

What treatments do you offer for sleep apnea?

Two of the most widely used and most effective treatments are continuous positive airway pressure (CPAP) and dental appliances. With dental appliances, there are a multitude of oral appliances. Some work by holding your tongue forward, while others reposition the lower jaw, known as the mandible. Our office creates non-invasive mandibular advancement appliance. These are designed and customized to fit your mouth and needs. The devices snap over the upper and lower dental arches and make it possible to reposition the lower arch and correct the position of the tongue. We have had great success in helping patients using dental sleep appliances as an alternative to the CPAP.

How long is treatment?

Treatment length is on a case-by-case basis, since every person is unique. Some factors include the severity of the problem, the physical structure of your upper airway, other medical problems present and your personal preference. Typically, our treatment is one month to get you into the sleep appliance from the initial assessment. Thereafter, a quarterly or semiannual checkup will be done. This reevaluation process will ensure the appliance is providing an open airway, symptoms are gone and the oral appliance is optimized with fewer risks of side effects. This step includes working closely with your sleep specialist or physician.

When do I or my practitioner know it is time for a referral to this office?

The best time to come to our office is when you have been diagnosed with sleep apnea by your physician or sleep specialist or if you are experiencing symptoms. Some of the symptoms are waking up with a sore or dry throat, a choking or gasping sensation, snoring, lack of energy, headaches, forgetfulness and, with children, additional difficulty with learning, poor attention span and poor performance at school. It is better to treat earlier then later, and due to the dangers with sleep apnea, it is better to be compliant with treatment to avoid other problems.

General Q&A About Dental Healthcare

Should I still see my general dentist?

Yes. Please continue every established cycle your dentist has created for you. Your dentist is focusing on the overall, general oral care of your teeth and gums. Your teeth and gums are the foundations for our appliances and need to be kept healthy.

Does my home care change with treatment?

Yes. Brushing and flossing more frequently as well as cleaning your appliance(s) may be required. There may also be food restrictions implemented while in treatment. This would be done to allow for joint healing. A few other good practices include limiting snacks that are high in sugar, eating a balanced diet of soft fruits and vegetables and avoiding hard, crunchy nuts and tobacco.

If you have a question that we have not answered or you would like to schedule a visit for TMJ or sleep apnea treatments in Falls Church, Virginia, contact our office at 703-821-1103. We will be happy to help you plan your visit with our dentist.