PART ONE
JAMISON SPENCER
CLICKING , POPPING & POSTERIOR OPEN BITES
“
Doctor ! Good news ! I ’ ve noticed that my jaw doesn ’ t click and pop anymore ! I used to get a lot of headaches too , and those have improved . My jaw feels so much better . My medical doctor told me that an oral appliance for sleep apnea could cause a TMJ problem — but mine has gotten significantly better !!! Thank you !”
“ Oh , by the way , I have noticed that my back teeth don ’ t seem to touch anymore . Is that a problem ?
“
Have you had this experience yet ? If not , you will .
There is A LOT of misinformation out there about TMJ problems . You may have been told that oral appliance therapy can cause
TMJ pain and dysfunction . The FDA makes appliance manufacturers put in their materials that the oral appliance shouldn ’ t be used with a patient who has TMD ( whatever that means ). Some insurance companies won ’ t cover an oral appliance if the patient has a history of TMD ( or simply marks on your history form that they have had a TMJ problem in the past ).
That ’ s ( excuse my language ) garbage !
I ’ m a “ sleep guy ,” but my background is as a “ TMJ guy .” I went directly from dental school into a practice limited to the diagnosis and treatment of TMJ disorders — so obviously I ’ m crazy ( and you should probably stop reading this right now ).
Because oral appliance therapy for OSA also involves putting pieces of plastic in people ’ s mouths , many of us TMJ guys and gals got involved in sleep early on . We have “ repositioned ” mandibles for various reasons for years , so doing so to protect the airway isn ’ t much of a stretch .
Unfortunately , some of those who came up with some of the “ rules ” out there did not have such a background , nor did they consult with those who did . Hence —“ you shouldn ’ t use an OA with a patient that has a TMJ problem ” becomes the standard wisdom .
Considering most dental school grads for the past 20 years have only gotten somewhere from zero to a couple of hours of TMD education , and the vast majority never receive any clinical experience at all ( I was the only student in my dental school class to actually fit a nightguard on an actual patient ), it ’ s no wonder there is a bit of confusion in this area .
So back to our opening story .
First of all , what is that clicking ??