Joined: 31 Mar 2005
Location: Gurnee, Skokie, Schaumburg, Bannockburn, Vernon Hills, Chicago, Illinois and serving southeast Wisco
|Posted: October 20 2011 Post subject: Fixing bite first or second
|The most important function of the jaws, teeth and tongue is to maintain an airway. I am always upset when doctors decide they have to fix bite before an oral appliance for several reasons.
The first is that the sleep apnea is dangerous and life threatening and treatment should never be put on hold.
The second is that if a bite is corrected and then an appliance is made it will change over time.
There are two main schools of thought in correcting the bite, neuromuscular position and CR position. The CR position is a retruded position that can make sleep apnea worse.
The neuromuscular position is generally more downward and forward.
CR is a joint position (TMJ)
Neuromuscular is exactly as it sounds.
When an appliance is worn exercises are given to the patients to do in the AM.b These exercises are designed to push the jaw back to its initial pathologic position. I call this position pathologic because the patient is experiencing sleep apnea.
The National Heart Lung and Blood Institute considers Sleep Apnea to be a TMJ disorder. www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf
If the bite is incorrect a more logical treatmment scnario is to first treat the sleep apnea with an appliance and then allow the jaw to reposition itself forward and support these changes with a daytime orthotic during healing. When the apnea is treated and the orthotic position is stable consider doing permanent correction of the bite.
Reconstruction prior to sleep appliance is not a logical approach.
It is never necessary to first treat the bite prior to sleep apnea treatment. It is frequently necessary to mange TMJ/myalgia pain as part of sleep treatment.
Long term studies have shown little evidence of TMJ problems from oral appliance therapy but bite changes frequently occur as the jaw "heals" to a new position.
Dr Ira L Shapira DDS, D,ABDSM