Treatment of Chronic Temporomandibular Joint Pain and Sleep Disordered Breathing by Teledontic and Telegnathic Protocol Utilizing Total Joint Replacement

Joseph Yousefian,Norman C Chiang,Samuel L Bobek,Michael N Brown,Ryan Y Chiang

doi:10.4236/ojo.2017.710031

Abstract

Orthopedic clinicians frequently encounter patients with temporomandibular joint (TMJ) pain and associated sleep disordered breathing (SDB) that coexists with the patient’s orthopedic conditions. The systemic effects and associated comorbidities caused by TMJ and associated SDB are commonly not recognized as potential contributors to the patient’s long-term orthopedic outcome. This article describes a comprehensive and interdisciplinary medical dental treatment, which was able to successfully address patient’s severe chronic TMJ, head, neck and shoulder pain as well as other health concerns including SDB. Moreover, a new teledontic and telegnathic treatment protocol and principles utilizing total joint replacement for care of patients with chronic TMJ pain and SDB will be introduced describing a completed case.

Highlights

A recent investigation employing polysomnogram (PSG) recordings and clinical sleep interviews in a sample of masticatory disorders (MD) cases showed that MD is associated with primary sleep disorders, such as insomnia and obstructive sleep apnea (OSA): nearly 36% of MD cases met diagnostic criteria for insomnia, and over 28% met criteria for OSA [8]
The case presented in this paper demonstrates the effective participation of the orthopedic physician and dental practitioner equipped with teledontics and telegnathic knowledge as a member of an interdisciplinary dental/medical team collaborating in the treatment of sleep disordered breathing (SDB) and chronic temporomandibular joint (TMJ), head, neck and shoulder pain by treatment of pharyngorofacial disorders (POFD)
Orthopedic specialist and subspecialty physicians commonly encounter patients with multiple orthopedic and chronic pains who suffer from other comorbidities of SDB and OSA

Summary

Introduction

TMJ disorders (TMJD) as part of masticatory disorders (MD), most often but not always characterized by painful musculoskeletal signs and symptoms in the masticatory and associated structures in head, neck and shoulder area, estimated to affect approximately 5% to 15% of the population, predominantly women [1] [2] [3] [4]. A high prevalence of MD was reported in clinical patients with mild to moderate OSA referred for a clinical dental evaluation, lending further support to the association between MD and OSA [9]. It was argued that a 28% rate of OSA diagnosis in a sample of MD patients composed mainly of young females with relatively low body mass index (BMI) lends support to the possibility of elevated risk of OSA in MD, requiring further evaluation in a large scale study [8]

Results

Discussion

Conclusion