Author: Mayoor Patel, DDS, MS

Oral appliance therapy can successfully treat sleep apnea by dilating the upper-airway by positioning the mandible forward. This prevents upper-airway obstruction during sleep. However, the use of oral appliance therapy also has its short-term side effects, such as occlusal discomfort.

While there have been no studies focused on the prevention of temporomandibular joint and/or masticatory muscle pain, or TMD pain, associated with use of an oral appliance in patients with obstructive sleep apnea. A recent study from the Journal of Prosthodontist Research worked to determine the effect of jaw-opening exercises on TMD pain associated with oral appliance therapy in sleep apnea patients.

The Results of the Trial

Researchers looked at 25 patients with sleep apnea without pain-related TMD. These patients were consecutively enrolled into a two-arm, randomized, double-blind, placebo-controlled trial. One group performed jaw-opening exercise and the other group performed placebo exercises for one month.

Pain-related TMD was not found in the group that performed jaw-opening exercises out of all the different evaluation periods. This same group showed lower morning and daytime visual analog scale scores than those of the placebo group at all evaluation periods as well. There were also significant differences found in terms of chewing pain and jaw-opening pain in the morning at the first evaluation and of the jaw-opening pain during daytime at the third evaluation.

From this we learn that jaw-opening exercise before oral appliance therapy reduced the risk of TMD pain associated with the use of the appliance. This concludes that jaw-opening exercises are key to preventing TMD pain in our patients using oral appliance therapy for treatment of sleep apnea.

Jaw-opening exercises your patients can use

To help your patients with TMD pain, try recommending some exercises. In addition to icing their jaw, they can stretch out the muscles as well. One exercise you can recommend begins when the patient touches their tongue to the roof of their mouth, keeping their teeth gently apart. This allows the patient to relax their jaw.

While the tongue is at the roof of the mouth, encourage the patient to keep their tongue there and slowly open their jaw as wide as they can before feeling any pain. From this position, have them hold and close their mouth gently. As with all good exercises, encourage them to repeat 2-3 times. By completing jaw stretches and exercises, our patients can find relief.

Another simple exercise you can do is open your mouth wide, but very slowly. After closing your mouth, move your jaw to the left and then to the right. Remember to perform this exercise slowly and relaxed, otherwise further pain might develop. Repeat this exercise as you see fit.