The Stress-Induced Smile Issue That Stems from a Compromised Airway

Three common concerns Huntington Beach, CA cosmetic dentist Katherine Ahn Wallace, DDS pinpoints as having an uptick since the pandemic started are: TMJ-related symptoms, breathing and sleep issues, and—not surprisingly—stress and anxiety, which she says can have some lesser-known, yet serious, smile-related consequences.

Have you seen more patients complaining of or experiencing TMJ issues over the past year-plus (i.e., due to stress)?

Yes, definitely. But first, let’s clarify what TMD is. Temporomandibular disorders (TMD) are disorders of the jaw muscles, temporomandibular joints (TMJ), and the nerves associated with facial pain. Factors that prevent the complex system of muscles, bones and joints from working together harmoniously contribute to inflammation and TMD.

Some of the common TMD symptoms include:

• Aching or pain in and around the ear
• Ringing in the ear
• Pain or tenderness in the jaw
• Pain or stiffness in the neck and shoulders
• Clicking or grating noise in the joint
• Pain while chewing
• Dull headaches or migraines
• Limited range of motion when opening your mouth

Some common known factors that contribute to TMD symptoms include:

• Injury to the jaw, head or spine
• Excessive gum chewing
• Clenching or grinding 
• Hypermobility or ligament laxity
• Arthritis (systemic inflammation of the joints)
• Stress (can be internally induced from pain or an effort to maintain healthy oxygen level while sleeping, or externally induced from environmental factors such as family dynamics or COVID-19) 

What are some of the underlying factors that contribute to TMD that most patients are not aware of?

The following structural and functional imbalances can predispose us to clenching, grinding and developing inflammation and TMD symptoms:

• Narrow or retruded jaw
• Misaligned jaw
• Crooked teeth or uneven bite
• Swollen tonsils or adenoids
• Constricted or unstable airway
• Mouth Breathing
• Tongue tie or Poor tongue posture 
• Forward head Posture
• Poor body posture
• Fascial distortion or tension
• Snoring, sleep disturbances and other sleep issues
• Diabetes, stroke, acid reflux, high blood pressure, arrhythmia and other heart issues

What is your typical course of treatment?

In my cosmetic dental practice, Impression Dental Care, I review the patient’s aesthetic goals as well as perform a thorough health-history review and airway health screening to identify any potential foundational problems that can affect the smile. If the patient does not display any signs or symptoms that could compromise the long-term health of the restorations, we proceed with the cosmetic work. However, if the patient has foundational issues that should be corrected prior to a cosmetic procedure, we schedule the patient for a thorough airway health (sleep, TMJ and orthodontic wellness) evaluation at one of our Aviara Whole Body Wellness speciality centers.

At Aviara, the exceptionally trained interdisciplinary team of medical & dental professionals performs a comprehensive evaluation of the patient’s structural and functional findings to find the best possible solutions to retrain the muscles and develop the jaw structures to improve sleep and breathing and restore TMJ health. Advanced diagnostic tools such as a CBCT (cone beam CT), HST (home-sleep study) and JVA (Joint Vibration Analysis) are available to assist in identifying the severity of the patient’s airway and overall health. Based on the comprehensive review, evaluation and diagnostic findings, the team at Aviara recommends or provides one or more of the following treatment options to address each patient’s specific needs:

• Self-care therapy
• Laser therapy
• Myofunctional therapy
• Myofascial release or craniosacral therapy
• TMJ management therapy with a nighttime splint
• TMJ stabilization therapy with 24/7 splint
• CPAP or Mandibular Advancement Device
• Bite adjustment or restoration
• Jaw development and alignment with an appropriate expander 
• Bite Alignment with braces or clear aligners
• Oral and maxillofacial surgery to advance or enhance jaw development 
• ENT surgery (including tonsillectomy or other surgeries to improve the airway)
• Lifestyle Wellness Therapy (weight loss or nutritional programs to reduce systemic inflammation and promote healing…)

Are there any aging aesthetic-related conditions that can occur with prolonged TMD?

Yes. It is helpful to first understand that aging and modern diseases stem mostly from inflammation triggered by airway compromise and lifestyle choices. With this said, it is also important to note that sleep, TMD and occlusal issues associated with inflammation can affect our aesthetics as well.

• Upper airway restriction and sleep apnea contributes to accelerated aging, TMD, chronic pain, systemic inflammation, cardiovascular diseases and many other diseases
• Clenching and bruxing wear our teeth, gum and bone, making us look older
• A small, narrow jaw collapses our bite, cheeks and smiles, making us look older

In your experience, do many patients who have TMJ not realize it?

Like many other ailments of our body, temporomandibular disorders are progressive. It is estimated that about one-third of the population suffers from a symptom related to TMD. But, many who are afflicted with the earlier stages of TMD likely do not seek treatment because it may not be significantly affecting their quality of life yet. However, it is essential to address the symptoms in the earliest stages and find the appropriate treatments to minimize further damage to the critically necessary structures that affect our most important functions and behaviors.

Many people who have noticeable TMD symptoms first assume that the problem is ear-related or neurological and will seek an ENT or neurologist for a solution. The specialists will usually refer them back to their general dentist for a night guard. Sadly, most dentists do not have sufficient training in TMD and will do nothing, prescribe medications or make a traditional night guard which may not address the underlying issues and many times can trigger further aggravation.

Mouth breathing, a soft refined diet and restricted frenulum are three of the root causes of underdeveloped jaw and facial structures, crooked teeth and constricted airway. And these issues frequently lead to TMD and many other health problems. Unfortunately, 80 percent of the people with underlying airway issues are undiagnosed and unaware of the risk this poses to their overall health. The ADA (American Dental Association) recently made a recommendation that all dentists screen their patients for airway compromise for three main reasons: Most of the signs of airway compromise are present in or around our mouth, many corrective solutions for airway compromise are available through a dental professional trained in sleep, TMD and orthodontics and most people see their dentists more regularly than they see their primary care physicians. The recognition of airway compromise is especially important in growing children. At Aviara, we provide advanced integrated diagnosis and treatment options to guide our patients (birth to 100-plus) in making the best possible decisions for their overall wellness. A smile supported by a well developed jaw and airway will be more brilliant, youthful and long lasting than the one that is built on a collapsed foundation. ‘Ahncore Smile’ is a smile design concept we use for the smiles we create which addresses the foundational structural, functional and aesthetic components of a smile. Our ultimate goal for our cosmetic dental practice as well as our specialty sleep, TMD and orthodontic practice is to help our patients breathe, live and smile!

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