Resolving Sleep Breathing Pattern for a patient who had experienced pain for over twenty years, cost twenty thousand dollars with prior orthodontics and other doctors, yet brought her no relief…and yet it is all so simple!
Twenty years ago a woman developed a TMJ/Pain pattern as the result of a car accident. In reality, the accident was nothing more than the straw that broke the camel’s back. She had worn a headgear to retract her front teeth as part of adolescent orthodontics, and both jaws were seriously recessed. About ten years after the car accident her symptom pattern got even worse from a roller coaster ride. By the time she was referred to us she had seen multiple doctors, had worn multiple orthotics, had spent over $20 K and had little to no relief from the pain which had now come to rule her life. She couldn’t be the wife and mother she wanted to be because of the pain she was in constantly.
She had seen some very competent people to address the pain pattern, but nearly 20 years of searching left her with no resolution and pretty much no hope. The dark look on her face, particularly around her eyes, told the story without a word being said. What really is her problem?
She brought many records including a CBCT x-ray with a radiologist report. The report was clear that her airway was moderately reduced, but no one had addressed this. Her intermolar width was a paltry 28 mm. with 42 mm. being far more ideal for a tongue to be positioned properly to the palate and OUT OF THE AIRWAY. Her tongue was clearly down and back in her throat causing her difficulty in breathing and sleeping. Her head was held forward substantially so that she could breathe, and all her cervical muscles were extremely tender to palpation because they were working all the time to keep her head forward.
Her sleep test did not result in an OSA diagnosis despite the fact that she states she never awakens well rested. Women frequently don’t have OSA, but have horrible sleep patterns that are usually ignored. We referred her to our ENT/sleep specialist who will review her sleep test and her airway. Broadening both of her arches orthodontically can help her tongue have space to be to the palate, and this may be enough to resolve her problem. If that falls short the retraction she did with her headgear as an adolescent can be reversed by an oral surgeon who can advance both her upper and lower jaws and dramatically increase her airway. There are no promises of results, but it is obvious to me that nothing gets better until the sleep/breathing pattern is resolved.
