Mandibular Repositioning Appliance (MRA). If you’ve been suffering from sleep apnea you may be successfully treated with a Mandibular Repositioning Appliance. Why? For patients with sleep apnea, this treatment is an effective, conservative option that’s become a routine part of many dental practices. The MRA positions the lower jaw forward, and since the tongue is attached to the lower jaw, the tongue moves forward also, opening your airway and reducing constriction associated with sleep apnea.
But there is more.
Physical therapists specializing in patients with Temporomandibular Joint Dysfunction (TMD, as we all call it), are seeing more patients effectively treated with Mandibular Repositioning Appliances for secondary soft tissue issues that develop from the repositioning, even when applied only while you sleep. These include joint and muscle pain, changes in the joint noises when you open and close your mouth and changes in your bite.
We should note the importance, and massive daily use of your temporomandibular joint(s). The joint is a “ball and ramp” connection of your jaw to the temporal bones of your skull, which are in front of each ear. It’s the mechanical piece that allows you to move your jaw up and down and side to side, allowing you to talk, chew and yawn. When there’s pain, malocclusion, limited opening or joint pops/clicks, it impacts patient’s lives in meaningful ways.
The complications with the appliance treatment tend to fall into one of three categories, and here’s how physical therapy treatments can help:
PROBLEM: Posterior open bite (meaning your back teeth no longer touch when you bite.) This is caused by shortening of a muscle called your Lateral Pterygoid and ligaments around your TMJ due to the forward positioning of the lower jaw with the appliance. Your dentist will show you exercises to prevent this from happening, but occasionally, patients will still develop bite changes due to soft tissue tightening.
PT SOLUTION: Treated early with physical therapy, specifically a Forced Biting regiment with anterior blocking and mandibular/TMJ mobilization (posterior-superior). Heat, electric stimulation and ultrasound can help prepare tissues for the mobilization, stretching and re-education therapies.
PROBLEM: Jaw pain, including joint and muscle pain. Moving the condyle forward can result in new weight loading surfaces which can get inflamed. Translation? The treatment can cause pain in the mouth, much like a runner who buys a new pair of running shoes and develops foot pain in areas.
PT SOLUTION: Localized iontophoresis and ultrasound delivers dexamethazone to the area, effectively reducing inflammation. Exercise and mobilization techniques also help to restore normal motion and position.
PROBLEM: TMJ anterior/medial disc derangement changes. Disc derangement with reduction is present in 38% of the population and is usually not a painful condition. Moving the mandible forward can result in a loss of the reduction, which is frequently associated with a loss of the joint “pop” present prior to appliance intervention. This can be painful and result in a loss of motion (reduced opening).
PT SOLUTION: Manipulation of the joint by a TMD-trained physical therapist to restore joint mobility is key to successful treatment and pain resolution. Heat and ultrasound help prepare the tissue for the clinical treatment, and home exercises are prescribed by the PT to ensure correction of the problem.
There is no doubt about it. Mandibular (Anterior) Repositioning Appliance therapy is an effective treatment for many sleep apnea patients. But concurrent physical therapy can often be used to prevent and treat musculoskeletal complications.
Look for a physical therapist skilled in TMJ and occlusal assessment, restoration of normal soft tissue length and correction of non-structural occlusal mal-alignment.
Or find a Tidewater Physical Therapy clinic near you and we’ll help guide you to a physical therapist to help and get you in for an assessment.