Subscribe 

Good Morning,

One of the most common unspoken concerns dentists have when entering sleep appliance therapy is this:

“Am I going to cause a TMJ problem?”

It’s a reasonable concern.
We’re advancing the mandible.
We’re altering joint loading.
And whether we acknowledge it or not, we are influencing the TM joints every time we deliver a sleep device.

So let’s talk about this clearly and without drama.

Do sleep devices cause TMD?
Or are we finally addressing a system that was already under strain?

In Today’s Edition:

This week’s edition of More Than Teeth is a 6-minute clinical discussion grounded in peer-reviewed literature and reinforced by decades of hands-on experience treating patients with TMD, craniofacial pain, and sleep-disordered breathing.

6-minute read👇

Clinical Corner

🥼Use the clinical corner as your secret weapon to impress your colleagues and patients!

Key Takeaways🔑

• Oral airway appliances don’t create TMD in healthy joints.
  They interact with systems that are often already adapted, compressed, or compensating.

• Most joint sounds and posterior open bite reflect adaptation, not failure.
  Especially in patients with pre-existing joint compression or degenerative change.

• CBCT-based TMJ screening should precede airway therapy.
  Identifying joint-space narrowing or arthritic changes helps anticipate risk and set expectations.

• Documentation is clinical care, not defensive medicine.
  Screening forms and informed consent align expectations and reduce unnecessary alarms during adaptation.

• When you treat sleep, you influence the entire craniofacial system.
  Airway stability, joint health, and neuromuscular regulation are inseparable.

The Concern: “Sleep Appliances Cause TMD”

Many dentists were trained to view mandibular advancement devices as inherently risky for the TM joints.

That belief persists not because it’s well-supported, but because bite changes and joint symptoms are visible, and visible changes make clinicians uneasy.

Yet when you step back and look at the broader pattern, a different story emerges.

Patients with sleep-disordered breathing frequently present with:

• Jaw pain

• Clicking or popping

• Muscle fatigue

• Headaches

• Bruxism

In other words, the joint is often involved before treatment ever begins.

The real question isn’t whether sleep appliances affect the TM joints—they do.

The question is how and in which direction.

What the Literature Actually Shows

Many well-designed studies have examined how oral appliance therapy (OAT) affects temporomandibular disorders (TMD). The findings are clear: OAT does not increase the long-term risk of TMD. Some people may experience temporary joint or muscle symptoms at first, but these usually resolve on their own. In fact, many patients see an improvement in their TMD symptoms. This makes sense because sleep-disordered breathing is linked to increased stress on the body, teeth grinding, jaw muscle overactivity, and repeated joint stress during sleep disturbances. By keeping the airway open, OAT often reduces the forces that cause joint strain.

Bottom line:
The evidence does not support the idea that properly managed sleep appliances cause TMJ disorder. In many cases, they reduce symptoms by addressing upstream drivers.

Where Dentists Actually Get Burned

When problems arise, they tend to sound familiar:

• “My jaw is popping again.”

• “I can’t touch my back teeth in the morning.”

• “My bite feels different.”

At this point, it’s tempting to assume something has gone wrong.

But most of the time, these findings reflect expected physiologic changes in higher-risk joints rather than treatment failure.

What’s Happening in the Joint

In certain patients, the condyles are already functioning in a compressed or adapted position within the glenoid fossa.

This often corresponds with:

• Reduced joint space

• Disc displacement or deformation

• Adaptive or degenerative changes

When an oral appliance decompresses the joint, several predictable things may occur:

• Synovial fluid re-enters the joint space

• Adaptive remodeling begins

• Posterior teeth may temporarily lose contact

This is not pathology.

It’s joint physiology responding to a change in load.

Trouble arises when we don’t anticipate this—or when we reflexively prescribe a morning anterior repositioning device that forces the condyles back into a pathologic position. In those cases, we may undo the very adaptation we initiated.

Example Normal (left) and Degenerative (right) TM Joints on Sagittal CBCT

This sagittal CBCT view demonstrates advanced degenerative changes of the temporomandibular joint, including loss of joint space and bony remodeling of the condyle and glenoid fossa.

While CBCT does not visualize the articular disc, markedly reduced joint space and arthritic changes suggest a compromised joint environment. In patients with this anatomy, decompression during oral airway appliance therapy may be associated with joint sounds or temporary posterior open bite as the joint adapts.

A Principle Worth Keeping in Mind

This reality comes with responsibility. Every sleep case should include a basic TMJ screening, which involves:

- Imaging of the TM joint (using CBCT or a tomogram)

- Checking the position of the condyle and the joint space

- Assessing how far the jaw can move: maximum opening, left and right side movements, and maximum forward movement

- Watching for any deviation or deflection when opening the mouth

This is not advanced TMJ care; it's essential for airway dentistry.

Why Expectations Matter More Than Adjustments

Many post-delivery concerns resolve when patients are properly educated before treatment begins:

• Temporary bite changes can occur

• Posterior open bite is often transient

• Joint sensations may change during adaptation

• These changes are monitored, not ignored

Clear expectations don’t create anxiety.
They prevent it.

One of the simplest ways to reduce confusion, anxiety, and downstream conflict is to clearly document expectations before treatment begins. We’ve created a patient-friendly informed consent for oral appliance therapy that outlines benefits, limitations, and possible side effects in plain language.

👉 Download the Oral Appliance Therapy Informed Consent (PDF)
(Designed for patient education, shared decision-making, and documentation.)

Selected References (Peer-Reviewed)

1. Doff MHJ, et al.
   Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side effects.
   Clinical Oral Investigations. 2012.
   https://pubmed.ncbi.nlm.nih.gov/21538074/

2. Mehta NR.
   Oral appliance therapy and temporomandibular disorders.
   Dental Clinics of North America. 2019.
   https://pubmed.ncbi.nlm.nih.gov/30396445/

3. Huynh N, et al.
   Sleep bruxism is associated with micro-arousals and increased cardiac sympathetic activity.
   Journal of Sleep Research. 2006.
   https://pubmed.ncbi.nlm.nih.gov/16911037/

4. Martins OFM, et al.
   Side effects of mandibular advancement splints for the treatment of snoring and obstructive sleep apnea: a systematic review.
   Sleep Science. 2018.
   https://pmc.ncbi.nlm.nih.gov/articles/PMC6150709/

5. de Almeida FR, et al.
   Long-term compliance and side effects of oral appliances used for the treatment of snoring and obstructive sleep apnea syndrome.
   Journal of Clinical Sleep Medicine. 2007.
   https://pubmed.ncbi.nlm.nih.gov/17561628/

Final Thought

If you’re worried about causing TMJ problems with sleep appliances, the answer isn’t to avoid treatment.

It’s to practice with clarity, screening, and intention.

Sometimes the appliance isn’t the problem.

It’s the first intervention that actually makes the joint honest.

—Dr. Michael & Cathy Bennett
More Than Teeth | A Mission for Generational Health

Coach Cathy’s Take

(A Functional Nutrition Lens on Reducing Physiologic Stress)

From a functional nutrition perspective, chronic jaw tension and TMD symptoms often reflect a body that has been operating in survival mode for far too long.

Poor sleep, unstable breathing, and blood sugar swings all keep the nervous system on high alert. When the body doesn’t feel safe at night, it compensates everywhere—including the jaw.

Nutrition can either amplify that stress or help quiet it.

Simple, consistent strategies matter most:

• Stabilizing blood sugar with balanced meals that include protein, healthy fats, and fiber—especially at dinner

• Reducing nighttime stimulants, including late caffeine, alcohol, and heavy sugar intake

• Supporting key nutrients involved in neuromuscular regulation, such as magnesium, B-vitamins, iron, and zinc (food first; supplements when indicated)

• Prioritizing digestion, because gut stress and sympathetic overdrive often travel together

When sleep improves and nutritional stress is reduced, the body often releases long-held protective patterns. Muscles soften. Joints adapt. Sensations change—not because something is wrong, but because the system is finally recalibrating.

Healing doesn’t happen in isolation.
It happens when the body has the resources—and the safety—to let go.

Miscellaneous….

Every patient you help breathe better, sleep deeper, and feel stronger is a life changed for the better. Keep asking the deeper questions. Keep connecting the dots. You're not just treating teeth, you’re transforming health.

Thanks for being part of the movement.

Until next week,
The— Dr. Michael & Cathy Bennett
More Than Teeth | A Mission for Generational Health