When screening patients for potential sleep-related breathing disorders, three common visual screening tools are used; The Friedman Tongue Position, The Mallampati Index, and The Friedman Tonsil Index.  Most undergraduate dental education does not cover these three screening tools. If you will be referring your patients to physicians to help get undiagnosed Obstructive Sleep Apnea patients diagnosed you need to become acquainted with them. Below is a guide to help familiarize yourself with the indexes. The Friedman Tongue Position, sometimes referred to as a “Modified Mallampati” The Frie ..read more

After a night of not using his CPAP in 2016, U.S. Supreme Court Justice Antonin Scalia never had the chance to walk the steps to the Supreme Court again. Five years ago, U.S. Supreme Court Justice Antonin Scalia went to sleep while visiting a ranch in West Texas and never woke up.  When the Texas Marshals searched his room, the only thing they discovered amiss was that the CPAP machine he had brought with him on his trip had been removed from the suitcase and placed on the nightstand but had not been plugged in.  Justice Scalia had many health problems, but it is likely that on that ..read more

This week, I ran across a bit of humor published in a Colorado Springs newspaper in 1904. The vignette reminded me of my Dental Sleep Medicine and Orofacial Pain practice, so I thought I would share the story. Where is your journey taking you? “I have been called an optimist, and I plead guilty to the charge, but I am not such an optimist as the man who fell from the roof of a 10-story building. As he passed the eighth story, he called out: ‘I’m all right so far!’ As he passed the fifth story, he cried out again: ‘I’m all right so far!’ and as he flew past the second story, the same chee ..read more

When it comes to treating your jaw joint problems, it all begins with a careful diagnosis of your condition. Treatments range from stretches to surgeries and more than a dozen places in between.  We begin by learning what is wrong We begin by discovering where you are on the path of troublesome transformation from a healthy jaw joint to a painful or poorly working TMJ joint. Once we know where you are, we can determine the best course of action. Often, the first step is to stop the progression. Treatments range from non-invasive to invasive to surgical.  Invasive procedures such as i ..read more

There are dozens of different types of headaches with an equally large number of causes.  One of the more frustrating varieties of headache is the morning headache.  A morning headache is defined as a headache that either wakes you up from sleep or whose onset is within an hour of waking. Morning headaches are more common than you might think.  In fact, 1 out of 10 people regularly wake up with a headache. So what is the cause of this condition?  Research has shown that the primary causes of morning headaches are jaw clenching and poor oxygenation related to obstructive sle ..read more

A TMD Case Study The patient is a 78-year-old female who presented as a referral from her ENT due to TMJ pain. This patient experienced significant tooth pain as a young adult, and multiple teeth were extracted. Due to numerous edentulous areas, the patient lost all posterior stops and began to function solely on her front teeth. The resulting occlusion led her to lose the vertical dimension of occlusion. I suspect that the asynchronous loss of teeth without replacement led to a chewing, clenching, and resting position that put unusual stress on her left jaw joint. This chronically over closed ..read more

Is it normal to hear a noise in my jaw when I chew? I have had patients who have walked in, and they can make their jaw pop louder than I can snap my fingers and others who complain of popping every time they chew that is loud to them but takes a stethoscope for me to hear. Often with both of the extremes, the patient will say something like “this is normal for me.” That statement may be true in the sense that it is a frequent occurrence, but it is false in the sense that it represents a “normal” jaw joint. A healthy jaw joint is silent and often a popping or clicking in front of the ear is th ..read more