Sleep Appliances and Jaw Exercises
In the December 2011 issue of Sleep and Breathing there is an article, “Mandibular Exercises Improve Mandibular Advancement Device Therapy For Obstructive Sleep Apnea”, which I think could be beneficial to many of our current Sleep and TMJ patients. I would like to briefly touch on the importance of the article and share a simple set of exercises with you that may be of great benefit.
Although the study was to evaluate the effect of exercising the mandible on Temporomandibular disorders (TMD) in patients wearing oral appliances for the treatment of snoring and obstructive apnea, I believe these exercises can benefit most everyone that suffers with TMD. These mandibular exercises were found to be effective in reducing pain and therefore increasing compliance of wearing the appliance.
Following are the exercises that were utilized:
This protocol consisted of coordinated exercises to stretch the mandibular muscles, and it was adopted to control pain in those individuals hampered by TMD pain.
For coordinated movements, patients were instructed to perform sequences of exercises by controlled mouth opening. This was achieved by maintaining the tongue in contact with the palate, followed by a sequence of lateral left-right movement of the mandible against light-hand resistance. This type of movement was used with the intent to exercise the lateral pterygoid muscles and the TMJ. For stretching, they used the movement of opening the mouth against light resistance of the hand, followed by a maximum opening of the mouth assisted by the fingers, with the intent of stretching the temporal and masseter muscles. Patients were instructed to exercise twice a day, in three sets of five repetitions of each movement.
These exercises have proven to be efficient and effective in the treatment of TMD in general and with mandibular advancement appliances (snore and OSA appliances) as well.

Accumulation of dental plaque can cause gingivitis and periodontal disease with loss of bone tissue. Long term exposure to plaque can also lead to tooth demineralization and destruction due to decay. I recently read a research article that investigated the continuity and change in plaque levels across the long term and the association of plaque with oral health. The study involved collecting plaque data on individuals at 5, 9,15,18,26 and 32 years of age. Much of what you would expect was found. For instance, those with high plaque levels lost more teeth (nearly five times more teeth) due to dental decay as compared to those with low plaque scores.
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