Jaw Pain After Dental Work – Snoring – Breathing Stops When Sleeping – TMD and Sleep Apnea? In this article I describe how a dental patient (me!) dealt with TMD (Temporo Mandibular Joint Disorder) and sleep apnea (stopping breathing while sleeping). I also explain a cause of loud snoring and how I cured it (well at least I think I have!)
For some time I have wanted to share with you some very unpleasant problems I experienced following a dental appointment a few months ago. As things developed I actually found myself suffering from something that has been known to lead to strokes, heart attacks and even death.
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My dental appointment was nothing out of the ordinary I needed preparation for a crown to be installed where a large filling from my childhood had started falling apart (when I was a child my parents owned a candy store!). This was not my first crown. The work, on the last molar of my upper right jaw, required a local anaesthetic and some pretty hefty drilling and grinding work to remove the filling and the rather sparse remains of the original tooth. I was given a temporary filling while a new crown was prepared.
Within a couple of days the ache on that part of my mouth became so strong that I had to give up eating any food that required strenuous chewing (and when I had to chew I did it on the other side of my mouth). I don’t like to take pain killers so I put up with the ache and focused on trying to remove the cause of the pain. After about 4 weeks the pain seemed to be improving and the dentist fitted the crown. The pain returned so I continued to avoid heavy chewing to give the crown a few days to ‘settle in’.
Any attempt to start chewing again was followed by considerable pain in my jaw (my diet has a large amount of vegetable matter which requires lots of heavy chewing for periods of up to 30 minutes – a bit like a cow chewing its cud). More worrying I found that whenever I tried to sleep I would wake up in agonising pain, also in the jaw area. This happened when any part of my jaw was in contact with the pillow or bed as I slept.
I normally sleep on my stomach with my head turned to the right or left. I usually alternate between the two several times during a night’s sleep. This is something I have done for a number of years. Previously I had slept on my sides (both of them) but I found this often gave me back or side ache. Also when sleeping on my side I would often find that I slept on one of my arms disturbing circulation so I would wake up with a ‘dead arm‘. Somehow sleeping on my stomach was forcing my back into a ‘better’ posture and my back (and arm) pains disappeared. I also try to sleep with my feet over the bottom of the bed (where they stick out) which tended to keep me stretched out rather than adopting on a foetal position. I found the foetal position could also lead to pains in my side.
Just to be clear – I am not someone who regularly suffers from back, side or neck pains. The description above is simply intended to explain that on the few occasions when these pains have occurred I tried to work our what was wrong with my posture in bed and fix it.
Following my dental experience I found that I could avoid waking up with jaw pain if I slept on my back with the pillows so positioned to force my head into a vertical (looking up towards the ceiling) position. Sleeping like this took a bit of getting used to but it did help to avoid the jaw pain and also didn’t give me a stiff back. This was presumably because my back was stretched out in a horizontal posture.
After a bit of research I realised that following the dental work I had been suffering from TMD (Temporo Mandibular Joint Disorder). The tempero mandibular joint is where the jaw is attached to the skull and together with the muscles attached to it this is the main junction involved when we chew (see picture).
There is a lot of discussion about what can cause problems in this area and what you can do about it. Rather than having a single cause this type of pain may even be due to multiple issues, some physiological and some possibly psychological in nature (for example related to stress or anxiety). It can also be linked to other symptoms like teeth grinding which can also take place while you are sleeping. TMD is considered to be either acute (less than 3 months in duration) or chronic (lasting longer).
In my case I did not remember having this kind of pain in the past and I felt certain it resulted from my dental work – other people have also reported similar problems after visiting the dentist. It may be caused by the long periods that a patient has to sit with their mouth in a strained open position while the dentist does their work. It might be related to damage, perhaps done to the nerve or other tissues, when the dentist injects a local anaesthetic. It might be due to trauma on the joint caused by prolonged drilling or grinding of the tooth. This trauma could be transmitted through the jaw bone and into the sensitive joint area (a bit like injuries caused in the knee following an excessive running session – especially if one is overweight, unprepared or runs on a hard surface). Of course being a heavy chewer doesn’t help – it is a bit like trying to continue running on an injured knee – it just makes the problem a lot worse.
As my research turned up no simple or certain cure for TMD I decided that I probably had the acute version and that the best approach would be to immediately minimise further strain on the joint. I hoped that, if this was like a knee injury, lots of rest and avoiding further strain would allow the body to do its own reparative work.
So I stopped eating anything that required heavy chewing which meant no salads (mine are usually very crunchy), no chewing gum, no muesli (especially the lumpy sort), no nuts and seeds and even my daily ration of 80% dark chocolate was taken out of the fridge to reduce its brittleness. Clearly my diet became somewhat limited – try living off mashed bananas, Weetabix and honeyed Greek yogurt for a couple of months. OK I could suck on the chocolate for a treat.
I forced myself to continue sleeping on my back with my head facing straight up. This was necessary because any contact of the temporo mandibular joint area (just to the front of, and below, my ears) with the pillow led to agony after a few minutes. The was the same regardless of whether I was lying on the side of the dental work or the other side. I believe this is because contact with any part of my jaw bone (left, right or front) would put pressure on the injured part of the TM joint even if the main injury was just on one side. Clearly the TM joint region was very sore.
I knew of an acquaintance with a similar more chronic TMD problem which also involved grinding their teeth when asleep. Their doctor had prescribed a special head-gear to wear in bed which forced the person to sleep in a posture that avoided contact with the jaw or TM joint. I wanted to see if I could adapt my sleeping posture without wearing anything on my head (OK – I was a bit concerned that wearing a mask in bed might inhibit my chances of a nice romantic relationship – the ladies I know don’t like that sort of behaviour).
With time I managed to adapt to the new sleeping posture. The fixed position on my back could become uncomfortable for long periods (like a whole night). I think this is because my body enjoys dancing around when I sleep. If I don’t dance around the bed at night my joints start to ache. Therefore some of the back ache that I had eliminated by sleeping on my stomach returned but this was much better than the jaw pain if I slept on my front or side.
The good news was that after about a couple of months the TMD problems subsided and I was able to gradually return to my rather chewy diet. My jaw continued to be a bit sensitive to prolonged contact so I stayed sleeping on my back to avoid the risk of a recurrence.
Quite recently (about 5 months after the original dental work) I noticed an unusual development when I was sleeping on my back. Sometimes if I had a little power nap during the day I would lie on the bed (face upwards, back down) and drop off. After a short time I would wake-up to hear myself making a rather loud snoring sound – something I had not experienced before. In addition I would wake up in the night during an unusually unpleasant dream (historically I have tended to be a ‘happy’ dreamer). My heart would be pounding like mad and I would be out of breath and breathing as if I had just run a marathon. Try to imagine you have just been saved from drowning – this was how I felt. In addition my fingers and feet would tingle.
As I am getting on a bit in terms of years I thought: “OK better get ready for a heart attack – check the last Will and Testament is signed and that the kids know I am leaving my body to medical science”.
After a bit of time on the internet checking how to subscribe to multiple religious organisations (spreading my options) I came across something called sleep apnea. Put simply this is where you stop breathing when you are asleep and although many people live long lives with this problem it can, in extreme situations, lead to heart attacks, strokes or even death. If you stop breathing for a prolonged period your body, and most importantly your brain, can get starved of oxygen and cells/tissues may be damaged and start to die.
There are many things that can lead to this condition but one particularly caught my attention – it can be caused when you sleep on your back with your head facing the ceiling. In this position the soft tissue in your mouth and throat area can settle in the back of your throat and block the ventilation passage effectively starving you of oxygen and causing the levels of carbon dioxide (the ‘waste’ gas your lungs try to expel when you breathe out) to rise in your blood stream.
Fortunately the body has various safety mechanisms. The increase in carbon dioxide in the blood acts as a signal which can make you may start to choke (or snore ‘aggressively’) to try to clear any possible blockage (I guess this is a defence mechanism from when we lived in caves – it prevented people from choking on any bats they swallowed while asleep). In addition your rate of breathing increases to try to replenish the reduced oxygen levels in your blood and your heart starts pumping rapidly to try to get the limited oxygen to the parts of the body where it is needed as quickly as possible.
If you have ever experienced suffocation I believe the reaction of your body after waking from sleep apnea is very similar. The same response mechanisms are triggered to try to get oxygen (air) back into your lungs. When you drown these automatic responses make you gulp water into your lungs. The tingling sensation I was experiencing in my hands and feet when I woke up was probably due to those areas starting to be deprived of oxygen.
Needless to say I decided it was a good time to stop sleeping on my back. I have now returned to sleeping mainly on my stomach – although I do have short periods on both sides and on my back to satisfy my body’s need for a night-time dance. Fortunately the jaw has recovered sufficiently for this to not be too painful although it took a while to get used to it. I have found soft, thin pillows can help in this process. The upside is that I can now sleep through the night without getting a stiff back, arms, legs and neck. I am actually getting a much better quality of sleep and my dreams have become decidedly more cheerful (being a recluse this is where I meet most of my friends!).
I am not a doctor so if you see any familiar symptoms here and are concerned make sure you get professional medical advice. Some of these problems can have serious consequences and various forms of help are available. Rest assured – jaw pain is a pretty common occurrence after dental treatment and apparently sleep apnea occurs in about a quarter of middle-aged men (according to a US study). So if you also think you may have these problems you are not alone. If you want to share your own experiences with other readers please do not hesitate to use the comments section (but if you include links to Viagra or sexual ‘fun’ sites the spam filter will automatically prevent your comments getting published – yes that includes you – ‘Over-the-counter’ Doris).
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