Can exercises help my TMJ pain from using a Mandibular advancement device?

Mandibular advancement device (MAD) therapy is nowadays widely used in the treatment of mild-to-moderate obstructive sleep apnea. Research has shown both an increase and a reduction in signs and symptoms of temporomandibular disorders (TMD) have been reported during long-term usage of a MAD.

As a physical therapist who treats TMD — commonly referred to as temporomandibular joint (TMJ) pain — I am biased that exercises and other therapies can help as I see the patients from our local dentists for treatment of TMD following initial use of a MAD.

The patients I see usually have an increase in the following from using the device.

• Jaw pain

• Ear pain

• Jaw discomfort

• Jaw tiredness/stiffness

• Clicking and/or crepitation

• Masticatory muscle pain on palpation

• Restricted mandibular opening

• Headaches

The symptoms are common side effects of MAD therapy and most go away over time. With that said, patients with existing TMJ crepitation discontinue their MAD therapy more often than patients without this finding.  I want my readers to know that possible development of TMJ pain or TMD should not be a contra-indication for oral appliance therapy in obstructive sleep apnea patients. Still give it a go!

Generally speaking, many patients have discomfort initially and then the body adapts over time and symptoms decrease over time. Overall consensus with dental research is that signs and symptoms of temporomandibular disorders do not necessarily increase during long-term mandibular advancement device therapy.

However, in some cases, symptoms worsen to the point where the individual cannot continue to wear the device. These are the cases that may need short term or even maintenance follow ups so the individual can continue to don the device.

Can exercises help my TMJ pain from using Mandibular advancement device?

Overall, a tough question to answer openly but with most musculoskeletal conditions, exercise usually do help!

Through research, manual therapy alone or in combination with exercises at the jaw or cervical level showed promising effects in a recent systematic review but still low quality research for the treatment of temporomandibular disorders. But then, jaw exercises were one of several recommendations on the management of temporomandibular disorders on a 2010 systematic review.

I agree with the research that exercises can help, but not overwhelming support. It is best to complement jaw exercises WITH neck exercises, as well as in combination with manual therapy for myofascial work (sometimes dry needling) and joint mobilizations to both the jaw and the neck. I find the combination and a tailored approach to be the best approach to help you keep using MAD therapy!