Temporomandibular joint disorder (TMD) involves the temporomandibular joints, which connect the lower jaw to the skull, and the surrounding muscles and tissues. It is commonly recognized for symptoms like jaw pain, clicking sounds, and limited jaw movement. While these joint and muscle issues are the primary focus of TMD, a relationship exists between jaw dysfunction and breathing problems. The connection is often indirect and related to the close anatomical relationship between the jaw and the airway. This link is especially relevant during sleep, where jaw position can significantly influence the space available for air to pass.
The Anatomical Link Between Jaw Alignment and Airway
The connection between the jaw and the airway is rooted in a shared anatomical space within the head and neck. The lower jaw, or mandible, provides the structural attachment point for several muscles that also control the position of the tongue and the tissues lining the throat. These muscles include the suprahyoid muscles, which attach to the hyoid bone located just above the voice box.
Chronic misalignment or a posterior shift in the jaw’s resting position, often seen in TMD, influences the tension of these muscle groups. Tension in the muscles surrounding the joint can contribute to the jaw moving backward. This posterior displacement of the jaw physically pulls the base of the tongue backward toward the throat.
When the base of the tongue shifts, it reduces the dimension of the oropharynx, the part of the airway behind the mouth. This physical narrowing makes the upper airway more susceptible to collapse, especially when muscles relax during sleep. TMD-related changes in jaw posture and muscle tension create a biomechanical environment that promotes airway restriction.
Specific Breathing Difficulties Associated with TMD
TMD-related jaw changes can directly contribute to several respiratory manifestations. One common issue is the exacerbation of Sleep Disordered Breathing (SDB), a spectrum of conditions characterized by abnormal breathing patterns during sleep. This includes increased snoring and more significant conditions like Obstructive Sleep Apnea (OSA).
OSA involves repeated episodes where the upper airway completely or partially collapses, leading to breathing interruptions and reduced oxygen intake. The reduced posterior airway space resulting from a retruded jaw position can be a contributing factor to OSA. To maintain an open airway, the body may instinctively clench or grind the teeth (bruxism), which further strains the jaw joints and muscles, linking the two conditions.
A less severe but still disruptive condition is Upper Airway Resistance Syndrome (UARS). UARS involves increased resistance to airflow in the upper airway, causing brief awakenings that fragment sleep without the full obstruction seen in OSA. This resistance is often the direct result of a compromised airway space influenced by jaw position. Patients with TMD may also experience chronic mouth breathing when the nasal or oropharyngeal airway is compromised.
Treatment Approaches Targeting the TMD-Breathing Connection
Management of breathing issues related to TMD often focuses on non-surgical interventions that stabilize the jaw and maintain an open airway. One of the most effective tools is the use of custom-fitted oral appliances, specifically Mandibular Advancement Devices (MADs). These devices are designed to gently hold the lower jaw in a slightly forward position while the patient sleeps.
By preventing the jaw from falling backward, MADs stabilize the tongue and the soft tissues of the throat, physically increasing the posterior airway space. This forward repositioning helps reduce the likelihood of airway collapse, improving airflow for both snoring and mild-to-moderate OSA. These appliances can also alleviate the strain on the temporomandibular joint itself by stabilizing the joint in a more favorable position.
Physical therapy is another important component, targeting the muscle tension that contributes to TMD and poor jaw posture. Exercises and manual techniques focus on relaxing the masticatory muscles, the neck muscles, and the suprahyoid muscle group. Reducing this chronic tension can promote a more natural resting position for the jaw and tongue, indirectly supporting better airway function. Simple lifestyle adjustments, such as adopting a side-sleeping position, can also be recommended to prevent the gravitational collapse of the airway that often occurs when sleeping on one’s back.