To: NIDCRWebupdates@nidcr.nih.gov
nidcrinfo@mail.nih.gov
From: Sean Smith
Date: 2.5.2024
Subject: Please Update TMD/TMJ Health Info Web Page
Hello National Institute of Dental and Craniofacial Research,
I was reading through your health info section today. It’s been a few years since I last reviewed NIDCR guidelines. I was surprised to see that they are still out of date.
https://www.nidcr.nih.gov/health-info/tmd
l am writing to formally request that the NIDCR spend some time updating their health information on Temporomandibular Disorders (TMD). No where does your health information mention how jaw structure influences the airway and can cause TMD to develop.
To be frank, the omission of how jaw anatomy and positioning of the jaws affects the airway and can cause disordered breathing, cause Sleep Breathing Disorders, places the NIDCR’s health information over a decade out of date. One can find teaching materials from the 2010’s from Dr. Jeff Rouse and many others using the scientific literature to establish and explain to fellow physicians the link between jaws, airways, and patient health complaints.
By 2012 the scientific basis for explaining how jaw structure influences breathing and sleep and often causes a person’s TMD had become a pointed subject of interest in the dental and sleep medicine communities. By 2017 the subject had become mainstream in dentistry, evidenced by the American Dental Associations 2017 ratification of its “Policy on the Role of Dentists in the Treatment of Sleep-related Breathing Disorders”. And in 2019, an ADA conference for “Children’s Airway Health” sold out, and at the conference the creation of a Task Force to create pediatric sleep screening guidelines was made [https://www.oralhealthgroup.com/features/organized-dentistry-takes-a-turn-toward-the-airway/].
The ADA Childrens Airway conference led to the create of the Childrens Airway Screener Taskforce (CAST). “CAST is an independent group of stakeholders and subject matter experts led by neurologist and sleep specialist Jerald Simmons, M.D” [https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/about/governance/30003999-committee-b–dental-benefits-practice-and-related-matters–all-inclusive.pdf]. Some of the noted subject matter experts include educators and clinicians Dr. Mark Cruz, Dr. Richard Roblee, Dr. Barry Raphael, Dr. Steve Carstensen, and others.
The interest in children’s airway health and its relationship to TMDs might not seem apparent at first. But, it’s there, and it’s always been there. The Answer to the Problem for so many TMD Patients. That answer being, the adult with TMD and OSA has TMD and OSA because their jaws didn’t grow properly as children. Thus comes the focus of physicians to help children develop optimal jaws to have airways that lead to optimal breathing and sleep.
In fact, Dr. Kevin Boyd, a jaws-airway focused pediatric dentist, in his pursuit of knowledge did find publications in The Dental Cosmos going back into the early 1900s which detailed how jaw structure affects breathing in children and dentists can treat the jaws to improve the child’s breathing. [Airway Health Solutions. (Nov 3, 2022). Airway Chat #39 with Dr. Kevin Boyd: Early Childhood Expansion Case Reviews. Retrieved: https://www.youtube.com/watch?v=8tsVh0V7ZM0 Time 13:30-15:50].
I think the time has arrived where it is no longer understandable for the NIDCR to omit the importance of jaw structure upon the airway and its contribution to TMDs.
The amount of teaching materials and scientific publications has grown such that it is bordering on being a shameful omission for a national institute of dental and craniofacial research.
Even in 2019, at the National Academies of Science Engineering and Medicines Study on TMDs, wherein the physicians included in this study tended to be academics and a bit out of touch with understanding the role of jaw structure on the airway and it’s contribution to TMDs, even there, it was noted, by Dr. Dan Clauw that “…if you look at classic psychological factors such as anxiety, depression, catastrophizing those are only weak predictors of the development of TMD in OPPERA, or weak predictors of the development of fibromyalgia in population based studies…these are very weak. Having a sleep disorder in the population is a more powerful predictor of developing pain than having depression or anxiety.”
Sleep Disorders, such as Obstructive Sleep Apnea, which is predominantly caused by underdeveloped jaw structure.
I could extensively reference the scientific literature and explain in painstaking detail the scientific basis for how jaws affect airways and can cause or contribute to TMDs. But this is to be a letter with a plaintive request. And, I think it would be better if the professionals at NIDCR reached out to the educators I have mentioned and engaged with them to provide the scientific and clinical information the NIDCR should seek to publicly communicate via an update to the Health Information on TMDs web page.
Sincerely,
Sean Smith
A disabled adult whose disability is due to underdeveloped jaw structure.
Defend The Disabled 