TMJ Disorders and GERD. Is Sleep Disordered Breathing the Missing Link

This study showed a two-fold increase in TMJ disorders in patients with Gerd. While there are multiple causes of Gerd, sleep disordered breathing and sleep apnea are frequently involved. If the airway collapses on inspiration then the vacumn “sucks” acid out of the stomache and into the throat. It is interesting that the study found that myofascial pain was common in the TMD group.

Sleep apnea has been shown to be a cause of some cases of fibromyalgia and upper airway resistance disrupting sleep can lead to chronic pain problems. The NHLBI considers sleep apnea to be a TMJ disorder.

Should all patients with GERD be evaluated for TMJ disorders and sleep disordered breathing. Gerd also causes destruction of the teeth and results in loss of vertical dimension that will worsen apnea and TMJ problems further.

Oral Appliances are used to treat both problems by bringing the jaw foward and more open. Both TMJ patients and sleep apnea patients frequently have an abnormal swallow or deviate swallow that results in scalloped tongues. Information on oral appliances for treating sleep apnea can be found at and information on treating TMJ disorders thru Neuromuscular Dentistry is available at The changes in swallowing may also contribute to GERD. Peristalsis begins with swallowing and travels as a wave to move food through the digestive tract. Does abnormal swallowing create a tendency for GERD?

Wikipedia defines peristalsis as “Peristalsis is a radially symmetrical contraction of muscles which propagates in a wave down the muscular tube. In humans, peristalsis is found in the contraction of smooth muscles to propel contents through the digestive tract. Earthworms use a similar me chanism to drive their locomotion. The word is derived from New Latin and comes from the Greek peristaltikos, peristaltic, from peristellein, “to wrap around,” and stellein, “to place”.
In much of the gastrointestinal tract, smooth muscles contract in sequence to produce a peristaltic wave which forces a ball of food (called a bolus while in the esophagus and gastrointestinal tract and chyme in the stomach) along the gastrointestinal tract. Peristaltic movement is initiated by circular smooth muscles contracting behind the chewed material to prevent it from moving back into the mouth, followed by a contraction of longitudinal smooth muscles which pushes the digested food forward.

PubMed abstract
J Oral Maxillofac Surg. 2009 Dec 1. [Epub ahead of print] Prevalence of Temporomandibular Disorders in Patients With Gastroesophageal Reflux Disease: A Case Controlled Study.
Gharaibeh TM, Jadallah K, Jadayel FA.

Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jordan University of Science and Technology Faculty of Dentistry, Irbid, Jordan.
PURPOSE: The present study estimated the prevalence of temporomandibular disorders (TMDs) in patients with gastroesophageal reflux disease (GERD). PATIENTS AND METHODS: A study group consisting of 60 adult patients (34 women and 26 men) diagnosed with GERD was matched by age and gender to a control group of 60 patients without any signs or symptoms of GERD. The diagnosis of TMD was established using the Research Diagnostic Criteria for Temporomandibular Disorders. RESULTS: Of the 60 patients in the study group, 22 (36.6%) had TMD compared with 11 (18.3%) in the control group (P = .025). Most patients with TMD in both groups were diagnosed with myofascial pain: 19 (31.7%) in the study group versus 9 (15%) in the control group (P = .031). CONCLUSIONS: The increased TMD prevalence in patients with GERD should be explored further to better characterize the association between TMD and GERD. The physicians treating the 2 disorders should consider the clinical implications of this association.

PMID: 19954879 [PubMed – as supplied by publisher]