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Expert Q&A – February 2021

Expert Q&A with: Dr. Damian Teo

"The reality is, most of the treatment us dentists can offer our patients for TMD is a splint. The design, and bite registration of the splint is important, but end of the day, the splint can only do so much, and if we become too dependent on the splint, we’ll limit the amount we can help our patient."

Dr. Damian Teo

Bio:

  • Sleep & TMJ Dentist in Melbourne
  • Bachelor of Health Science (Dentistry) – Latrobe University
  • Masters of Dentistry – Latrobe University
  • Post Graduate Diploma Dental Sleep Medicine – University of Western Australia

Damian is a holistic dentist with a focused interest in snoring, sleep disorders, teeth grinding, TMJ disorders and airway focused orthodontics. In his dentistry, Damian is passionate about looking “beyond the mouth” and treating the body as a whole. He believes dentists play an important role in being able to recognise airway/breathing issues, sleeping problems, and craniofacial pain (such as headaches, neck pain, and TMJ disorders). This led him to undergo extensive postgraduate training with world renowned specialists in the field of sleep medicine and TMJ disorders, and achieving his Post Graduate Diploma in Dental Sleep Medicine with the University of Western Australia. Damian also previously worked in Darwin’s first official TMJ & Sleep Therapy Centre, where he exclusively treated patients for snoring, sleep apnoea, teeth grinding and TMD.

Damian has setup his own specialised TMD and Sleep clinics: Melbourne Dental Sleep Clinic. Damian understands the value in working with skilled allied health practitioners outside of dentistry. He currently consults with the sleep respiratory physician team at Lung And Sleep Victoria, and the specialised TMJ physiotherapy team at the Melbourne TMJ & Facial Pain Centre. He has presented lectures and held seminars to medical and dental professionals to spread the knowledge that dentists can help one’s health and quality of life “beyond the mouth.” You can find free online lectures presented by Damian on https://sleeptmjstudyclub.teachable.com/ and he also has a Facebook dentist group: Sleep & TMJ Study Club where he uploads cases and tips for dentists treating TMD, bruxism and sleep disorders.

What do you think is the most common misconception about TMD?

I believe the biggest misconception is: “I can treat the TMJ alone.” This doesn’t apply just to dentists, this applies to any health professional that delves into treating TMD (e.g. physiotherapists, chiropractors, surgeons etc). When I first started my TMD journey, I was so amazed by the knowledge I was exposed to. I was taught not just about the TMJ, but I was taught about head/neck posture, chronic pain neurology, sleep apnoea, proper sleep, proper nasal breathing, myofunctional therapy, nutrition and more (and this was all from just one TMD residency).

This made me understand that I alone, as a dentist, can only do so much. The reality is, most of the treatment us dentists can offer our patients for TMD is a splint (sometimes surgery or orthodontics). The design, and bite registration of the splint is important, but end of the day, the splint can only do so much, and if we become too dependent on the splint, we’ll limit the amount we can help our patient. A splint won’t fix all our patient’s postural issues, or improve their diet, or unblock their nose. A splint may be able to “help” these issues, but very likely, we will need to work with a team of other health professionals to properly help our patients. I send 80-90% of my TMD splint patients to a properly trained TMD physiotherapist, chiropractor, or osteopath. I currently work a few days in a TMD physiotherapy clinic, and the recovery rate in my patients has improved rapidly, compared to when I was treating with only a splint. My treatment modality has changed to the point, some of my patients; don’t even need a splint.   

What do general dentists/ specialists often miss when diagnosing and or managing TMD?

The first thing I learnt about properly treating TMD, is to look at the sleep and breathing. There is a huge link between TMD and sleep breathing disorders such as snoring and obstructive sleep apnoea (OSA). Proper quality sleep is so important in the maintenance of many bodily functions we use daily. For example, if we are sleep deprived, our body’s immune system and healing rate decreases, and our sensitivity to pain increases. Many chronic pain patients (which include TMD sufferers) are sleep deprived, which will contribute to their TMD pain. 

Many of my TMD patients have undiagnosed OSA (and vice versa), and sometimes the key to treating them, is focusing on their sleep. During my other work days, I consult in a specialist sleep physician clinic and I see many OSA patients with undiagnosed TMD and bruxism everyday. The relationship I see joining these OSA and TMD patients is sleep bruxism. One theory in the literature relating to sleep bruxism, is the tensing of the orofacial musculature (bruxism) is a sympathetic nervous system response to help the person breathe when they are choking (e.g. experiencing snoring or apnoea). If you ever see a TMD or bruxism patient in your clinic, before you shove a splint in their mouth, first assess their breathing and sleep.

In your experience, what did you find to be the most interesting thing you have learned about the field?

Learning about TMD opened my eyes to look into the health of humans as a whole. I was really fascinated to learn how a healthy human body works, and how sometimes innocuous things such as changing our diet, can “fix” a person’s TMD. In these chronic pain patients, some people say the body is in a chronic “fight-flight” state. We should only be in a fight-flight state when we are in danger. We shouldn’t be in a fight-flight state watching TV at home. E.g. At home, we want our smoke alarm to go off while there’s a fire. We do not want it to go off when we’re cooking. A person in chronic pain, has a ‘smoke alarm’ that goes off whenever we’re cooking. Their senses are constantly ‘fighting/flighting’ to protect itself.

The fight-flight response involves activation of the sympathetic nervous system. Activation of the sympathetic nervous system triggers a number of bodily responses such as increased ventilation (breathing issues), increase in adrenaline/noradrenaline (disturbs our sleep), increase in cortisol (increase stress- bruxism), inhibits bladder contraction and reduction in digestion (diet/stomach issues). If our body is constantly performing the above actions 24/7, our overall health will gradually decline, and a piece of acrylic in the mouth is only going to help so much. I believe our role as health practitioners in this field, is to recognise these people are suffering many bodily changes, and our goal should be to try guide them from a sympathetic ‘fight-flight’ state towards a parasympathetic relaxed state. Treating their TMD will help start them down this path of healing, though dentists may only be a small piece of the puzzle. 

Some of the most interesting things I have learnt in this field are from my own patients. I have seen patients suffering from debilitating TMD for years, and I was able to eliminate 90% of their pain with a splint. However, the last 10% still lingers. Then, these same patients were able to completely eliminate their pain by starting a gluten free diet, or starting personal training to strengthen their core muscles and posture, or sometimes learning to breathe properly through their nose using their diaphragm. These encounters fascinate me, because it goes to show how amazing and complex our bodies are.

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