Hi all of my wonderful TMJoiners! I’m Priya Mistry the TMJ doc and in this video we are going to
be talking about mouth breathing, forward head posture, and TMJ Disorders. This video is part 2
of a 2 part series. So I would encourage you that if you have not seen Part 1, please stop and watch
that now because the information in both of these videos is pretty complex if you haven't heard it
before and I truly believe that you'll understand Part 2 - this video - better if you watch part 1.
In Part 1, I spoke a lot about tongue posture, about mouth breathing,
and about airway - so I'm going to be taking all of that and relating it to forward head posture
and how all of that can kind of come together and lead to TMJ Disorders. So again the
information in both of these videos is quite complex. I call both of these videos "information
heavy" so they really come as a pair. So again, be sure to watch part 1 before watching this one.
All of these things that I'm mentioning - tongue posture, mouth breathing, airway, forward head
posture - they're all related even though they might seem like they're all all separate issues!
Before getting into it, be sure to check my social media and my office website for more
information on TMJD. Or pick up the phone and give our office a call and set up your first
appointment if you're looking for TMJD relief. As for this channel, please be sure to hit
that Subscribe and the little bell notification button to get notified of when each video is out.
For those of you who don’t know me, I’m a general dentist with a practice in Vancouver,
Washington where we are dedicated to taking care of patients with TMJ disorders.
So now let’s get right into it. At the end of Part 1, I sort of left off with bringing together the
concepts of tongue posture and nasal breathing vs. mouth breathing. so let's review that really
quickly. Those with correct tongue posture - with their tongue up against the roof of the mouth
with a light suction - tend to breathe through their noses. Those with low or incorrect tongue
posture tend to breathe through their mouths. Those who breathe through the mouth and have
that low tongue posture also tend to have smaller and narrower nasopharyngeal airways,
the air space behind the nose and the mouth. This CBCT - Cone Beam Computed Tomography - scan
shows the airway in black and I'm highlighting it here. The image on the left shows a nice,
wide airway and correct tongue posture. The second image shows a constricted, narrow,
smaller airway and that low tongue posture that's associated with mouth breathing.
The way this relates to forward head posture is that those with a narrow airway will over time
adapt a forward head posture to ease the burden of breathing and make it less difficult.
Bringing the head and therefore the jaw bone and therefore the tongue forward actually widens the
airway and makes breathing easier. Essentially bringing the head forward brings the tongue out
of the airway. This forward head posture will make breathing less difficult for those who breathe
through their mouths. So examples of famous people who are likely mouth breathers because they have
this forward head posture are Napoleon Dynamite - I don't know the actor's name sorry. Ray Romano
who I love and adore - I love "Everybody Loves Raymond" but he's definitely got that forward
head posture and there's so many more but those are just the two that come to mind right now.
So this forward head posture over time will have negative impacts on the neck,
which will then feed up and affect the jaw.
Each inch the head is forward from ideal - ideal posture is having the ears and
shoulders in line with the hips and feet - so every inch that the head is forward from that
adds an additional 10 pounds of strain and pressure on the cervical spine and the muscles
of the neck. The neck and jaw are intimately related which I talk about in depth in my video
called “Neck Pain and TMJD” which I've linked above and below so be sure to check that out.
Neck strain can contribute to muscle dysfunction in the head, neck, and jaw which can then cause
a lot of pain - headaches, neck pain, and jaw pain which are classic symptoms of TMJ Disorders.
In Part 1, I talk about tongue posture and how it affects development of the bones in the face.
Correct tongue posture supports ideal development. So what happens with correct tongue posture is
that the jaw bone here and the maxillary bones - these bones right here - develop forward and
wide which is ideal growth. With low tongue posture, we see that these bones
tend to grow narrow, long, and sit too far back. That includes his jaw bone right here.
An underdeveloped jaw bone - one that did not grow forward and sits too far back - will increase the
chances of dysfunction inside of the jaw joints. This then leads to clicking, popping, and episodes
of the jaw actually locking. This image shows the components of the temporomandibular joint - the
TMJ, the jaw joint. The condyle is the little bony knob that our jaw bone ends on. On top of
that condyle sits a disc of cartilaginous tissue called the articular disc. Above that disc is the
temporal bone - which is a skull bone. In an ideal situation, the articular disc should sit on top of
the condyle kind like a hoody and when we open and close, it should stay on top of the condyle
and there should be NO clicking and popping noises. So that's ideal. When that disc starts
coming in and out of alignment, it will click and pop and make noises - which is NOT ideal.
When that disc is out of alignment, it typically comes too far forward and goes
sort of in towards the centers of our heads. When the jaw bone - the mandible here - does not grow
forward which is ideal, there's a higher chance of the disc coming out of alignment.
So think about that, if the jaw bone sits too far back due to lack of forward growth - which
I covered in depth in part 1 of this series - then that means that the condyle - the little bony knob
that the jaw bone ends on - also sits too far back far from ideal. This makes it easier for
the disc to come out of alignment too far forward leading to the clicking and popping noises.
Those with clicks and pops are actually at a higher risk for the jaw locking closed - which
is a very painful condition during which you can barely open more than 1-2 finger widths. During
this condition, the articular disc is actually dislocated - it's displaced too far forward and
so there are no clicks or pops - that's actually stopped at that point - and the disc is actually
serving as a barrier to opening. It's incredibly painful and it's not fun to go through. So the
point I want to really drive home here is that if the jaw bone is sitting too far back
due to lack of forward growth, there's a higher chance of developing dysfunction in the jaw joints
with the articular disc coming out of alignment too far forward more easily.
At my TMJD-only practice, the majority of my patients
have forward head posture, underdeveloped facial structure, low tongue posture, narrow airways,
sleep disordered breathing, and breathe through their mouths. I don't think this is a coincidence.
I just see it way too much. And all of that can come together and then lead to TMJ Disorders.
I strongly believe that all of this related, all of this is correlated,
connected, however you want to say it because I literally see multiple times every single day.
If you’re watching this and you notice these same things - forward head posture, low tongue posture,
narrow airway, sleep disordered breathing - with YOURSELF, with a friend or a family member, do NOT
panic. Things can be done to correct all of this, but they must be done slowly in the correct order
over time. Trying to fix everything overnight can lead to more dysfunction, it can strain
the muscles of the head, neck, and jaw and it can cause a lot of pain. So please don’t try to
correct your tongue posture or force yourself to breathe through your nose if you just can't do it.
You could end up kind of making things worse, especially if you're already having pain.
Tongue posture, the ability to breathe through your nose - these things should
be evaluated by a professional and then treated by that professional.
If you're having TMJ issues, I'd first recommend getting evaluated and treated by a TMJ
Dentist or TMJ Physical Therapist. If you're concerned about sleep disordered breathing,
you can always consult with a Sleep Doctor to see if they recommend a sleep study.
If you have difficulty breathing through your nose, I’d recommend seeing an ENT - an Ears,
Nose, and Throat doctor - also called an Otalaryngologist. Quite a mouthful there.
If you have low tongue posture and this is something that concerns you,
I'd recommend seeing a provider who is skilled and trained in providing Myofunctional Therapy.
Myofunctional Therapy is a very specific type of physical therapy for the muscles of the head,
neck, and jaw and specifically the muscles that surround and support the tongue. These are all
good first steps to take and again, please don’t try to “correct” any of this on your
own at home because it could lead to just too much strain in the muscles of the head, neck, and jaw.
Additionally, I’d HIGHLY recommend reading the book “Breath” by James Nestor. This book
is jam packed with information about the far-reaching negative effects of mouth breathing
and these effects can be on the entire body. So I learned a lot by reading this book.
It's also of course jam packed with information about the positive effects
of nasal breathing - breathing through your nose. So this book even encouraged me to change the way
that I breathe, and I'm primarily a nose breather. So I'd really recommend picking
this book if you have some time for reading. So I've linked this in the description box
below - please be sure to check it out. It is a wealth of information - thank you James Nestor!
So that’s really it my friends! Again, I’m Dr. Mistry and I hope you found the information in
this video helpful. If so, please feel free to like, Subscribe, and share with your family and
friends! For TMJD relief from the comfort of your own home, please download my free PDF Guide called
“3 Steps to TMJ Relief”. This is available on my office website - which is linked below. As always,
questions and comments are always welcome. Please feel free to let me know if you learned anything
from this 2 part video series, I suppose. There's a lot of information so you may need to watch it
a couple of times but I'd love to know if you've learned anything about yourself, a family member,
a friend, etc. And remember, my friends, you can never have TMI about TMJ! Thank you!