Prof.Dr Anmol Agarwal

TOPIC - Sleepy Eyes and the Dancing jaws – A mystery unveiled (40 MIN )

Abstract

The masticatory organ which originally developed as a tool of expressing aggression for emotional management, has evolved over geological time. According to literature majority of patients diagnosed with Temporomandibular Joint Disorders (TMDs) are found to have concomitant sleep related issues. These individuals usually suffer from apnoea while sleeping, which initiates an automatic response resulting in forward and backward movement of the mandible in order to keep the airway patent. This repetitive jaw-muscle activity is characterized by clenching, grinding, bracing or thrusting and is termed as ‘Sleep Bruxism’ (SB) which is considered a function of the masticatory organ to cope with stress. It is known to down-regulate the limbic system (LS), the autonomic nervous system (ANS), and the hypothalamic-pituitary- adrenal (HPA) axis thereby mitigate stress-induced psychosomatic disorders. SB is also known to result in activation of a powerful cranial reflex called The Trigemino-Cardiac Reflex (TCR), that alters the heart rate, respiration, blood pressure, gastric motility and cranial pressure. On one side where extreme forces produced due to SB results in dental damage, TMDs, myofascial pain, and tension/migraine type headaches (migraines without aura), TCR might be playing a protective role, while an exaggerated form of this reflex could be responsible for Sleep Death (SD) and Sudden Infant Death Syndrome (SIDS). When evaluating patients who present with symptoms of TMDs, it is important to consider sleep-related causes, in particular SB and its relation with HPA axis & TCR. Based on available literature and exemplary cases, the TCR can be thought of as also playing an important role in various sleep disorders, though further evidence is warranted before it can be definitively implicated. Prof. Agarwal will be talking about the relation between SB, HPA axis, TCR and their role in patients suffering from TMDs.