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In their paper, where symptomatic gastro-oesophageal reflux disease (GERD) and temporomandibular joint (TMJ) disease was associated with somatization, anxiety and poor sleep,1 a contributory pathophysiological mechanism, hyperventilation,2 and/ or assessment of the patients’ breathing pattern and posture was not described.
Relaxed diaphragmatic breathing appears to reduce GERD severity.3 During inspiration, the crural diaphragm provides an additional extrinsic sphincter independent of the lower oesophageal sphincter.3 As assessed by pH-metry, quality of life scores and proton pump inhibitor usage, relaxed diaphragmatic breathing reduces GERD severity.4 The teaching of relaxation skills and coping strategies are effective, proven TMJ disease therapies. A consideration of breathing patterns potentially explains how biomechanical factors associated with psychosocial influences might contribute to TMJ pathophysiological changes.5 Patients with a dysfunctional breathing pattern typically have rounded shoulders and a forward head position (FHP),6 which is implicated in TMJ disease.7 A FHP is believed to alter occlusion, lead to increased posterior tooth contact and increased TMJ compression: all anatomical changes emphasized in TMJ disease.6 The restoration of diaphragmatic breathing is an important musculoskeletal and psychological therapy used in helping TMJ disease patients,6,8 Relaxed diaphragmatic breathing techniques have an important role in anxiety management,9 and in improving sleep quality.10
An assessment of a patient’s posture and breathing pattern, and when necessary instruction in relaxed diaphragmatic breathing can help people with these pathologies. Future research might also consider use of the Nijmegen Questionnaire.2
Jim Bartley
[email protected]
Otolaryngologist/ Pain Medicine Physician
Counties Manukau District Health Board
Auckland, New Zealand
References
1. Li Y, Fang M, Niu L, et al. Associations among gastroesophageal reflux disease, mental disorders, sleep and chronic temporomandibular disorder: a case-control study. CMAJ 2019; 191: E909-E15.
2. Vansteenkiste J, Rochette F, Demedts M. Diagnostic tests of hyperventilation syndrome. Eur Respir J 1991; 4: 393-9.
3. Casale M, Sabatino L, Moffa A, et al. Breathing training on lower esophageal sphincter as a complementary treatment of gastroesophageal reflux disease (GERD): a systematic review. Eur Rev Med Pharmacol Sci 2016; 20: 4547-452.
4. Eherer A, Netolitzky F, Högenauer C, et al. Positive effect of abdominal breathing exercise on gastroesophageal reflux disease: a randomized controlled study. Am J Gastroenterol. 2012; 107: 372-8.
5. Bartley J. Breathing and temporomandibular joint disease. J Bodyw Mov Ther 2011; 15: 291-7.
6. Hruska RJJ. Influences of dysfunctional respiratory mechanics on orofacial pain. Dent Clin North Am. 1997; 41: 211-27.
7. Rocha CP, Croci CS, Caria PH. Is there relationship between temporomandibular disorders and head and cervical posture? A systematic review. J Oral Rehabil. 2013; 40: 875-81.
8. Sherman JJ, Turk DC. Nonpharmacologic approaches to the management of myofascial temporomandibular joint disorders. Curr Pain Headache Rep 2001; 5: e431.
9. Jerath R, Crawford MW, Barnes VA, Harden K. Self-regulation of breathing as a primary treatment for anxiety. Appl Psychophysiol Biofeedbac. 2015; 40: 107-15.
10. Neuendorf R, Wahbeh H, Chamine I, et al. The effects of mind-body interventions on sleep quality: a systematic review. Evid Based Complement Alternat Med. 2015; 2015: 902708.