Wanting to add some support to SnuzyQ's answer.
In my case, the TMJ problems preceded the OSA by several decades. But they were always managed decently enough by the standard TMJ guards that a family dentist can easily make---except that I tended to chew through them at an accelerated rate.
After starting CPAP, I cracked my current guard, went to my family dentist and he made another one. That one cracked after less than 2 months of wearing it with my nasal pillows mask. The family dentist was frank with me and told me he was no longer comfortable treating my TMJ and referred me to a dentist who specializes in treating TMJ and oralfacial pain (and who also does make oral appliances for OSA).
In my case, the TMJ specialist is covered
by my insurance. The kicker is he never charges anything under "TMJ". All the claims go through codes for "oral facial pain" problems. After doing some diagnostic studies to get some real data concerning the mechanical functioning of my TMJs, he designed a treatment plan that allowed my TMJs to actually heal from the years of being dislocated every time I opened or shut my mouth. The treatment plan consisted of several coordinated things:
- a slightly more specialized guard to encourage my jaw to close in a position that is more forward (and where my TMJs want the jaw to be. At the start of the treatment cycle, I was wearing the guard 24/7 including when I was eating.
- a no-chew diet for two months, followed by a soft chew diet for another couple of months followed by a slow return to a normal diet
- ample use of moist heat on the TMJs. At the start I was using a moist heating pad for 20 minutes per side three or four times a day.
- a very slow weaning of the day time use of the oral appliance.
Things pretty much worked as planned---except that I chewed through the guard much faster than the specialist had anticipated. So he made another one. And I chewed through it. So he made a third. I didn't chew through that one right away. And after about a year or so of treatment, my TMJs were feeling substantially better (as in almost entirely pain free every day) and the specialist said, "We don't need to see you any more unless you start having problems again."
Problems started up about nine months later and included my chewing through the guard along with substantially increased pain. After a quick call to the specialist, they got me in for another evaluation and to make another guard. And recommendations to wear the new guard 24/7 as needed and to go back to a soft-chew diet and start using moist heat. All of which helped, but I chewed through in less than a month. And then they made me a day guard as well as the night guard. And I chewed through it too. This past fall, the specialist was looking at the two recently demolished guards (one upper and one lower), and said that he had an idea of what might be causing me to demolish the guards so quickly and we scheduled an hour long appointment for him to take a whole bunch of additional measurements before
crafting yet another guard. This time, he took multiple measurements of how my TMJs wanted to functionally close and how my teeth wanted to functionally close. The two do NOT agree on how my mouth should close. And this discrepancy together with the fact that the previous guards would favor one over the other caused a feedback loop to be set up in my brain when wearing a guard. Which lead to the chewing and grinding. So the new guard was designed with all this in mind and it's now almost 3 months old. I've had two follow-ups to see how its officially holding up and how the TMJs are doing since the guard was made. Both times, the specialist made a few modest adjustments to the guard, but both he and I are pleasantly surprised by the fact that the wear/chew marks on this guard are minimal so far. And the TMJ pain is back down to a very low level and sometimes is even gone. And I've been able to wean myself off daytime use of the guard without any real problems in terms of TMJ pain.
And all of this---including the cost of something like 5 or 6 night guards in the last 2 years---has been paid for by my health insurance
because it's been billed under a medical code for oralfacial pain instead of "TMJ disorder." All I've had to pay for are the co-pays for the office visits and the co-pays for the original diagnostic testing.
The points of my story?
1) It's worth asking TMJ specialists if they take health insurance instead of just dental insurance. If they do, they've probably figured out a way to code the treatment they provide in a way that gets them compensated while allowing you to pay your normal copays.
2) It can take some time and patience to properly treat the TMJ issues as opposed to just "managing" them. Hence it's important to find someone who is willing to work with you long term if need be on addressing the TMJ issues. I was (and continue) to be amazed at how much better my TMJs function in the daytime now that my mouth is closing in a slightly different way that has my lower jaw somewhat further forward than how it was closing before treatment.