In their study, Li and colleagues found that gastroesophageal reflux disease (GERD) was associated with temporomandibular disorders (TMDs), mediated to a certain extent by somatization, anxiety and poor sleep.1 However, the authors did not describe a contributory pathophysiological mechanism, hyperventilation,2 or assessment of breathing pattern and posture.
Relaxed diaphragmatic breathing appears to reduce the severity of GERD.3 During inspiration, the crural diaphragm provides an additional extrinsic sphincter independent of the lower esophageal 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 is an effective, proven therapy for GERD.3,4
A consideration of breathing patterns potentially explains how biomechanical factors associated with psychosocial influences might contribute to pathophysiological changes in the temporomandibular joint.5 Patients with a dysfunctional breathing pattern typically have rounded shoulders and a forward head posture,6 which is implicated in TMDs.7 A forward head posture is believed to alter occlusion, lead to increased posterior tooth contact and increased temporomandibular joint compression: all anatomic changes emphasized in TMDs.6
The restoration of diaphragmatic breathing is an important musculoskeletal and psychological therapy used in helping patients with TMDs.6,8 Relaxed diaphragmatic breathing techniques also have an important role in managing anxiety9 and improving sleep quality.10
An assessment of a patient’s posture and breathing pattern and, when necessary, instruction in relaxed diaphragmatic breathing may help people with these pathologies. Future research might also consider use of the Nijmegen questionnaire.2
Footnotes
Competing interests: None declared.