When your turns start getting more tension OR you’ve reached 20 turns — whichever comes first
It’s now time to measure the centinewton force of your turns. The reason we do this is because with Dr. Adams SLOW MASPE Protocol, he likes the max force of your turns to stay between 500-700 cN.
If you haven’t already received a gauge to measure with, please contact the office, and we will send one to you.
Measuring is easy! Follow the simple steps outlined in the video below, and always let us know if you reach 700 cN on a turn or if there is any pain associated with turns. We’re always here for you if you have any questions or concerns. If something comes up after hours, you are welcome to text our after-hours line for assistance.
Mild pressure/soreness is normal – Take ibuprofen 400–800 mg every 8 hours as needed (or acetaminophen if you have ibuprofen allergy or contraindication).*
Speech may sound “lispy” – this usually improves with time.
Increased saliva – this typically reduces as your body gets adjusted to the new appliance.
1. Palatal Expansion (MASPE)
Follow Dr. Adams’ exact schedule. Most patients start with:
1 turn every OTHER day
How to Turn
Insert wrench onto center of appliance at the roof of your mouth.
Turn downward until the wrench touches your lower teeth — that’s 1 full turn (~1/12 mm).
Remove wrench straight out.
NEVER turn more often than instructed.
Notify Us Immediately If:
You feel pain when turning
A space opens between front teeth that floss passes through easily (no rubbing)
Turns feel harder than usual
You have any questions or concerns — we’re here to help!
2. Starting & Changing SPARK Clear Aligners
(Only begin when Dr. Adams says “GO”)
Rule
Details
Wear Time
22+ hours/day — remove only to eat/drink
Change Schedule
Every 7 days (or as Dr. Adams directs)
Scanning
Scan weekly using Dental Monitoring app — WAIT FOR “APPROVED” before changing trays
Fit Issues
If tray feels tight, loose, or painful → contact us same day
Keep Prior Trays
Always save the last 2 trays (in case we need to step back)
Drinks
Only water with trays in. Remove for all food/drinks (except water). Rinse mouth before re-inserting.
Cleaning
Use retainer tablets or sonic cleaner daily
3. Dental Monitoring – Remote Scanning
Download the Dental Monitoring app (iOS/Android)
Activate your account using the text/email link we send
Scan weekly on your assigned day/time
Wait for GREEN “APPROVED” before advancing to next tray
4. Oral Hygiene (Non-Negotiable)
Task
Frequency
WaterpikMASPE Appliance
After every meal (minimum 3×/day)
Brush teeth& Floss
2×/day minimum (soft brush around MASPE)
Mouthwash
As directed by regular dentist (who does cleaning)
Regular dentist
Cleanings every 6 months (or as advised)
5. Emergency? Call or Text SAME DAY
Office: 703.712.1053 Email photos to: tmjsleepbreathe@gmail.com After-Hours: Text 240.277.2627
Red Flags:
Pain with turning
Tray won’t seat fully
Lost/broken wrench
Bleeding, swelling, sores >3 days
We’re thrilled to guide you through MASPE expansion with SPARK clear aligners! Share progress photos or wins anytime — it brightens our day! 😊
*Please inform our office if you have any drug allergies and/or Medical conditions that prevent NSAID use (e.g., ulcers, kidney issues, blood thinners.
Wait until ALL numbness from the procedure is gone before eating anything that requires chewing OR any food or drink that is hot.
Eat a well-balanced diet, focusing on soft foods (e.g., yogurt, eggs, smoothies) for the first 48 hours. Avoid hard, crunchy, sticky, or chewy foods (e.g., nuts, gum, hard bread) to protect the TAD site.
Drink plenty of water, but avoid straws for the first 24 hours to reduce pressure in the mouth.
Medications
All instructions regarding medication apply, unless you have a contraindication (like drug allergy) or have been otherwise directed by Dr. Adams or another doctor.
Follow Dr. Adams’ instructions for any prescribed or recommended medications.
Ibuprofen: Take 600-800 mg of ibuprofen every 8 hours for the first 3 days, and then as needed to manage pain and inflammation. Take with food to avoid upset stomach.
Dexamethasone (if prescribed): Take IN ADDITION TO ibuprofen for best results or as directed by Dr. Adams. Complete the entire course as prescribed.
If Ibuprofen alone does not control pain, alternate Ibuprofen (600-800 mg) and Tylenol (500 mg) every 8 hours.
Example Schedule:
8:00 AM: Ibuprofen 600-800 mg
12:00 PM: Tylenol 500 mg
4:00 PM: Ibuprofen 600-800 mg
8:00 PM: Tylenol 500 mg
12:00 AM: Ibuprofen 600-800 mg
Do not exceed 2400 mg Ibuprofen or 1500 mg Tylenol in a 24-hour period.
Oral Hygiene
Keep the area clean: Use a Waterpik and soft toothbrush to gently clean around the TAD sites, preferably after every meal, and no less than 3x daily. Avoid aggressive brushing to prevent irritation or dislodgement. Our preferred toothbrush is Sonicare.
Avoid harsh mouthwashes, like Listerine, for the first 4 weeks.
Rinse with warm salt water (1 tsp in 8 oz of warm water) twice daily for at least the first 5 days to promote healing.
Resume normal brushing and flossing, being cautious near TADs.
Activity – Warning Signs – Follow Up
Rest for 24-48 hours: Avoid strenuous activities (e.g., heavy lifting, intense exercise) for 1-2 days to minimize swelling or bleeding.
Contact our office or seek immediate care if you notice and of the following:
severe pain not relieved by Ibuprofen or Tylenol
Excessive bleeding or swelling that worsens after 48 hours
TAD feels loose or moves significantly
Signs of infection (redness, warmth, pus, or fever above 100.4 F
Difficulty swallowing or breathing
Follow Up: Your next visit will be to install your MASPE appliance. If this was not scheduled at your TADs appointment, please contact us ASAP to schedule.
For any concerns prior to your next visit, please call or email us anytime.
AVOID smoking or alcohol for at least 48 hours, as these can delay healing.
If the tip of your tongue cannot reach the roof of your mouth while your mouth is fully open, that can be a sign of a tongue restriction, aka tongue tie. Tongue ties are often linked to TMJ pain, clenching, tension, and even airway issues.
The tongue is supposed to rest fully against the palate. That stabilizes the jaw joint, helps guide proper muscle function, and even regulates how we breathe. If you can’t rest your tongue properly and you’re experiencing TMJ pain, it might indicate that a functional tongue tie release, combined with myofunctional therapy, will be appropriate.
We offer in-person and virtual Myofunctional Therapy. Contact our office to schedule an assessment to get started.
An anterior open bite can be caused by the tongue thrusting forward against the teeth and through the teeth when swallowing.
Let’s review a case, Maria, our Orofacial Myologist has worked on. When we first saw the patient, she had an anterior open bite due to tongue thrust, and her tongue sat low in her mouth due to a tongue tie. She was also a mouth breather. The constant pressure of the tongue against her teeth flared the teeth forward and prevented the bite from closing naturally.
Open Bite & Tongue Thrust Improvement
After releasing the tongue tie and working consistently with myofunctional therapy, the tongue no longer presses against the front teeth. Instead, it rests high in the palate where it naturally supports proper jaw growth. Watch this short video of Maria taking you through the case and showing the results:
Is mouth taping while you sleep good or bad? Well, that depends on why you are mouth breathing and snoring. Before deciding if you should mouth tape while you sleep, it’s important to understand the root cause of why you are mouth breathing and snoring at night.
When mouth taping is bad
Many times, snoring and mouth breathing while sleeping are caused by having an obstructed airway. You may have enlarged tonsils, enlarged adenoids, poor tongue posture, or a mouth that doesn’t have enough room for your tongue to stay on your palate and out of your airway. If you tape your mouth while you sleep when you have a functional problem preventing proper nasal breathing at night, you will be forcing yourself to breathe out of an obstructed airway. If there is a functional reason why you are mouthbreathing, that means you are mouthbreathing out of necessity. In these cases, mouth taping will not correct these problems and is not advisable.
Root cause of snoring and mouthbreathing
If you snore at night and mouth breathe, an assessment by a myofunctional therapist and airway-focused dentist can help determine the root cause of these issues. Often, a combination of expansion and myofunctional therapy can train the tongue to posture on the roof of the mouth with light suction, greatly improving or resolving these issues.
When mouth taping is good
Once you’ve addressed any functional problems leading to nighttime snoring and mouthbreathing, mouth tape can be used as a gentle reminder to seal your lips and nasal breathe while sleeping. Mouth tape should not be needed long-term. If it is, that likely means you still have functional problems that need to be addressed.
Our approach to fixing mouthbreathing
At TMJ Sleep & Breathe Center in Vienna, VA, Dr. Gary Adams and our Orofacial Myologist Maria, use a team approach to identify root cause issues and treat patients with mouth breathing, TMJ, and sleep issues. Usually, the treatment consists of identifying functional airway problems and treating them with myofunctional therapy, as well as the use of expanders to make more room in the mouth for the tongue.
Ehlers-Danlos Syndrome (EDS) is a connective tissue disorder known for causing joint hypermobility, chronic pain, and widespread instability—especially in the head, neck, and spine. Many EDS patients live with constant discomfort, unexplained tension, and musculoskeletal misalignment that conventional medical and dental treatments often overlook.
What many don’t realize is that jaw position and bite alignment play a crucial role in overall postural stability. At TMJ Sleep and Breathe Center, we offer a treatment approach that can relieve these interconnected symptoms: neuromuscular bite splints.
Understanding the EDS Connection: Why Bite Matters
EDS patients often experience:
Craniocervical instability (CCI)
Atlantoaxial instability (AAI)
Neck and shoulder tension
Chronic headaches or migraines
Poor postural control
Jaw pain, clicking, or facial tension
When the jaw is misaligned—even slightly—it disrupts the delicate balance of the muscles that connect the head, jaw, neck, and spine. This leads to compensation patterns throughout the body, which worsen the instability already present in EDS.
A properly designed bite splint can reduce these imbalances and ease the burden on overstretched or overactive muscles.
Why a Bite Splint (Not a Night Guard) Is Key for EDS Patients
Most EDS patients who seek dental help for clenching, TMJ, or jaw pain are prescribed night guards. While night guards protect the teeth from grinding, they do not:
Address the root cause of clenching
Balance the bite or jaw joints
Improve posture or neuromuscular function
Reduce muscle overactivity
In fact, bulky upper night guards may interfere with natural cranial motion, which is critical for patients with connective tissue instability.
By contrast, a bite splint (also called a TMJ orthotic or neuromuscular splint) is a custom therapeutic appliance that:
Fits the lower teeth, preserving cranial rhythm
Repositions the jaw into a neutral bite position
Relieves tension in the masseter, temporalis, and trapezius muscles
Helps align the head and neck
Encourages better tongue posture and airway function
Stabilizing the System: Head, Neck & Spine
Because the jaw joint (TMJ) is intimately connected with the upper cervical spine, correcting the bite has cascading effects:
Improved jaw alignment reduces cervical strain
Balanced muscle tone leads to less neck and shoulder tension
Neutral head posture can relieve back pain and instability
Proper tongue position supports the airway and spinal posture
For EDS patients, whose joints are already more vulnerable to misalignment, restoring neuromuscular harmony is not just helpful—it’s essential. Bite splints are sometimes incorrectly called occlusal guards or occlusal orthotic devices.
Our Process: Precision Bite Splints for EDS Support
At TMJ Sleep and Breathe Center, our bite splints are crafted with exceptional precision. This is not a boil-and-bite or lab-milled night guard. We use:
CBCT imaging to evaluate your airway and TMJ joints
Jaw tracking to assess muscular function and movement
Precise bite registration to capture the true neutral position
Custom lower appliances to support cranial movement
These devices are often the first step in treating chronic pain, instability, and dysfunction in EDS patients.
Who Can Benefit?
A properly calibrated bite splint may be ideal for EDS patients dealing with:
Chronic head or neck pain
Jaw clicking, locking, or muscle fatigue
Difficulty maintaining upright posture
Cervical spine or craniocervical instability
TMJ-related dizziness, tinnitus, or balance issues
Airway dysfunction or sleep-disordered breathing
We often use the bite splint as a diagnostic and therapeutic tool, sometimes in conjunction with:
Orthodontic expanders
Clear aligners (e.g., Invisalign)
Postural rehabilitation
Myofunctional therapy
In Summary-Bite Splint Therapy for EDS patients
For EDS patients, the road to pain relief and postural stability can feel long and frustrating. But addressing the jaw as a foundational structure of the head and neck may be the missing piece.
A bite splint is not just about the teeth—it’s about calming the entire musculoskeletal system and giving the body a stable foundation from the top down.
If you’ve been told to wear a night guard but still experience pain, fatigue, or instability, we invite you to schedule a consultation. Let’s determine whether a custom neuromuscular bite splint can help restore balance and comfort in your life.
Facial asymmetry in children and adults can often be traced back to imbalances in oral function and skeletal growth—especially when the tongue isn’t positioned correctly on the palate, or when tethered oral tissues (like tongue, lip, or buccal ties) pull unevenly on facial muscles and bones. At TMJ Sleep and Breathe Center, we use a holistic approach to the treatment of facial asymmetries that includes neutral bite plane appliances, frenectomy procedures, and myofunctional therapy to help the face grow more symmetrically from the inside out.
How Facial Asymmetries Develop
Facial asymmetry doesn’t usually result from trauma or genetics alone. It frequently stems from functional imbalances during growth, including:
1. Tongue Posture and Jaw Development
When the tongue does not rest on the roof of the mouth (the palate), it loses its natural role as an internal support for the upper jaw. Without that gentle, upward pressure:
The maxilla (upper jaw) can collapse downward
One side of the jaw may drop lower than the other
The entire midface can shift off-center
Facial elongation and asymmetry become more pronounced
2. Tethered Oral Tissues (Ties)
Tight tongue, lip, or buccal ties restrict movement and create asymmetric tension. When these restrictions are tighter on one side than the other:
Facial growth can be pulled unevenly
The jaw may grow at an angle
Cheeks and eye areas may appear imbalanced
3. Mouth Breathing and Muscle Imbalance
Chronic mouth breathing—often resulting from nasal obstruction, ties, or improper tongue posture—disrupts normal facial muscle tone and growth direction. This can:
Cause one side of the face to be more active than the other
Lead to muscular asymmetry and slanted growth patterns
The Role of the Bite Plane in Facial Balance
Bite plane appliances are used in many of our orthopedic and orthodontic devices to support the jaw in a neutral, balanced position. This “neutral bite plane” encourages:
Relaxation of head, neck, and jaw muscles
Equalized pressure across the dental arches
A more centered lower jaw position
Improved symmetry in bite force and muscular tone
By reducing the influence of an unbalanced bite, the bite plane gives the bones and soft tissues a chance to grow and settle more symmetrically.
Many of our appliances—including the Homeoblock, Schwarz, DNA appliance, and even our MASPE expanders can incorporate bite planes designed to encourage symmetry during growth.
Pairing Bite Plane Therapy with Tie Releases and Myofunctional Work
The best results in correcting facial asymmetry come from addressing both the structure and function of the oral environment. At TMJ Sleep and Breathe Center, we often pair bite plane therapy with:
1. Laser Release of Lip, Buccal, and Tongue Ties
When ties are released—especially if one side is more restricted than the other—we often see a dramatic shift toward more balanced growth and posture. We use the LightScalpel CO2 laser for precise, low-trauma frenectomies. Benefits include:
Improved tongue range of motion
Elimination of asymmetrical tension from one-sided restrictions
When combined with appliance therapy and tie release, myofunctional therapy reinforces the newly balanced environment and helps guide symmetrical growth.
Why Early Intervention Matters
Children’s faces grow rapidly—and the earlier we intervene, the more we can influence bone remodeling and symmetry. That said, adults can also benefit from this integrated approach. Facial asymmetries in adults may soften, and muscular imbalances can often be retrained and improved over time.
Signs your child (or you) may benefit from this treatment approach include:
A noticeable midline shift
Asymmetrical smile or jaw movements
Chronic teeth clenching or grinding
Mouth breathing
Narrow or high-arched palate
Slanted eye or cheek level in photos
Our Holistic Approach to Facial Balance
At TMJ Sleep and Breathe Center, we don’t simply treat the teeth—we work with the entire craniofacial system to improve form, function, and long-term wellness.
Our protocol for addressing facial asymmetry includes:
Comprehensive airway and skeletal evaluation (including CBCT imaging)
Custom appliance therapy with a neutral bite plane
Slow, biological palatal expansion (MASPE)
Targeted release of oral ties using CO2 laser
Myofunctional therapy from trained providers
Ongoing monitoring and functional integration
Schedule a Consultation
If you or your child are showing signs of facial asymmetry or imbalance, it’s important to address the root cause—not just the appearance. Our integrative approach can help restore balance, improve breathing, and support healthier facial development.
Contact us today at TMJ Sleep and Breathe Center to schedule a consultation and learn how we can help you achieve more symmetrical, functional, and confident growth.
703-712-1053 
