What are the ABCs of dental sleep medicine?

What do the airway, bruxism and craniofacial pain all have in common? It might seem like nothing, but there is a lot more than you might realize. And while we have discussed this previously, I think it is important to continue to revisit this area of dentistry to further help our patients.

A lot of dentists don’t know that much about these areas of the dental specialty, so you’re not alone. However, because of this, dentists are unable to recognize the risk of sleep apnea, let alone manage patients with oral appliances, which is the same for craniofacial pain and bruxism. Each of these conditions are often overlooked and our patients are suffering.

By taking the steps toward a better understanding of the unique connections between the airway, bruxism, craniofacial pain and other conditions, dentists can create endless opportunities for services in diagnosis and treatment options within their practice. To help, let’s examine the ABCs of advanced dental services.

Airway. This is commonly referred to in sleep disordered breathing disorders, such as obstructive sleep apnea (OSA). Dental practices are in a unique position to identify patients at risk for conditions involving the airway. Understanding the airway and how it can affect a patient’s sleeping patterns due to sleep apnea and other sleep disordered breathing conditions is vital in maintaining your patients’ health and improving service offerings. It can also help in treating other conditions when there is a clear link available.

Bruxism. This is the gnashing and grinding of teeth that occurs without a functional purpose. When a patient is suffering from bruxism, it can cause a lot of problems (as you know). Whether it is due to a nervous habit, stress or unknowingly grinding teeth at night, bruxism can cause damage to not only a patient’s teeth, but their overall health as well. Due to the breakage of dental restorations from bruxism, tooth damage, induction of temporal headaches and temporomandibular joint disorders (TMD) can occur.

Craniofacial Pain. We come full circle with craniofacial pain, as it covers a wide spectrum of symptoms exhibited in many areas of the head and neck. In particular, a majority of craniofacial pain complications can be associated with temporomandibular joint disorder (TMD). Can you see the pattern? Because of this, an essential part of routine dental examinations for all patients should include an evaluation for TMD, including a patient’s history, clinical examination, and imaging when appropriate.

What is the connection? While it might not be found in every patient, there are still some individuals that require further attention because there is an apparent connection. As a dentist, it is important to understand that clenching or grinding of one’s teeth can be a way for the brain to protect itself from suffocation during sleep–it connects the ABCs.

Educate yourself by completing continuing education courses and attending lectures or seminars. While it might not occur in every case, it is vital that we as dentists understand it for those certain individuals suffering from all three conditions.

Dr. Mayoor Patel receives the Haden-Stack Award 2018

Recently, at the 2018 American Academy of Craniofacial Pain (AACP) Annual Meeting in Kansas City, Mayoor Patel, DDS, MS, received the prestigious Haden-Stack Award.

 

The award is named after two major icons and pioneers of craniofacial pain and TMD dentistry, Dr. Jack Haden and Dr. Brendan Stack. The AACP created the Haden-Stack Award in 1998 to acknowledge those who have made significant contributions to the advancement of knowledge in the field of Craniofacial Pain and Temporomandibular Disorders.

Dr. Patel’s experience

Each year, Dr. Patel has dedicated as much of his time as possible to personally educating hundreds of dentists on TMD and craniofacial pain. And not only has he provided education to dentists, but he also mentored them. Through this he was able to help guide dentists in their journey into TMD, craniofacial pain and dental sleep medicine. He challenged them to become the best providers they possibly can be for their patients.

With his wealth of knowledge and easy-going teaching style, Dr. Patel maintains a unique ability to connect with people while also transferring knowledge in a very accessible way. It doesn’t matter what your personality type is, Dr. Patel connects with you and provides you with a learning experience that is unlike any other.

Going beyond just lecturing, Dr. Patel engages with other dentists throughout the process and asks the right questions to get his students to think and apply information to their own specific situation.

Dr. Patel also received over 15 credentials from major organizations related to orofacial pain or sleep apnea, which enables him to accurately and properly treat TMD, orofacial pain and sleep apnea in his dental office.

The next time you see Dr. Patel, make sure to congratulate him on this amazing accomplishment. Way to go, Dr. Patel!

How to help TMD patients best choose their food

Limited jaw movement or locking of the TMJ can have a negative effect on mandibular opening, biting and chewing. Myofacial pain is characterized by pain originating from the masticatory and other pericranial muscles. TMD also limits the mandibular opening and pain aggravated during function, specifically when eating and chewing.

Choosing food for TMD patients

A patient’s eating habits can be significantly altered by this condition. It can also compromise the quality of their diet. When patients are experiencing jaw pain and difficulty eating or chewing, how do you help them? What diet suggestions can you offer?The food choices in the infographic below can help:

For more information on TMD and helping your patients improve their diets, please contact me. We can discuss food options and how to cook meals. I can also provide you with this fun handout for your office and patients! What else are you doing to improve your patients’ diets?

Creating a referral network for the treatment of craniofacial pain

Patients can feel discomfort without knowing that the underlying cause might have a dental origin. This can include anything from headaches to jaw pain. And with an estimated 45 million Americans complaining about headaches each year–that’s almost 1 out of every 6 people–it is time to take a stand and complete continuing education as a dentist. By better understanding craniofacial pain, how to treat these condition and how to create a referral network, you can be that solution they need for pain relief.  Let’s take a look at the treatment of craniofacial pain and how building a relationship with an appropriate medical professional is important.

Craniofacial pain treatment

There is a large portion of the  U.S. population that is not getting treatment they need to overcome their often debilitating disorders. This has created an incredible need for dentists who understand the neuroanatomical relationship within the cranio-cervical area and how to diagnose common pain complaints in the head and neck. But remember, the treatment of craniofacial pain is a team effort.

This team-based care often includes you, the dentist, an ENT, neurologist, physiatrist, physical therapist and psychiatrist. Each specialist plays a role in the diagnosis and treatment of craniofacial pain. However, it is important for the dentist to understand what physicians do in a diagnostic workup and treatment, as well as when it is necessary to refer out. This helps dentists to better understand their role and to fulfill their duties in patient care, as well as establishing referral relationships across various medical specialties.

Establish a Working Relationship with a Medical Professional

Patients will often find themselves in a neurological, primary care, chiropractic, pain management or an ENT’s office when experiencing craniofacial pain. However, these offices are not always be the best place. For example, undiagnosed TMD may be mistaken for different ailments because this condition can often stump many medical practitioners with the wide variety of a crossover of symptoms patients experience.

A patient might complain of TMJ pain, but in reality they are suffering from a disease or infection of the ear, nose or throat. It is also common for a patient to complain of ear pain, but have the pain really be related to an affected TMJ. When this occurs, patients might be in the wrong medical office seeking treatment, or the clinician is frustrated that their prescribed therapy based on symptoms has not helped in resolving a patient’s complaints.

Whether it is neurological or sinus related, you want your patients to get the best care available, and that means joining forces with other medical professionals. From neurologists and otolaryngologists to family practitioners, it is important to create a working relationship with each medical practitioner in order to discuss or refer for diagnosis and management of your patients when further assistance is needed.

By learning how to diagnose and treat craniofacial pain, dentists gain a great power to change their patients’ lives. With great power comes great responsibility for the proper diagnosis and management of pain in and around the mouth, face and neck.