Matters of pain and sleep

September 29th, 2015

An illustration showing one of the epicenters of TMJ painA new clinical center is in the works at TAMBCD.

Orofacial pain and sleep-disordered breathing are hardly novel health conditions. Both can significantly affect patients’ quality of life and have been recognized for decades, but in recent years the terms have begun cropping up in headlines with increased frequency.

As many as 67 percent of men and 28 percent of women are found to be at high risk for obstructive sleep apnea — when the airway repeatedly collapses during sleep — according to a study published in Sleep and Breathing in 2008. What’s more, temporomandibular joint disorders — also known as TMJ or TMD — impact the jaw and chewing muscles of an estimated 10 million Americans.

Dentists are on the front lines in treating these often related conditions.

“It’s almost like we have a new profession,” says Dr. Keith Thornton, a 1969 alumnus and owner of SleepWell Solutions, a Dallas dental practice dedicated to sleep-related breathing disorders. “We’re treating not only the teeth and their position and how they work, but the function of the area with eating and swallowing, speaking and breathing. All of those things are critically important; it’s about the whole system,” Thornton adds.

Progress continues on a clinical center for pain and sleep at Texas A&M University Baylor College of Dentistry. Since fall 2013, Dr. Steven Bender, a 1986 alumnus and president of the American Academy of Orofacial Pain, has spent several mornings a month on campus treating patients with head, face and TMJ pain. Plans are in the works for Bender, who owns the North Texas Center for Head, Neck and TMJ Pain to join the TAMBCD faculty full time in 2016 to head up the clinical center.

“My hope is that the addition of this clinical center at the school will provide easier access for patients with these disorders,” says Bender. “Most patients and their health care providers do not know where to turn when traditional therapies for facial pain don’t seem to work. The addition of our center will improve recognition of these problems and provide a method in which patients can receive the most appropriate care,” says Bender, who adds that he would like to see the center utilize physical therapy and clinical psychology in diagnostic and treatment protocols, something not easily accomplished in a private practice setting.

The clinical center will encompass both TMD and sleep-related breathing conditions because the two often have a cause-and-effect relationship.

“A lot of abnormal muscle activity at night, whether you call it bruxism or clenching, is due to a collapsible airway,” says Thornton. “All of a sudden we are finding that if you treat the airway, the TMD goes away.”

Thornton recently donated $50,000 to the dental school toward the establishment of the pain and sleep center, which initially will be housed in the college’s Center for Maxillofacial Prosthodontics.

Since a June 2014 ruling by the Texas State Board of Dental Examiners permitting dentists to diagnose and treat sleep-related breathing disorders, TAMBCD has been on the forefront of ensuring dentists have training in this growing discipline. In fall 2014, TAMBCD and the UT Health Science Center dental schools in San Antonio and Houston created a standardized, statewide course for dentists to learn how to treat sleep-related breathing disorders, most commonly with oral appliances. TAMBCD’s pain and sleep program, which initially will be unaccredited, builds upon such offerings to expose dental students and residents to this discipline. It also opens the door for research in order to glean a deeper understanding of sleep-related breathing disorders, TMD, and head and face pain.


The Thornton Adjustable Positioner, an oral appliance used to treat sleep-disordered breathing

Once the center is up and running, the college will seek accreditation from the American Dental Association in order to provide advanced training, says TAMBCD dean Dr. Lawrence Wolinsky. The most important item on the agenda right now: offering this crucial service to more of the dental school’s patient base.

“There is a significant portion of the general population seeking care for orofacial pain disorders, i.e., TMD, headache disorders related to TMD and sleep disorders,” says Wolinsky. “There are practitioners in the community who will see those patients, but most dental offices are not interested in treating those patients because they demand a lot of oversight.

“I think the dental community sees a need for a place to refer their patients, and TAMBCD is a good fit. We have a team of specialists in one place here.”

— Jennifer Fuentes