Wednesday August 3, 2011

Are you a victim of chronic headaches? Or perhaps you wake in the morning feeling as if you haven’t slept at all and sleepwalk through your day. maybe you have consulted with a chiropractor, neurologist or sleep specialist, with varying results. There is another avenue that should be considered, according to one local doctor: your problems may be the result of jaw issues.

If that is the case, Dr. Frederic Hyman, general dentist and owner of Berkshire Center for Craniofacial Pain and Dental Sleep Medicine on Church Street in Great Barrington, may have answers for you.

Hyman, who has had a general dental practice for 27 years, started seeing patients about 10 years into his practice who were experiencing jaw pain and headaches.

“I was seeking ways of helping the patients. Tufts University was offering a year-long residency,” he said. “I really began to learn and develop skills to go out and help patients much more than I had in dental school.”

Hyman continued on with his studies at Tufts, earning his diplomate in oral facial pain and then staying with the university on a part-time basis as an instructor “to stay on top of the field,” he said.

His patients started coming via word of mouth, “but then a year ago, we had a name change to let the public know we’re doing this as a special interest.”

And who are the people who make use of Hyman’s specialized skills? the first group is made up of people who are experiencing temporomandibular joint pain (commonly known as TMJ), clicking sounds when opening or closing the jaw or even problems with opening or closing it. they may be also suffering from chronic headaches and may have tried other solutions, unsure of what the actual problem is. “It’s really by its nature a problem that can mimic other things. they may seek treatment from other practitioners and may get some relief.”

A headache sufferer, for example, may try drugs to treat the headaches or may see a chiropractor.

“But the headaches continue,” he said, “because it may be a problem with their jaw or muscles surrounding the jaw.”

In fact, it is these other providers the patient may have already consulted with who are today providing Hyman with many referrals.

“I get many referrals from physician providers, chiropractors, physical therapists and others,” he said.

Hyman works in concert with these other providers to provide the patient with the best care possible.

“My whole sort of mission is to provide an integrative pain management approach Š to provide the patient with options,” he said.

Types of treatment for these jaw issues may include splint therapy, better known perhaps as a night guard or bite guard. in addition, Hyman may use a low-level laser to help muscles and joints where there is pain to help the body heal itself, he said, or an “alpha stim,” a low-level current. the pain is usually reduced by one or more of these methods, he said, although it can take several visits.

Hyman said, however, that the focus is on pain management, rather than a cure, and that he tries to give patients things to do at home if the pain recurs — ice or heat, for example.

“But by working with the other providers, we can really help the patient to feel better, to function better,” he said.

Jaw issues may not only manifest, however, in the symptoms described above. they may in fact cause a patient to be very sleepy during the day from disrupted sleep the night before. “They may also experience a morning headache,” Hyman added. they may snore so loudly that the snoring affects others. these are all symptoms of obstructive sleep apnea.

That patient is usually referred by a sleep physician or a sleep center, Hyman said, and has had a sleep study done overnight at a sleep center with a diagnosis of sleep apnea. the first step, he said, is to try the patient with a CPAP (continuous positive airway pressure) machine, which pushes air into the airway to prevent it from collapsing overnight.

“An alternative is to use an oral appliance. It is very useful for mild to moderate sleep apnea,” Hyman said. “The nice thing about an oral appliance is it’s a reversible procedure.”

Hyman stressed that untreated sleep apnea can lead to serious medical issues, including cardiovascular problems, stroke, heart attack, diabetes and even depression.

“There are probably 18 million people in the country undiagnosed with sleep apnea, and probably 12 million to 15 million with craniofacial pain like TMJ pain,” he said.

With his approach to treatment, “80 percent to 90 percent can be made to feel better. But it’s not like a broken arm, where you can say ‘we can stabilize it and it will be healed in six to eight weeks,’” he explained. “Sleep apnea tends to be a progressive problem. as they (patients) get into their 50s, 60s, 70s, it gets much worse.”

Obstructive sleep apnea occurs, Hyman said, when a person lays back and his or her jaw drops open. the tongue falls into the back of the throat, and now the person has a very narrow passageway to breathe. as the flow of oxygen to the brain lessens, the brain eventually wakes from sleep far enough to cause the person to take a breath or even gasp.

“This cycle could be repeated 100 times an hour if it’s severe enough,” Hyman said. Thus, the person’s sleep is disrupted over and over throughout the night.

When using an appliance, it advances the jaw forward. “The tongue follows the jaw. as that occurs, the airway is wider. the net effect is the person has less apneas during the night. It may not eliminate it the way CPAP can,” he said, but some people are not successful with CPAP and this offers another option.

Dental sleep medicine is an emerging area, Hyman said, and he is very excited by that, but even more so that he can bring relief to those suffering from TMJ pain or related sleep issues.

“To me, it’s very satisfying to be able to help people who have maybe tried several different things and are really quite desperate,” he said. “The goal of the whole treatment is to feel, function and sleep better.”

Dr. Frederic Hyman’s Berkshire Center for Craniofacial Pain and Dental Sleep Medicine practice, a general dental practice as well as an integrative pain management center dedicated to helping patients who suffer from TMJ, headaches and sleep apnea, is located at 29 Church St., Great Barrington. for more information, call 413-528-4680 or visit berkshiretmjcenter.com.