Jerald H. Simmons, MD Featured Speaker at Greater Houston Dental Society

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Dental problems affecting the airway cause several medical conditions but often go undiagnosed by many doctors. This topic will be the focus of Dr. Simmons lecture on February 26, 2013.

Breathing is one of the basic functions required for life so it is not surprising that when something affects normal breathing that health consequences occur. The mouth can be thought of as the beginning of the airway and the breathing process with the jaw functioning as a valve that influences the degree of opening or closing of the airway which, in turn, controls air to the lungs. Dentists spend their entire career working on the mouth and should be trained to recognize abnormalities of the mouth that affect the airway. However, most dental training does not take this approach of the mouth controlling breathing and the airway so most dentists do not know how to look to see these abnormalities that are within their gaze.

Working to enhance the training of dentists on the airway is Jerald H. Simmons, MD and he leads-the-way mentoring and teaching dentists on this cutting-edge approach in the field of sleep dentistry. Dr. Simmons is Triple Board Certified by the American Board of Psychiatry and Neurology, American Board of Sleep Medicine and the American Board of Clinical Neurophysiology and he is also the founding director of the Sleep Education Consortium that provides education to dentists and physicians on sleep medicine. He explains how there is a strong inter-relationship between dentistry and medical problems such as attention disorders in children and other conditions such as TMJ Dysfunction in adults. Dr. Simmons will be a featured speaker at the Greater Houston Dental Society, Tuesday. February 26, at the University of Texas School of Dentistry in Houston, where he will be providing cutting edge information on the new field of Dental Sleep Medicine.

"We frequently evaluate children with difficulties concentrating during the day, many of whom have been diagnosed with Attention Deficit Disorder (ADD) or Attention Deficient Hyperactivity Disorder (ADHD).. Our evaluation demonstrates that many of these children have abnormalities in their sleep as the main underlying cause for their daytime symptoms, resulting in the being labeled as ADD or ADHD. Frequently the sleep problem is a result of abnormal breathing during sleep, not always so obvious by observation alone. Enhanced measure during the sleep testing, not typically performed by most sleep centers, allows our facilities to properly diagnose and treat these patients," said Dr. Simmons.

In children who have obstructive breathing as a cause for their fragmented sleep and ADD / ADHD symptoms, Dr. Simmons explains that initially a treatment with Continuous Positive Airway Pressure (CPAP) administered through a mask while asleep is used. The pressure overcomes the narrowing of the airway when the muscles and jaw relax. Once improvements are demonstrated in children sleeping with the CPAP mask then the next step is to provide the same benefit to the airway via orthodontics or other surgeries. Dr. Simmons and his team communicate their findings and goals with the child's orthodontist so that treatment can be implemented to orthodontically open up the airway though methods of palatal expansion and mandibular advancement, so that the child can get off of the CPAP mask. "We have been able to get children off of medications such as Adderall and Ritalin, when we identify the problems as related to breathing. By treating the airway either with CPAP or orthodontics we improve sleep and these children improve without the use of medications," states Dr. Simmons.

Classic views of anatomy do not recognize the jaw or masseter muscle as part of the respiratory system. But more modern concepts have included these parts of human anatomy into the respiratory system. This means that the field of dentistry is involved with the respiratory system. There is little research showing how movement of the jaw influences the airway like a valve at the end of a pipe and the changes in the flow that goes through the pipe or airway. “By making observations over the years, listening to patients describing their problems and then modifying how we monitor patients during our sleep studies by adding extra sensors, I have finally come up with very exciting data that demonstrates how breathing changes as the jaw muscles during sleep go from clenching to being relaxed. We are now
treating patients with TMJ pain from clenching in sleep by administering ways to improve their airway. This is changing the basic approaches that have been used in the past to help these patients.” states Simmons.

Education & research that amalgamates dentistry and medicine is another of Dr. Simmons professional endeavors. He continues to study the relationship between snoring and sleep apnea as they relate to sleep bruxism, which is grinding and clenching teeth during sleep. Through this research it has been found that many patients who suffer from sleep bruxism do so as an attempt to keep the airway open. Not surprisingly these patients have obstructive breathing either in the form of the Obstructive Sleep Apnea (OSA) or a more subtle form called the Upper Airway Resistance Syndrome (UARS). According to Dr. Simmons research, by clenching the teeth the airway is held open by keeping the jaw and tongue forward, thereby reducing the obstructive breathing. This subliminal need to grind and clench the teeth opens up the airway but causes major damage to the teeth and can lead to Temporal Mandibular Joint (TMJ) Dysfunction.

Dr. Simmons collaborative research with dental colleague Ronald S. Prehn, DDS has demonstrated that by treating TMJ patients for breathing abnormalities, their TMJ Disorder and Sleep Bruxism symptoms improve. Both Dr. Simmons and Dr. Prehn have presented their findings at the American Academy of Sleep Medicines and American Academy of Dental Sleep Medicine conferences over the past few years and their approach is changing the way many dentists view their patients who
suffer from these problems.

These unique collaborative efforts promoted by Dr. Simmons to enhance the treatment of patients with ADD / ADHD or TMJ Dysfunction, Headaches, etc. are not the only way in which physicians can work with dentists. A large number of dentists are now making oral appliances that help in the treatment of OSA by holding the jaw or
manidble forward while asleep. This type of treatment has been well established as a treatment option for patients with OSA however it is not 100% reliable and has a number of complications are associated with incorrect treatment methods. However, if utilized correctly, many patients can do well with oral appliances but this is best under the care of a collaborative team between dentists and physicians.

Dr. Simmons states, "I offer many of my patients the option to use an oral appliance for the treatment of their OSA. In some patients who are not adequately treated with a dental device, if we select the correct appliance we can use this to become an anchor for their CPAP mask. Many of my patients who have failed oral appliance therapy can still use their appliance in combination with a CPAP in such a way that the mask is held on the nose by anchoring to the dental device. This becomes a strapless CPAP mask that many find more comfortable with less leakage of air."

If interested in an evaluation or more information, questions can be directed to Comprehensive Sleep Medicine Associates in The Woodlands and Shenandoah at 281-407-6222 in the Houston Medical Center 713-668-4100 and in Sugar Land 281-240-3773. Another way to find out more is to go to the web page at ww where an online sleep questionnaire can be filled out for review to determine how to best undergo an evaluation and treatment of difficulties with sleep.

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