Most dentistry professionals focus on preventing cavities, whitening teeth or otherwise creating healthy and attractive smiles. Paoli-based Stephen D. Smith, D.M.D., does the same, but he also has a second calling.
Specifically, his practice centers on helping patients who are burdened with two unique yet serious problems—maladies associated with the temporomandibular joint, or TMJ, and sleep disorders such as apnea (the suspension of breathing) and hypopnea (shallow breathing)—that can be, at best, draining and/or painful, and, at worst, potentially life threatening.
“Sleep is not an option; it’s mandatory, and these conditions cause problems with sleep and, as a result, with everyday life,” says Dr. Smith. “Seven to eight hours of sleep is the average of healthy people, and people who sleep less than that often have a lot of co-morbidities like stroke, cardiovascular disease and hypertension.”
Dr. Smith received his dentistry doctorate from the University of Pennsylvania’s School of Dental Medicine in 1969, and has been helping patients find relief in these specialized areas for 35 years. He founded the Temporomandibular Center at the Philadelphia College of Osteopathic Medicine; became a Fellow of the American Academy of Head, Neck and Facial Pain and the College of Physicians of Philadelphia; and a Diplomate of the American Board of Craniofacial Pain and the American Academy of Pain Management.
Dr. Smith and his colleague, Kem Moser, D.D.S., are past presidents of the Pennsylvania Craniomandibular Society. Furthermore, both are Diplomates of the Board of the American Academy of Dental Sleep Medicine.
“Any kind of stress in your body releases cortisol, which stirs up the fight-or-flight mechanism and, in turn, causes total body inflammation,” says Dr. Moser. “Metabolic syndrome is an inflammatory reaction that occurs when the body is under stress, and all the major diseases spin off it: heart disease, arthritis, sugar control and arguably everything else. Obstructed sleep apnea has been indicted as a contributor to that, as has TMJ dysfunction, which is persistent and ongoing.
“Stress is good if it’s a warning and it’s temporary and it helps you out of a sticky spot,” he continues, “but if it becomes chronic—too much for too long—then it becomes something we should be concerned about.”
Specially designed myofunctional devices—among other prescribed therapies—that are adjusted at regular intervals by Drs. Smith and Moser can alleviate this chronic stress.
“It would be fair to say that for the past 30 years as dentists we’ve been studying TMJ disorders and the logical extension into sleep apnea and snoring,” says Dr. Moser. “The development of the different kinds of appliances for TMJ treatment evolved into other appliances for obstructed sleep apnea, though the appliances for sleep apnea are more complex and require a certain level of expertise.”
Many cases of TMJ disorder exhibit symptoms that are misdiagnosed as something else, thereby earning its reputation as “the great imposter.” Clicking, earaches and facial, jaw and neck pain are common TMJ symptoms, and migraine headaches often stem from a lingering bite problem. In fact, a high percentage of migraines will improve with appropriate TMJ therapy, according to Dr. Smith, such as custom noninvasive oral appliances, physical medicine modalities, jaw exercises and electrical stimulation therapy.
In treating patients who suffer from sleep deprivation caused by sleep apnea or related disorder, the practice works extensively with medical sleep laboratories throughout the Delaware Valley, including Bryn Mawr Hospital, Paoli Hospital, University Services and Lankenau Hospital. The doctors also consult with ear, nose and throat specialists for nasal and throat problems such as tonsils and adenoids. Statistics suggest that patients suffering from sleep deprivation are seven times more likely to be involved in an accident of some sort compared with those who are not sleep deprived. Some of the world’s most notorious manmade disasters—the Exxon Valdez oil disaster, the Three Mile Island nuclear accident and the reactor meltdown at Chernobyl—were partially the result of human error caused by sleep deprivation.
Although these are the instances that grasp the headlines, countless Americans get in car accidents, suffer from poor work performance or otherwise find themselves in a bad position due to sleep deprivation. Before receiving treatment from Dr. Smith, one patient admitted to regularly falling asleep at traffic lights while driving. According to Dr. Moser, 70 million Americans—many of them undiagnosed—have sleep disorders, 18 million of which struggle specifically with obstructed sleep apnea.
“In addition to the problems like sleep deprivation, sleep apnea can cause marital problems and snoring because it disturbs the bed partner as well, so sometimes they wind up sleeping in a separate room,” says Dr. Moser. “One of the tabloids in London once posted a story about a woman who cut off her husband’s nose in her sleep-deprived condition because of his excessive snoring.”
After a thorough history and examination, including imaging of one’s airway, the doctors create a patient-specific treatment plan, which often includes the implementation of a specially designed oral appliance.
One of these carefully prescribed oral appliances often helps patients remove themselves from the CPAP (continuous positive airway pressure) machine, a mode of respiratory ventilation worn at night to prevent sleep apnea. Many patients complain of having difficulty wearing the CPAP apparatus, and it often becomes a source of stress for the patient’s bed partner.
“You should be able to sleep and breathe simultaneously, but we don’t always express that blueprint; we take a deviation because of allergies or because of an inability to breathe properly through the nose, which requires mouth breathing and changes the function of the tongue,” says Dr. Moser. “The tongue is by far the most enervated muscle in the body. And when this sophisticated machine has to work differently, the body goes from Plan A to Plan B, C or D. That begets orthodontic problems and airway compromises and ultimately causes TMJ problems.”
Two of the practice’s preferred oral appliances are the SomnoMed, from an Australian firm of the same name; and the Moses, developed by a Chicago-based dentist named Allen J. Moses, D.D.S. These advanceable, titrateable devices position the jaw in a way that keeps the airway open during sleep.
“When you use these functional or myofunctional appliances, you correct the lip and tongue musculature and the jaw posture, and they encourage you to breathe through your nose,” Dr. Smith says. “When used properly, they encourage proper nasal breathing and proper tongue functioning, which corrects a lot of problems.
“We do certain customizable modifications from the basic framework,” he continues. “After a three-month interval typically we’ll refer the patient back to their sleep-medicine doctor, so we’re part of a team approach.”
Although patients need to make a long-term commitment to following a treatment plan prescribed by Drs. Smith or Moser, the results can be, quite simply, life changing.
“I now sleep better, and I feel rested with more energy,” says one of Dr. Smith’s patients, who reported tremendous success with the SomnoMed appliance. “I feel safe from apnea, which was a major stress for me, [and] I have escaped the CPAP, which I was unwilling to endure.”
Yet another patient’s experience after using the same device for only two weeks: “I feel that I get a better night’s sleep now. I expected some problems in having something strange in my mouth, but the appliance fits so comfortably that it never happened. … I have to agree with my wife’s assessment that I should have done this years ago.”
Stephen David Smith, D.M.D.
Route 252 and Waynesborough Roads
Paoli, PA 19301-2007
Phone: 610-647-2755
Fax: 610-647-6304
Web: www.sdsmithdmd.com
E-mail: sdsmith@sdsmithdmd.com
Rob Hall is a photographer from Plumsteadville.
