Treatment of Orofacial Pain can be complex and there are many issues that are both medical and dental in nature.
There is hope and this paper gives one clear example of what is wrong with many of the concepts of the Orofacial Pain Group that tends to discount valuable treatments with good scientific evidence.
One important concept in Orofacial Pain is the concept of MMI or Maximum Medical Improvement ie, this is the best results possible. This is an escape clause for doctors who do not have the expertise or knowledge to move their patients to a better quality of life or further reduction of symptoms. Very often the best treatment for a patient may never be offered. An example of this problem can be found in the conclusions of this paper from J Orofac Pain. 2010
“Systematic review and meta-analysis of randomized controlled trials evaluating intraoral orthopedic appliances for temporomandibular disorders.” By Fricton et al. which concluded that; “Hard stabilization appliances, when adjusted properly, have good evidence of modest efficacy in the treatment of TMJD pain compared to non-occluding appliances and no treatment. Other types of appliances, including soft stabilization appliances, anterior positioning appliances, and anterior bite appliances, have some RCT evidence of efficacy in reducing TMJD pain. However, the potential for adverse events with these appliances is higher and suggests the need for close monitoring in their use.”
Dr Fricton found that hard stabilization splints had “modest efficiency “compared to non-occluding appliances and no treatment” He also states that “Other types of appliances, including soft stabilization appliances, anterior positioning appliances, and anterior bite appliances, have some RCT evidence of efficacy in reducing TMJD pain.” One would assume when dealing with patients in pain that success alleviation of pain would be paramount but Dr Fricton actually finishes the conclusion stating “However, the potential for adverse events with these appliances is higher and suggests the need for close monitoring in their use.” This does not mean don’t use them but that use carries some risk. A patient in pain has the right to decide if that is a risk he or she wants to take. The problem is due to the politics of the AAOP patients are actually losing their right to the most efficacuos treatments.
This video is of a patient treated at Mayo Clinic who was told there was “NO HOPE” and was condemned by a neurologist at to a lifetime of pain. I utilized an appliance that “carried some risk of adverse consequences” but worked out very well for this patient. https://www.youtube.com/watch?v=IOJTPQEGr1w
Had we followed the satndard protocol of Orofacial Pain this patient was condemned to a “Lifetime of Pain and No Hope!”
Instead, she took advantage of a more efficacous and now lives pain free.
Yes, there are randomized Controlled Studies showing efficacy but even if there were only testimonials and clinical histories she has a right to chose her own fate.
We know that the third leading cause of death in this country is medical mistakes according to a study by Johns Hopkins.
Is the leading cause of pain in TMJ patients due to mistakes of non-treatment rather than overtreatment?
