Orofacial Pain and TMJ Disorders: Specialty?

Dr. Shapira Uncategorized 0 Comments

There is currently no specialty in Orofacial Pain and the American Dental Association does not believe one is needed. That does not mean that orofacial pain is not a problem, it is.

Most orofacial pain is actually well treated by the dental community. The most common causes of orofacial pain are related to teeth, gums dental abscesses, pulpitis and other disorders routinely treated by general dentistry. Sometimes non-dental pain is mistakenly treated as dental pain. The most common example is referred pain from muscles mistakenly treated as pulpitis pain and patients having root canal treatment preformed but the pain continues or moves to another tooth. I have seen patients with very healthy mouths with multiple teeth having had root canal treatment due to this type of misdiagnosis,

The second most common cause of orofacial pain is TMJ disorders which include Myofascial Pain, TM Joint internal derangements, capsulitis and tendonitis. These are commonly related to the bite, stress and parafunction, particularly night-time bruxism.

The majority of these problems are handled by a simple night-time bruxism appliance.

The more complicated TMJ disorders usually include multiple facets and affect not just the the oral structures but all of the muscles and nerve connections of the head and neck as well as the postural chain. They are not limited to the nerves of the somatosensory nervous system but are also firmly rooted to the sympathetic and parasympathetic divisions.

Typically dentists with advanced training in the treatment of TMJ disorders are very good at the differential diagnosis of orofaxial pain, particularly neuromuscular dentists.

Most of the chronic pain related to TMJ disorders is Myofascial Pain as described by Janet Travell in her landmark book; “MYOFASCIAL PAIN AND DYSFUNCTION: A TRIGGER POINT MANUAL” This ptype of pain is relatively easy to treat once it is understood that the problem is basically a repetitive strain injury.

Treatment of this Myofascial Pain and associated TM Joint pain usually involves utilization of a diagnost neuromuscular orthotic as part of the diagnostic process.

There are many other more infrequent and obscure conditions that fall under the umbrella of orofacial pain. Most of these are best treated by neurologists, ENT’s and Opthamologists. The push for an orofacial pain specialty is from a small group of doctors who think they are better equipped than the current medical specialties in doing differential diagnosis and treatment.

Differential diagnosis is the key to successful treatment. Dentists treating TMJ disorders need to understand this concept.
This link is to Chronic TMJ and Orofacial Pain Patients discussing treatment:
https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/playlists

There are groups in dentistry that are currently suing state boards to try to create a specialty denied by the American Dental Association, these are self appointed specialists.

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