Creating a referral network for the treatment of craniofacial pain

Patients can feel discomfort without knowing that the underlying cause might have a dental origin. This can include anything from headaches to jaw pain. And with an estimated 45 million Americans complaining about headaches each year–that’s almost 1 out of every 6 people–it is time to take a stand and complete continuing education as a dentist. By better understanding craniofacial pain, how to treat these condition and how to create a referral network, you can be that solution they need for pain relief.  Let’s take a look at the treatment of craniofacial pain and how building a relationship with an appropriate medical professional is important.

Craniofacial pain treatment

There is a large portion of the  U.S. population that is not getting treatment they need to overcome their often debilitating disorders. This has created an incredible need for dentists who understand the neuroanatomical relationship within the cranio-cervical area and how to diagnose common pain complaints in the head and neck. But remember, the treatment of craniofacial pain is a team effort.

This team-based care often includes you, the dentist, an ENT, neurologist, physiatrist, physical therapist and psychiatrist. Each specialist plays a role in the diagnosis and treatment of craniofacial pain. However, it is important for the dentist to understand what physicians do in a diagnostic workup and treatment, as well as when it is necessary to refer out. This helps dentists to better understand their role and to fulfill their duties in patient care, as well as establishing referral relationships across various medical specialties.

Establish a Working Relationship with a Medical Professional

Patients will often find themselves in a neurological, primary care, chiropractic, pain management or an ENT’s office when experiencing craniofacial pain. However, these offices are not always be the best place. For example, undiagnosed TMD may be mistaken for different ailments because this condition can often stump many medical practitioners with the wide variety of a crossover of symptoms patients experience.

A patient might complain of TMJ pain, but in reality they are suffering from a disease or infection of the ear, nose or throat. It is also common for a patient to complain of ear pain, but have the pain really be related to an affected TMJ. When this occurs, patients might be in the wrong medical office seeking treatment, or the clinician is frustrated that their prescribed therapy based on symptoms has not helped in resolving a patient’s complaints.

Whether it is neurological or sinus related, you want your patients to get the best care available, and that means joining forces with other medical professionals. From neurologists and otolaryngologists to family practitioners, it is important to create a working relationship with each medical practitioner in order to discuss or refer for diagnosis and management of your patients when further assistance is needed.

By learning how to diagnose and treat craniofacial pain, dentists gain a great power to change their patients’ lives. With great power comes great responsibility for the proper diagnosis and management of pain in and around the mouth, face and neck.

For further guidance, check out this educational book on TMD

In November “Take a Bite Out of Pain: A Journey to Overcoming Temporomandibular Joint Dysfunction (TMD)” was released and available for purchase. It is exciting to have both a book on TMD and sleep apnea for further outreach and education on topics that are often overlooked. This new educational book serves many purposes. It can be put on display at your office for your patients or it can be gifted to a friend or family member that might be suffering from pain.

This educational book is now available for purchase at Lulu.com, Amazon and Barnes & Noble. Pick your favorite website to go to and purchase it!

What can you expect from the book?

I wrote this book in collaboration with Sara Berg, my writer. As many of you know, she has been writing for me for almost five years now and this is our second book together. We decided to write about pain and TMD to better educate patients on these symptoms and what to do. As dentists, we are in a unique position to help our patients feel better, so why not continue to provide them with the resources they need to better understand their condition?

To help you get a better understanding of what the book is about, here is a brief description:

“Pain should never be ignored. Whether it is pain in your jaw, or what seems like a headache, don’t ignore the discomfort. Ignoring pain would be a waste of time, leading to further complications with your health.

Search for the underlying cause of your pain with help from qualified dentists that treat such cases. Finding the source of your nagging pain will help you continue on with your daily activities—hopefully eliminating any discomfort present.

Don’t just “put up with” pain—seek proper treatment. Pain is a complex and complicated symptom tuned by your brain, as it triggers every painful sensation. Are you just going to sit there and wish the pain away? No, absolutely not.

Educate yourself on the cause or causes, and treatment options. Pain isn’t a singular problem, it can be so much more.”
I look forward to hearing your thoughts and I hope that you utilize this book to help your patients before, during or after their visits to your dental office!

Long-term treatment for adolescents with TMJ pain

I want to take a moment to discuss a study I was looking at the other day. This study looked at the long-term treatment outcome for adolescents with temporomandibular joint (TMJ) pain. I find this interesting because it is a subject that doesn’t always get a lot of attention.

What the study says

In this study, their waim was to evaluate long-term, self-perceived outcomes in adulthood for individuals treated as adolescents for TMD. To find this they looked at two previous randomized controlled trials.

There were 116 participants with 81 percent female and were treated for frequent TMD pain in previous years. The treatment for these individuals consisted of an oral appliance or relaxation training. For those that participated, they answered a questionnaire based on their experience of “frequency and intensity of TMD pain impaired chewing capacity and daily social activities, help-seeking behavior and treatment, general health, other pain and depressive symptoms,” according to the study.

Older participants reported lower levels of frequency and intensity of TMD pain, impairment and depressive symptoms. They also reported better general health. Females, which were the majority of the participants, reported more frequent and more intense pain associated with the TMJ. They also reported greater impairment and more often reported other pain compared to males.

What did we learn from this?

From this study we understand that adolescents treated with oral appliance therapy showed a somewhat better sustained improvement over the extended follow-up period than those treated with relaxation therapy. This highlights the need to pay closer attention to these groups. By looking closer at this information we can extend or create different treatment plans to improve patient outcomes.

Keep an eye out for adolescent patients that might be experiencing TMJ pain and think about the long-term goals. By helping this patient population, we can better equip them for adulthood.

Patient adherence rate to sleep study referrals

Let’s talk about patient adherence. I think this is an area that we often overlook and really don’t pay too close attention to, but it is so important to better understand this. Patients become non-adherent for a variety of reasons and it is our job to make sure we know why this is happening so we can improve outcomes.

A study from 2017 looked at the facilitators and barriers to referral compliance among dental patients at risk for obstructive sleep apnea. The goal of this study was to determine the adherence rate to dentist referrals for sleep apnea evaluation. It also looked at the barriers and facilitators to referral compliance.

What the study found

Researchers looked at a sample of 1,099 patients that were given the STOP-Bang questionnaire. Based on the results from this questionnaire, those with elevated risk were referred for a sleep evaluation. After the referral, an interview was completed over the phone to determine if those patients followed through with the recommendation to determine compliance.

The study found that of the almost 1,100 patients screened, 224 (20 percent) were determined to be at-risk for obstructive sleep apnea. However, only 41 of those with an increased risk actually adhered to the referral recommendation. So only 18 percent actually followed through with what was recommended. That isn’t good.

It was found that the most common facilitators to compliance were increased awareness about OSA and dentist recommendation. The most common barriers to compliance were misconceptions about OSA and work responsibilities.

What can we do?

With only a small percentage of patients adherent to the recommendation of their dentist to see a sleep specialist, we need to do something. As dentists we should provide increased awareness about OSA, so that our patients better understand the importance of treatment for the improvement of their health and well-being. By providing better education, our patients can understand just how serious of a condition OSA really is. As far as work responsibilities go, we can look into home sleep testing and inform them that they can work with the sleep specialist to find the best solution.

Continue to educate your patients and staff so that you can not only improve your patients’ health but their adherence as well.