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.

Pay attention to dental side effects during long-term oral appliance therapy

We understand how successful treatment of obstructive sleep apnea (OSA) can be. However, we need to pay attention to the potential side effects from long-term oral appliance use. If we are aware of these side effects, we can help educate our patients and prevent them from occurring and interrupting care.

What do we do as dentists to help?

I have read several studies that looked at the predictors of dental changes associated with long-term treatment with oral appliances in patients with OSA. From these studies I have found that yes, long-term use can lead to dental complications if we do not educate our patients.

Before you fit your patient for an oral appliance, ask them if they are willing to take at least two-minutes out of their morning to perform exercises. That’s all it takes. Just two minutes (maybe even less) a day to prevent further complications. And, of course, if they do notice any shifts in their teeth, it is important for them to keep you up-to-date. You can provide an adjustment to their treatment or offer other solutions to improve this change.

When you are fitting your patients for their oral appliance, let them know that it is important to perform daily exercises after removal of the device. By performing jaw exercises, it can help prevent the patient’s mouth from becoming stiff or sore. It can also help to prevent lock-jaw and other complications.

It is our duty as dentists to take care of our patients and that means proper education for daily exercises after removing the oral appliance each morning.

What are you doing to help your patients through the oral appliance process? Are you having them perform exercises? If so, what kind? I am interested in learning what everyone is doing to help their patients each step of this journey.