Screen your orthodontic patients for TMD

There is a growing need for orthodontists to screen and evaluate their patients for temporomandibular dysfunction (TMD). It is even more important to discriminate between major and minor signs and symptoms of TMD if they are discovered during screening. If the patient has major TMD complications, the orthodontist will need to decide whether to take on the responsibility of management prior to initiating orthodontic treatment.

If you decide not to, then an appropriate referral will need to be made before orthodontic treatment is completed. And, similarly, orthodontists should also be ready to respond appropriately when a patient is referred specifically to the for the treatment of TMD.

The orthodontist’s role

When receiving referral from a dentist, it is important to maintain open communication with both the patient and the referring dentist. Remember to also follow current scientific concepts about TMD-orthodontic relationships.

If TMD signs and symptoms arise during orthodontic treatment, orthodontists must be cognizant of proper procedures. And because there is some potential for the development of TMD complications after orthodontic treatment, it is important for orthodontists to be prepared to react properly.

Just as dentists should complete continuing training, so should orthodontists. We owe it to our patients to provide the best care possible no matter what office they are visiting.

Now Available! An Educational Book on TMD

I am excited to announce that “Take a Bite Out of Pain: A Journey to Overcoming Temporomandibular Joint Dysfunction (TMD)” is now available for purchase! This new educational book is a great gift for a friend or family member suffering from pain, or even to display at your office for your patients.

This book is available for purchase at Lulu.com and will soon be available on Amazon and Barnes and Noble.

What is it about?

I wrote this book in collaboration with Sara Berg. 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.

To help you better understand 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 office!

Comparing chronic migraines with TMD pain, a study

Another study I recently read took at look at chronic migraines and temporomandibular disorder (TMD) pain. The researchers wanted to compare patients with chronic migraines and chronic TMD on disability, pain and fear avoidance factors. While the study didn’t utilize dental offices, they did take a look at a neurology department and a TMD consult in a tertiary care center. There were a total of 50 patients with chronic migraines and 51 with chronic TMD.

Results from this study showed that there were significant differences between those with migraines and those with TMD. However, there were no differences between the chronic migraine group and the neck disability, visual analog scale and kinesiophobia groups. For chronic TMD, the combination of neck disability and kinesiophobia was a significant covariate model of craniofacial pain and disability. For chronic migraine patients, the regression model showed that neck disability was a significant predictive factor for headache impact.

The differences between the chronic migraine group and chronic TMD group were found in craniofacial pain and disability, pain catastrophizing and headache impact. But these groups were found to be similar for pain intensity, neck disability and kinesiophobia.

We can take this study to further help us in treating our patients who are suffering from chronic pain, whether it is due to migraines or TMD. By understanding these relationships, we might be able to take preventive measures or catch conditions earlier in the process.

What other studies are out there that could better guide us in understanding our patients’ pain and discomfort?

The mechanisms of craniofacial pain

A recent journal looked at the mechanisms of craniofacial pain. The researchers worked to highlight peripheral and central adaptations that might promote chronification of pain in craniofacial pain states, including migraines and temporomandibular disorders (TMD). Pain is a common symptom that is associated with disorders of the craniofacial tissues, such as the teeth and their supporting structure, the temporomandibular joint (TMJ) and the muscles of the head.

Most acute craniofacial pain conditions are easily recognized and well managed. However, others, especially those that are chronic such as migraines and TMD, present clinical challenges for dentists and physicians. While the mechanisms of chronic craniofacial pain in patients remains limited, both clinical and preclinical investigations suggest changes in afferent inputs to the brain occur in chronic pain. This results in amplification of nociception, which promotes and sustains chronic craniofacial pain states.

Through an increased understanding of the physiological and pathological processing of nociception in the trigeminal system, we can learn about new perspectives for the mechanistic understanding of acute craniofacial pain conditions. This also helps with the peripheral and central adaptations that are related to chronic pain. We can offer improvements in treatment for chronic and acute craniofacial pain conditions.

What are your thoughts on this? Does this information help improve treatment options for your patients?