TMD Treatment Benefits from Collaborative Management

Collaborative Facial Pain Management Needs Orofacial Pain Specialists

Dentists in the United States are becoming more aware of the new orofacial pain specialty, meaning that now they are more likely to refer patients to an orofacial pain specialist (OPS).

Orofacial pain is terminology that describes pain and dysfunction in the head and neck region. Commonly, a dentist initially identifies a jaw pain issue that isn’t caused by or related to a tooth problem. OPSs are typically licensed dentists specializing in diagnosing, managing, and treating disorders that cause mouth, jaw, head, neck, and face pain issues.

Orofacial pain specialists can best explore additional causes of orofacial pain, such as:

• Bruxism (grinding of teeth).
• Temporomandibular Joint Disorders (TMJ).
• Muscular tensing due to psychosocial stressors.
• Headaches.
• Sleep Disorders.

It is too easy for a general physician or dentist to inadvertently cause TMJ pain with outdated technologies and a lack of specialty training. This is partly because of jaw joint and facial muscle pain; anatomy is taught in dental schools but not physiology. 

A better approach is an evidence-based, cross team, TMJ treatment plan that can be more easily achieved with collaborative management. It involves more than getting the needed work, for example, TMJ treatment, done quickly; it focusses on helping people get long-term help and pain relief comfortably.

Knowing that local anesthetic is toxic to muscle tissue, a jaw specialist understands what the patient may be enduring and can better avoid post-operative discomfort.

This joint jaw pain after a dental injection may likely be triggered by muscle injury combined with strain on the temporomandibular joint (TMJ) and surrounding structures. Additionally, sustained jaw opening at the dentist, or an oral surgical procedure can cause muscle strain and fatigue, resulting in jaw and facial pain.

Novel collaborative TMD rehabilitative concepts can be used to improve the diagnosis and treatment.

Orofacial pain specialists are well-suited to collaborative facial pain management because easily work with related healthcare professionals to provide patient-centered care. Orofacial pain specialists are uniquely trained to treat pain disorders of the face, mouth, head, neck, and jaw. They work daily with other healthcare specialists to address the many factors that contribute to chronic facial pain, such as: 

• Improving musculoskeletal function 
• Helping TMD patients make self-care changes at home 
• Assessing support needs for related depression and other psychosocial factors 
• Setting up collaboration with neurologists (and other providers), who may not be as experienced in treating headaches related to the TMJ complex 

Siloed Approach Versus a Facial Pain Specialist Co-Ordinator

Facial pain clinics are familiar with patients who learn of an OPS after going through a typical course of having each specialty evaluate them and suggest treatment only through their educational lens.

Often this means that a person, rather than gaining a multi-specialty, comprehensive treatment plan, may be missing overall function improvement as well as symptom reduction. Delays from being seen by various healthcare specialists - without consulting with a certified orofacial pain specialist – may be contributed to increased symptoms and lower daily function. Indeed, each clinician providing services to this patient likely did so with the best of intentions to reduce their pain and suffering.

If treatment is still based on a silo approach, it’s often found that it at a minimum delayed the patient’s recovery. Too often, it also can be attributed to the worsening of their disability, oral functioning, added sleep issues, and depressed mood symptoms.

Orofacial pain specialists also provide the following TMD-Related Services:

• Diagnose, evaluate, and treat pain disorders
• Prescribe medication and rehabilitative services
• Perform pain relieving procedures
• Counsel patients and families on how to assist the patient at home
• Coordinate care with other healthcare providers to ensure a best outcome

To avoid conflicts and miscommunication, it's important for healthcare professionals to understand the principles of interprofessional education and a collaborative approach to TMD care. 

Ongoing Discussion Among Interprofessional TMD Treatment Teams

Chronic facial pain patients often find that treatment includes specialists from neurology, physical therapy, sleep medicine, and behavioral medicine, among others. An interprofessional approach is commonly too challenging for the patient to achieve on their own.  It requires a commitment to communication, collaboration, co-location, and organizational support between healthcare providers.

People experiencing complex chronic orofacial pain can feel overwhelmed by the challenges of receiving sequential or isolated care.  Without coordinated pain management, this may include delays in diagnosis, invasive procedures, and deteriorating disability.

Facial pain treatment centers are striving to address common barriers to collaborative care and put forward possible steps to close these gaps.

Both providers and patients can benefit from an effective referral network. When it is best if the patient is seen beyond the local healthcare community, who is the best resource can be already established. Implementing coordinated care across multiple healthcare providers is less challenging, when even small steps to increase collaboration are taken.

Over time, more leadership is emerging in developing interprofessional dental and pain centers. This creates new opportunities for interprofessional and patient education, such as conferences, meet-ups, forums, and continuing education events. With an additional focus on advocating for reimbursement structures that support interprofessional work, investments in bridging wellness will pay off.

 “Unfortunately, it is not uncommon for patients with facial pain to go through an arduous journey of seeing multiple providers before finally receiving an accurate diagnosis. During this time many patients undergo irreversible dental treatments due to a lack of understanding of the origin of pain.” - Challenges for the Dentist in Managing Orofacial Pain

It's in OPS’ dentists’ and pain patients’ best interest to further develop collaborative relationships with a local orofacial pain center if possible. This will make it less arduous for everyone to see sustained pain reduction and ease of care.  

A facial pain patient’s journey to find coordinated facial pain treatment is best if supported by a dedicated team of professionals, all working together to provide the best care possible. Open communication, coordinated efforts, and a holistic approach are the pillars of effective pain management. 

The goal is to never let the facial pain patient feel confused or alone while trying to sort through appointments from various providers; a collaborative approach to Facial Pain Management is central to bridging wellness.