For people living with chronic orofacial pain, quick and appropriate treatment is paramount and can be cost-saving. According to a study conducted in the United Kingdom and published in the Journal of Dental Research, “screening patients with a well-established graded chronic pain scale could ensure that those most severely affected immediately receive specialist care — saving money.” [1] While these findings are specific to the UK and highlight disparities in treatment modalities within that part of the world, the results are still valid and may be used to better develop and improve the U.S.’s current system of care.
Chronic orofacial pain (COFP) is characterized by pain occurring in the mouth, jaws and the face lasting for a prolonged period of time, and it is not uncommon for it to be dental-related. According to the American Academy of Orofacial Pain, orofacial pain encompasses:
- Temporomandibular Joint Disorder
- Masticatory musculoskeletal pain
- Cervical musculoskeletal pain
- Neurovascular pain
- Neuropathic pain
- Sleep disorders related to orofacial pain
- Orofacial Dystonias
- Headaches
- Intraoral, intracranial, extracranial, and systemic disorders that cause orofacial pain
Two of the most significant discrepancies within the COFP treatment are the inability to effectively diagnosis the patient within a reasonable time frame and the failure to treat the condition appropriately. Because COFP patients are so rarely seen by general practitioners and dentists alike, misdiagnosis and lengthy treatment protocols are all too common. Both of these factors contribute to sky-rocketing medical costs and prolong patient discomfort and pain. One patient who participated in the United Kingdom study recalls changing dentists three times over the course of 12 years. When she was finally seen by a specialist, the doctor determined the problem was neurological and prescribed a medication to address her needs. Within a few weeks, she felt remarkably better.
One of the most common COFP conditions is temporomandibular joint disorder (TMJ). The symptoms of this condition generally include chronic headaches, jaw pain, facial pain, lockjaw, popping in the jaw and limited jaw movement. The treatment options for TMJ include long-term medications, therapies, and even surgery. But for a Seattle-based dentist, Dr. David Buck, his approach to treating this chronic condition is less invasive. He believes in using neuromuscular dentistry to help treat the symptoms associated with TMJ, because for patients living with this condition, placing the jaw into its optimal position can make all the difference.
“Many of my adult patients need to have their bites corrected,” Buck said. “If you look at a neuromuscular approach to how you’re going to treat your patients, you can set up a bite which will allow the head to stay neutral over the top of the body. The rest of the body then has an orthostatic posture where all planes of reference are basically parallel to the floor or perpendicular to the long access in gravity.”
Part of the key to treating not just this type of COFP but others as well is getting the diagnosis right the first time and recommending a course of treatment that will help bring the patient long-term relief. Buck understands the mechanics of the jaw, mouth, tongue and neck and how they intersect and impact the bite. If that bite is misaligned, a person can easily exhibit TMJ-related symptoms.
“When you develop the bites with a holistic, neuromuscular approach, we allow for the bite to be in harmony so that the joints and muscles are in balance in the jaw and in the neck.”
While almost any form of treatment for chronic conditions does come with a price tag, the healthcare system can help reduce unnecessary exuberant costs for patients by ensuring they are diagnosed correctly by a specialist the first time around and prescribing the right course of treatment. As the UK suggests, “an initial test to establish whether specialist treatment should be offered straight away,” and as such could prevent patients from living chronic pain longer than necessary.
