455: What You Need to Know About Orofacial Pain as a Specialty - Dr. Mary Charles Haigler - a podcast by ACT Dental

What You Need to Know About Orofacial Pain as a Specialty

Episode #455 with Dr. Mary Charles Haigler

A toothache may be more than a toothache. It could be TMD, TMJ, or even symptoms of a heart attack! Learning about orofacial pain can change and save your patients’ lives, and Kirk Behrendt brings in Dr. Mary Charles Haigler to encourage you to find out more. Dentists are the best professionals who can make a difference for these patients. And to do that, education is the key. To learn how you can help your suffering patients, listen to Episode 455 of The Best Practices Show!

Main Takeaways:

Orofacial pain is broader than just TMD.

There are many risk factors for pain symptoms.

Listen to your patients and take good medical histories.

For orofacial pain patients, opioids can make things worse.

If you don't see anything wrong with the tooth, step back and reassess.

Keeping up with CE and different fields is very important for this specialty.

Quotes:

“Patients will come in and they’ll inform me that they’ve been diagnosed with TMJ. And so, I have to tell them, ‘Well, let's break it down a little bit more, because there can be a disorder that involves the articular disc being out of place. There can be arthritis, which can either be osteoarthritis or an autoimmune condition. There can be muscle pain or myalgia. There can be a combination of those, or they can be separate.’ So, it’s trying to figure out exactly what that patient has going on so that we can tailor the treatment or the management to whatever symptoms they're actually having.” (5:38—6:20)

“You can learn a lot just from hearing what the patient has to say. Even if they don't fully know what's going on, they could still tell you, ‘Well, when I open, I can only open this wide now. I used to click, and now I don't.’ All of those are little key words that tell you maybe it’s a disc disorder. Or some patients will tell you that they have other joints that are achy and painful, so then that clues you in. So, getting a good history helps to start the process.” (6:49—7:22)

“I look for comorbidities like mood disorders, anxiety, depression. I'll look for sleep disorders such as obstructive sleep apnea because those things can be correlated to jaw pain as well. And so, we like to look at the whole picture, the whole patient, to try to figure out the best treatment for them.” (7:24—7:43)

“Looking at the whole patient helps you to be able to — I'm not going to necessarily treat every part of that if they have hypertension or they have a mood disorder. But I can help them to get that treatment, which then helps us to get them well.” (9:37—9:53)

“I've heard people say, ‘Well, I'm concerned about working with [TMD and TMJ] patients because some patients will come in and say that they have a tooth that hurts. And you look at the tooth, and there's nothing wrong with the tooth, but they're convinced that it is.’ Well, that could mistakenly lead to a practitioner thinking that the person’s either making it up, trying to get something done that's not needed, or get medicine that's not needed. But the reality is that in a lot of those cases, they do feel pain in a certain tooth — but the pain is not coming from that tooth. There's a discrepancy in the site versus the source of the pain.” (10:12—11:58)

“I'd like other dentists to be aware that if a patient has a toothache — and I know you're trying to help them — but you don't see anything wrong with the tooth, just step back and try to reassess.” (11:48—12:01)

“We can only do the best we can with what knowledge we have. And so, that's why I feel like it’s really important for the orofacial pain community to reach out to dentists, reach out to ENTs too, because a lot of patients will have earaches that are actually pain from the temporomandibular joint as...

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