How orofacial pain is treated

A big increase in facial, jaw, neck and headache pain has occurred during the COVID-19 pandemic because we are grinding and clenching our teeth so much more.

Even if we or our family members have not personally suffered from COVID-19, nearly the whole world has felt the mental stress from it. Lockdowns, loss or reduction of employment, worry about the vaccines, having to home-school, social isolation, the large rise in suicide, inability to travel and see family, and numerous other factors have weighed heavily on our minds for the last 2.5 years.

Orofacial and jaw pain is the second biggest reason people visit a dentist because of pain, and so the dentist needs to be aware of its typical manifestations. Too frequently, these pains appear to come from the teeth.

Very frequently, however, these “toothaches” are referred pain coming from hyperactive jaw muscles due to clenching and grinding (bruxism). Because of this common misdiagnosis, we hear far too often that a tooth needs to be extracted because the dentist cannot diagnose the real problem.

It takes a dentist with extensive knowledge of referred pain and trigger-point pain sources to diagnose where the real problem comes from. If this is done correctly, it can save a lot of very expensive and unneeded dentistry and bring about a cessation of the pain.

What sort of orofacial pain can occur that is not tooth-related?

The sort of pain that can occur which is not tooth related is:

• Chewing muscle pain (Myofascial Pain Dysfunction or MPD)
• Temporomandibular joint (TMJ) pain
• Temporomandibular joint disorders (TMJ disorders or TMD)
• Neurogenic pain
• Tumours

MPD, or chewing muscle referred pain, is the cause of about 75% of all these orofacial pains. It occurs in the muscles which control the jaw, which is situated in front of your ears. It is quickly and easily diagnosed by a dentist with extensive training and knowledge in this field. About 20% comes from the TMJ itself, although frequently MPD and TMD occur together, as both are triggered by stress.

The remaining 5% cover the other potential causes and they include various neuralgias like Trigeminal Neuralgias although quite a few of the 12 pairs of Cranial Nerves, can be the source of neuralgia. Tension-type Headaches are a very common result of hyperactivity of the muscles of the jaws and neck. Migraines are also not infrequently associated with these same muscle groups.

Quite often, we find out that a patient has suffered unexplained headaches and facial/jaw pain for years, and has seen numerous specialists and had numerous investigations, tests and x-rays. Some patients come to us because they are at their wit’s end with the pain, while others come to us and tell us their stories as a result of us asking the right questions. Are you someone who has endured these long investigations and are still looking for an answer, or have you just accepted that you are stuck with this problem? Don’t give up if you are either of these, as your dentist may be able to assist.

No singular doctor or dentist is the entire solution to these problems, but we are often the ones who set the patient on the right path to finding solutions. If we are the first health professional to be investigating your pain, we are almost certainly going to work as part of a team with the relevant other health professionals to create your solution.

What can be done about it?

In diagnosing TMD or MPD, we are almost certainly going to follow one of the following treatment paths:

• Start treating you with myofunctional therapy to start the process of unlocking those overworked muscles in your jaws and neck.
• Refer you to our physiotherapy partners who specialise in this field.
• Possibly refer you to other professionals for treatment like, chiropractic treatment, Low-Level Laser Therapy (LLLT or photobiomodulation), applied kinesiology, osteopathic treatment, or acupuncture may help.
• Once this has been initiated, we may suggest a dental splint for you.
• The last acute treatment option may be to use muscle relaxants and/or Botox on the jaw muscles.

About Dental Splints, otherwise known as occlusal splints or orthotics

Unfortunately, private health insurance companies know nothing about dental splints and see them as just an item number. The same item number can describe dozens of different types of splints with varying costs.

No two types of splints have the same application, and only a dentist with extensive experience in these problems can know what type of splint is most suited to your needs. So, if you are told by your health fund that one of their health fund-contracted dentists can make you a cheaper splint, they have no idea what type of splint is required for your problem.

Our splint-manufacturing Dental Laboratories are all specialist laboratories that 3D prints your dental splint to a very specific design and a very specific bite registration that our training demands. At times, a complex and severe temporomandibular disorder or MPD may require several different splint types to address your problem over a period and treat the pain coming from your jaw joint.

We have not even mentioned the last reason for having a splint, which is obstructive sleep apnoea (OSA) and/or snoring. OSA is almost in plague proportions and is largely undiagnosed. We are also the local experts in the dental management of OSA in Far North Queensland, with over 3 decades of experience in dealing with this plague.

We have also greatly simplified the process of formally diagnosing OSA. Only a sleep specialist is entitled to make that formal diagnosis, and we have greatly reduced that long waiting period to get that result. We are likely to suggest trialling a CPAP machine in this scenario.

Your treatment options

We are well aware that about 35% of the population are not even prepared to try CPAP machines because of their negative image. Whilst it is amongst the most effective treatments, research has indicated up to 50% of users cease use within the first year and up to 83% within two years.

What happens then? Do you simply give up on treating your OSA and accept the potentially life-threatening risks? One solution is to look at the other common and much better-tolerated form of treatment, a Mandibular Advancement Splint (device, or MAD).

The benefits of mandibular advancement splints

Not only is there a far higher tolerance of a MAD compared to CPAP, but it is also now similarly effective in treatment. In some cases, both treatments combined can improve outcomes.

Knowing the right splint to use for each patient only comes from decades of experience. Like other splints, these all have one common health fund item number and fail to understand the differences. Like our splints made for TMD or MPD, these are all created in major specialist dental laboratories, and 3D printed for a precise and accurate fit.

If you think you need a dental splint, no matter what type, come to the experts at Future Dental, as we have far greater experience than any other FNQ dental office in accurately diagnosing and treating these conditions with our methods of physical therapy.

Orofacial Pain relief in Cairns

If you are looking to relieve any orofacial pain or TMJ symptoms and have your condition medically reviewed by an expert, we recommend that you contact Future Dental. With over 45 years of experience in dentistry, they can provide the perfect solution for your issue, and have you in comfort for the long term.

If you are interested in the treatments offered for orofacial pain at Future Dental, take a look at our range.

Get in touch with Future Dental today and see the difference they can make for you.