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Orofacial Pain

 How many providers do patients see to treat their knee pain? One? Three? Maybe their GP, an orthopedic surgeon and a physical therapist. Patients often seek treatment from many more than three providers when they have orofacial pain. The National Societies of Sciences, Engineering, and Medicine estimates patients seek care from an average of 6.7 providers (1). These providers often include dentists, ENTs, physicians, and nurse practitioners. What do they do when it is not their tooth or ear that is the cause? What if it is a joint and/or muscle disorder? Physical therapists play an important role in helping these patients.  

Orofacial pain disorders can include musculoskeletal pain of the head, neck and temporomandibular joints. Oftentimes education and experience in this area of PT is lacking, making therapists less confident in treating these patients. Physical therapists receive an average 12 hours training on temporomandibular disorders or TMD (2) in DPT programs. This mostly includes lecture-based instruction with little to no access to actual clinical experience with this population. To make matters worse, dentists have even less education on TMD than that. My own husband is a general dentist and he couldn’t name the masticatory muscles if winning a contest depended on it; not to mention, actually palpate them.

I found myself in this realm of PT after starting out in a chronic spine pain clinic that hosted a speaker on treating TMD. Fast forward a couple more outpatient orthopedic jobs later, and I am “that PT that treats orofacial pain.” Naturally my caseload expanded and I made connections with  those providers I noted previously: dentists, ENTs, and physicians. I have gone on to teach continuing education courses on this topic nationally and continue to mentor locally. I earned  my Certified Cervical and Temporomandibular Therapist (CCTT) certification in 2020. I find you can really make a difference with these patients and it is so rewarding to be that 6 and 1/2th provider that actually makes a difference.   

With estimates of >50% of the population having symptoms of TMJ disorders and 6% of them having functional limitations (1), there is a large number of patients who could benefit from physical therapy. How then, do we go about improving access to PT services for these patients? 

Let’s start with further education. There are several resources available to get you started including a few organizations that offer a certification in this area. Most of these websites will have a member list allowing you to see if there is a PT in your area you could connect with for further resources and possible mentorship. There are also a variety of continuing education companies that do a great job of advancing knowledge, in addition to many books, journal articles and free resources on the internet. These include:

This is not an exhaustive list, but should get you started along the path to advancing your knowledge. 

Once you feel more confident in your skills, the next step would be getting the word out there in your community that PT can help with orofacial pain. I would recommend starting by reaching out to the most common providers these patients see: dentists and ENTs. I find they are often very open to discussion and are happy to have a place to refer when they have ruled out a tooth or ear problem. Have a flyer with your info on it and let them know what PT can do. Also check out this great Choose PT resource for patients from the APTA.  

There is an unmet need for patients with orofacial pain and physical therapy can help fill that need. Orofacial pain was just finally recognized as a dental specialty in 2020(3) so awareness of this field will only continue to grow and PT has a very valuable role in that. I invite you to come along.  

 

References

  1.  Bond EC, Mackey S, English RA, Liverman CT, Yost OC. Temporomandibular Disorders: Priorities for Research and Care. Washington, DC: The National Academies Press; 2020. 
  2.  Prodoehl J, Kraus S, Klasser GD, Hall KD. Temporomandibular disorder content in the curricula of physical therapist professional programs in the United States. CRANIO®. 2019;38(6):376-388. doi:10.1080/08869634.2018.1560983 
  3. American Academy of Orofacial Pain. Accessed November 22, 2022. https://aaop.clubexpress.com/content.aspx?page_id=22&club_id=508439&module_id=107327 .  

 

Author Bio: 

Leslie Hovda, PT, DPT, OCS, SDN2, CCTT graduated with her physical therapy degree from the University of North Dakota in 2010. Since that time she has gone on to take many advanced training courses in the areas of temporomandibular disorders and the spine, including completion of a board certification in Orthopaedic Physical Therapy and Synergistic Dry Needling Level 2. Leslie has also taught courses nationwide and is an APTA-Credentialed Clinical Instructor. In addition, she has developed and provided Safe Patient Handling courses for dental offices including continuing education credits through the Minnesota Dental Association.

Leslie’s passion for excellence in treatment of temporomandibular disorders extends not only to her patient care but to her community. She seeks to develop strong interdisciplinary connections between physical therapists, dentists, oral surgeons, chiropractors, and ENTs.  Working on this passion has led her to many mentorship roles including leading local and national journal clubs focused on TMD, lecturing at local colleges, presenting to dental practices, and participating in the upper Midwest’s premier dental conference – Star of the North.