In our previous blog on Pain Management, we had covered key aspects of facial pain related to neurology. In this blog, which is part two of our Pain Management series, we cover Dentistry – and dental factors that contribute to pain.
Pain Management – Dentistry
Orofacial pain with an obvious cause such as toothache can be managed very effectively. However, a chronic pain which occurs spontaneously without evidence of structural cause is difficult to manage, due to lack of understanding of pain mechanism.
As mentioned in our earlier blog, pain around head, neck and shoulder area, often relates to neurology or ENT or Orthopedics. In most cases, the last doctor or specialist that a patient considers consulting is a dentist! This is an outcome of poor awareness even among the dental fraternity about TMD – the condition that causes the above symptoms.
#DidYouKnow
A migraine, neck and shoulder pain could actually be due to a TMD.
What is TMD?
Temporomandibular joint dysfunction, or TMD for short, is the name given to the condition where seemingly unconnected symptoms ranging from headache, vertigo, and neck and shoulder pain, to mention a few, along with dental symptoms, can be sourced to the temporomandibular joints and a bad bite. TMD is quite prevalent and could exist in a subdued manner for many (they might not even realise they have a problem), and in an acute manner for some.
The temporomandibular joints connect your lower jaw bone to your skull and allow the jaw to move.
How does TMD cause pain around the head, neck and shoulder area?
The coming together of upper and lower teeth is called ‘occlusion’. This should happen with the temporomandibular joints in a comfortable position. If the joints have to adjust their position to achieve good occlusion, the muscles working with the jaw get overworked and become painful and spastic. The neck and shoulder pain become part of the problem along with facial pain, as the neck also has to posture as the lower jaw readjusts. As the powerful muscles of the head and neck go into spasm, they compress various nerves and structures causing pain, which appears as if they are not related to teeth.
A few examples of pain due to TMD: headache, migraines, neck & shoulder pain, frozen shoulder, vertigo, tinnitus, chipping and breaking teeth, joint clicks and teeth sensitivity.
Diagnosis of TMD is to be done first.
A splint, to be worn in the mouth at night, is given to the patient, typically for a month. Many a times with splint wear, the patient’s “migraine” headache vanishes from the very next day. The splint thus helps the dentist to decide if the underlying cause was a problematic dental bite.
Treatment of TMD
The initial treatment process involves taking records of the mouth, and the jaw, and creating dental casts attached to an articulator (a device that simulates the jaw joint), where the proper diagnosis is made. Based on this, appropriate treatment plansare suggested to make necessary corrections to the patient’s bite.
The treatment can be as simple as ‘equilibration’ of the bite through selective grinding, or may involve more detailed treatment requiring fillings, crowns and possible orthodontics (correcting misaligned teeth with brackets and wires).
Today, 99% of migraine is related to the dental bite. In recent years, the explosion of knowledge in this area is so great that it is now possible for a clinician to identify its causes and treat it effectively. Enormous scientific evidence is now available with which dentists are able to differentiate between pain that arises from dental, oral and masticatory sources or those that emanate from elsewhere. Dentists, therefore, have a major role for proper management of pain in and around mouth, face and neck. Once the source of pain is correctly identified as a condition amenable to dental therapy, treatment by the dentist is in order. In cases where the condition is not amenable to dental therapy, the primary role of the dentist is to identify such cases where interdisciplinary management is needed with appropriate health care professionals. Unfortunately, while discussions are happening around this, not too much of awareness has been created among people to relate pain management to dentistry. Dentistry should be an essential part of the diagnostic process for migraine and other facial related pain, to determine if it is a possible cause. This is especially important as research indicates that in most of such cases where dental issues are the cause, treatment could even be simple and therefore more affordable, which works in favour of patients.