Orofacial Pain Specialists and Solutions

Orofacial pain specialists are dentists who diagnose and treat orofacial pain disorders. Orofacial Pain (OFP) is the latest specialty of dentistry recognized by the National Commission on Recognition of Dental Specialties and Certifying Boards. In 2020, this discipline became the 12th new dental specialty that aimed to expand care for patients with orofacial pain. OFP patients present with temporomandibular disorders (involving masticatory muscle and joint pain disorders), neuropathic and neurosensory disorders (Burning Mouth Syndrome, atypical facial pain), headache disorders (tension-type headaches, migraine, autonomic trigeminal cephalalgias), orofacial sleep apnea disorders, and oromotor disorders, to name a few (Table 1). 

The specialty of OFP is dedicated to the evidenced-based understanding of the underlying pathophysiology, etiology, prevention, and treatment of these disorders and improving access to interdisciplinary patient care.

Table 1. Common chief complaints categories of OFP patients

1. Jaw and/or Neck Pain (arthrogenous, myogenous, arthritis)
2. Headaches (tension type headaches, migraines, headaches secondary to TMD)
3. Ear Problems (earache, ringing, pulsing, stuffy, dizziness)
4. TMJ (Temporomandibular Joint) Dysfunction or Mobility Disorder (Joint noises, restrictions, hypermobility and locking problems including ankylosis)
5. Orofacial Nerve Disorders (Neuropathies, Neuralgia, Neuritis and Neuromas; Burning Mouth Syndrome, Dysgeusia, Dysesthesia, Distortions)
6. Oral Motor Disorders (Spasm/Paralysis; involuntary and voluntary)
7. Tooth/ Gingiva Pain/Dysesthesia (any persistent tooth sensations)
8. Jaw Structure Abnormality (major malocclusion, and asymmetry and bony tooth anomalies)
9. Sleep Disorder Breathing (OSA, CSA, Insomnia, Parasomnias)

Prevalence of OFP conditions

According to the American Academy of Orofacial Pain (AAOP), 25 to 35% of the population have a current orofacial pain problem severe enough to warrant treatment. More than 9.7 million people go untreated, with an additional 1,000 new patients yearly per orofacial pain dentist.

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According to MedCrave research, “32.7% of patients recognized a TMJ-related problem that affected their quality of life, while 67.3% suffering from TMD were unaware of their TMJ disorder. It affects 5-12% of the population, and the peak age is 20-40 years.” Author Dr. Danya A Alhussini highlights in her article (October 8, 2017, Prevalence and awareness of temporomandibular joint disorders among patients article that the temporomandibular joint (TMJ) is one of the most complex joints in our bodies).

In the United States, TMDs and OFP are a public health problem affecting up to 15% of the adult population and 7% of the adolescent population.

Untreated pain has the propensity of becoming chronic. Approximately 15-18% of patients fall into this category. A 2002 Study found that 18% of subjects receiving TMD treatment have a success rate of 85% over 20 years. To summarize, the personal and public costs can be reduced by early intervention and diagnosis of pain, which would prevent the conversion into chronicity.

The National Institutes of Health reports the cost of TMD and OFP management in the United States per annum, excluding imaging, has reached $4 billion. 

Orofacial pain professional organizations and certifications

One professional organization that groups the orofacial pain specialists (dentists and allied healthcare providers) in the United States is the American Academy of Orofacial Pain (AAOP). This organization promotes excellence in education, research, and patient care in orofacial pain and associated disorders. The members of the AAOP meet in annual conferences and collaborate with the specialty in several approaches. Currently, among members and fellows, the academy presents 546 active members in the US and 33 active members in Canada.

The available programs offering orofacial pain programs in the US are present in 12 institutions where dentists can obtain certificates, master’s degrees, and/or Ph.Ds.

The board certification of the orofacial pain specialists is regulated and granted by the American Board of Orofacial Pain (ABOP). This organization is the sole Certifying Board recognized by the American Academy of Orofacial Pain and the National Commission of Recognition of Dental Specialties and Certifying Boards (NCRDSCB).

The AAOP and ABOP, while distinct organizations, maintain a close working relationship regarding the dental specialty of orofacial pain. Both organizations have available free searching tools to look up specialists by name, address, and credentials.

Multidisciplinary Approach

Orofacial pain disorders are not merely a dental problem. Moreover, most of the time, it involves psychosomatic, psychological, neurological, and physical aspects. An interprofessional (Table 2) approach is recommended to increase the probability of successful treatment and a better prognosis of orofacial pain disorder.

Table 2. The professionals who more commonly collaborate with orofacial pain specialists are

Conclusion

More than 90 percent of dentists and physicians admit needing to be more adequately trained to manage or refer these patients to an orofacial pain dentist.

As a profession, dentistry is now more than teeth and adjacent tissues, and OFPM has assumed a leadership role in this transition. Recognition of this specialty solidifies another link between dentistry and medicine, acknowledging that the orofacial region, oral cavity, and masticatory system are integral to total patient care.

Dentists and healthcare providers who have patients experiencing symptoms such as pain in the head, face, oral and neck regions, temporomandibular disorder (TMD, jaw pain), sleep disorders related to breathing problems, or similar concerns, should consider contacting an orofacial pain specialist for additional evaluation, diagnosis, and treatment advice.

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Like what you’re learning? Consider enrolling in the Herman Ostrow School of Dentistry of USC’s online, competency-based certificate or master’s program in Orofacial Pain and Oral Medicine in partnership with the Keck School of Medicine of USC.

References

1. Fricton JR, Okeson JP. Broad support evident for the emerging specialty of orofacial pain. Tex Dent J. 2000 Jul;117(7):22-5. PMID: 11858060.
2. American Academy of Orofacial Pain (De Leeuw R, et al, eds). Orofacial Pain. Guidelines for Assessment, Diagnosis and Management. Ed 7. Hanover Park, IL: Quintessence Publishing, Inc. 2023. (Updated every five years.)
3. National Academies of Sciences, Engineering, and Medicine. Temporomandibular Disorders: Priorities for Research and Care. Commission Report 2020. https://www.nationalacademies.org/our-work/temporomandibular-disorders-tmd-from-research-discoveries-to-clinical-treatment. Accessed July 11, 2022.
4. Schiffman E, Ohrbach R. Executive summary of the Diagnostic Criteria for Temporomandibular Disorders for clinical and research applications. JADA 2016 Jun;147(6):438-45. Doi: 10.1016/j.adaj.2016.01.007. Epub 2016 Feb 26. PMID: 26922248; PMCID: PMC4884471
5. American Academy of Orofacial Pain website resources.
6. Crandall JA. An Introduction to Orofacial Pain. Dent Clin North Am. 2018 Oct;62(4):511-523. Doi: 10.1016/j.cden.2018.05.001. Epub 2018 Jul 27. PMID: 30189979.
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8. Prevalence of temporomandibular disorders discovered incidentally during routine dental examination using the Research Diagnostic Criteria for Temporomandibular Disorders, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 125, Issue 3, 2018, Pages 250-259, ISSN 22124403, James Lipton, Jonathan Ship, Dina Larach-Robinson,
9. Valesan LF, Da-Cas CD, Réus JC, Denardin ACS, Garanhani RR, Bonotto D, Januzzi E, de Souza BDM. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clin Oral Investig. 2021 Feb;25(2):441-453. doi: 10.1007/s00784-020-03710-w. Epub 2021 Jan 6. PMID: 33409693.
10. Marcela Romero-Reyes & James M Uyanik (2014) Orofacial pain management: current perspectives, Journal of Pain Research, 7:,99-115, DOI: 10.2147/JPR.S37593
11. Mansur Ahmad, Eric L. Schiffman, Temporomandibular Joint Disorders and Orofacial Pain, Dental Clinics of North America, Volume 60, Issue 1, 2016, Pages 105-124,ISSN 0011-8532,ISBN 9780323414470,https://doi.org/10.1016/j.cden.2015.08.004.