#197 We Don’t Need a Specialty to Treat TMD

I am an Oral and Maxillofacial Surgeon that treated Temporomandibular Joint Disorder, TMD, surgically for the first 36 years of my 50-year career.  The last 14 years I have treated TMD non-surgically after discovering and applying the basic knowledge that orthopedic surgeons have known for a very long time about joints.  Until I discovered and applied what orthopedic surgeons know, I was under the impression that TMD was difficult to treat.  I am now convinced TMD is relatively easy to treat with excellent and predictable results.  I am personally, along with my practice in Franklin Tennessee, and my company TMD Services LLC, now on a mission to educate as many dentists as possible about the simple science that makes all the disparate symptoms of TMD disappear.  This information has been in the peer reviewed scientific literature for years but large swaths of the dental profession, and especially the dental professional schools do not want to look at it because it undercuts their perceived control of the disease. 

No one group, no business, and certainly no institution of higher learning should control the treatment of any disease.  But that is exactly what is going on.  In 2020, American Dental Association at the behest of the National Commission on Recognition of Dental Specialties and Certifying Boards (NCRDSCB), an independent agency of the ADA agreed to make Oral-Facial Pain (OFP)a specialty of Dentistry.  This was accomplished by a small group of dentist/members of the American Academy of Orofacial Pain (AAOP), who held themselves out as having specialized knowledge for treating the disease, while denying what the orthopedic surgeons in the medical profession have known about treating joint disease for a century.  This is quite an unusual situation in comparison to the other eleven (11) specialties in dentistry.   

Every dentist, and every other dental specialty deals with oral-facial pain on a daily basis. Because oral-facial pain is commonly misdiagnosed and confusing is no reason to make a specialty out of it unless it is appropriate to make a specialty out of every disease that is confusing.  Following that train of thought, the American Medical Association should make Alzheimer’s Disease a specialty because it is a poorly understood disease.  A very confusing disease. (Pun Intended)   

Here are the seven inappropriate, unnecessary and confusing tenets (areas of  focus) that Orofacial Pain Specialists listed by the Facial Pain Association justify to being called a specialty along with my comments on each tenet. 

1. Temporomandibular Joint Disorders.  (Note that TMD is stated as disorders, plural, rather than a single disorder with multiple symptoms.  TMD is actually a single disorder created by chronic inflammation within the joint which in turn creates multiple symptoms.  Orofacial Pain Specialists insist on treating the symptoms rather than the cause of the symptoms.  This single error in understanding the disease they attempt to treat deserves their removal as a dental specialty) 

1. Neuropathic Pain like Trigeminal Neuralgia.  (Trigeminal Neuralgia is actually an “archaic catch-all term which has been used by both dentists and physicians for pain they cannot attribute a cause and associated with the innervation of the trigeminal nerves. The fact is, each and every kind of facial pain must be associated in some way with the innervation of the trigeminal nerves which cover the entire surface of the face and does not make it a separate disease.  This is a good example of using ill defined words to confuse the reader.  Basically, it’s “Word Salad”) 

1. Neurovascular Pain like migraines and temporal arteritis. (Fist of all, the medical profession acknowledges they don’t know what causes migraine headaches.  There are a lot of theories, but no proven facts.  Treatment for migraines consists of throwing various drugs at the wall to see which one will stick.  What the drugs have in common is suppression of the entire nervous system and the patient is expected to put up with the suppressive side effects.  One of the most recent drug recommendations costs $100 per tablet and limited to 10 tablets per month because of potential serious side effects.  Total cost, $1,000 per month.  If you don’t know what is causing a disease you should not be experimenting on patients to see what drug works best at suppressing the nervous system.  And you certainly don’t need to be a specialist to do so.) 

1. Muscular pain and Dysfunction. (When you understand that chronic inflammation within the joint creates muscular pain and disfunction you do not need to treat muscular pain and disfunction as a separate entity. Instead, treat the cause of the pain and dysfunction which is chronic inflammation within the joint.  These so-called specialists want to treat the symptoms instead of the cause.) 

1. Primary Headaches.  (Primary headaches is another catch-all phrase that by definition includes migraine headaches-already discussed, tension headaches, cluster headaches which are cyclical, exercise related and sleep related headaches.  Each of these variations of face and head pain can be caused by inflammation within the TMJ.  The Orofacial pain specialists insist on taking various painful symptoms which occur at various times and give it a unique name and call it a separate disease.)   

1. Atypical Dental Pain.  (Pain coming from the teeth or associated periodontal tissue is very easy to diagnose.  If all the dental causes have been ruled out, the pain is atypical and created by the muscles attached to the bone near those teeth being signaled to tighten up and stimulate the pain receptors on the bone near the tooth that feels like a painful tooth.  It feels like the tooth is hurting, but it is actually the pain receptors on the bone bear that tooth.  It is not uncommon for a patient to talk a dentist into taking out a perfectly healthy tooth when the pain is actually generated from inflammation within the TMJ.)  You don’t need to be a specialist to understand this relationship. 

1. Psychological Aspects of Pain.  (You don’t need special training to understand how pain makes a person anxious, irritable, stressed, and sometimes depressed.  By getting rid of the pain by properly treating the cause of the pain makes the psychological impediments improve.  One does not need specialized training or call yourself a specialist to understand this.  You just need a little empathy for your patients. 

So, it is obvious to see that those who want to be called specialists to treat orofacial pain are trying to make something that is quite simple into something complicated by using confusing, archaic, ill-defined terminology ad descriptions.  Any dentist with a few hours of training or an on-line course is able to successfully treat all variations and symptoms of facial pain. I believe the reason for the push to make orofacial pain a specialty was to make the orofacial pain doctors special and not the pain itself. 

A DENTIST DOESN’T NEED TO BE A SPECIALIST TO TREAT OROFACIAL PAIN.