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Orofacial Pain · Talking FACS

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  Welcome to Talking FACS and thank you for tuning into Kentucky Smiles on Talking FACS,
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  A podcast collaboration between the University of Kentucky College of dentistry and the U.
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  K.
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  College of Agriculture,
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  food and environment.
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  Cooperative Extension service,
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  Kentucky smiles offers listeners information on maintaining oral health advancements and dental treatments research and more.
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  Hello and welcome to Kentucky Smiles on Talking FACS.
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  I'm your host,
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  Mindy McCulley, family consumer sciences extension specialist for instructional support at the University of Kentucky Today I am pleased to welcome Dr. Isabel Mareno-Hay,
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  division chief and director of the oral facial pain program here at UK.
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  Welcome Dr Mareno-
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  Hay,
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  thank you so much for having me. just to kick us off.
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  Let's deal with the elephant in the room.
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  What is oral facial pain?
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  Yeah,
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  that's a very good good question.
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  And I get asked that a lot of times.
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  So orofacial pain is one of the specialties in dentistry and we are dedicated to the diagnosis and management of disorders are related with pain that are affect either the jaw,
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  the mouth,
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  face,
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  head and neck.
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  So it's a little bit over all the area of head and neck,
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  head and neck area.
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  Uh And and so that's what the type of patients that that we treat in our facial pain.
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  So not just the teeth but the whole top of the body.
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  Right?
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  Almost almost.
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  But but that's a very that's a very good point because usually you know the number one cause of our official pain is going to be dental pain.
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  So when it experiences pain in your facial pain region,
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  they're gonna usually assume that is dental pain because it's the most prevalent cause.
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  And they will probably consult the dentist once we have ruled out dental pain.
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  So it's not a problem of the tooth.
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  The second most common cause for our official pain is going to be what we call temporomandibular disorders,
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  which a lot of people refer to as TMJ.
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  TMJ actually stands for the name of the temporomandibular joint.
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  So it's a fairly common condition as the second is the second most common condition after then,
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  don't they?
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  Yeah,
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  I was gonna say that TMJ is something that I have heard of frequently.
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  So,
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  and let's just talk about some other common complaints that your patients might have.
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  You know,
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  as as we just mentioned,
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  TMJ pain or temporomandibular disorders is one of the conditions that can cause our official pain aside of dental pain.
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  We also manage other type of associated disorders or conditions that can assess show up as space pain.
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  So we can have maybe some sort of job movement disorders with those are also some disorders that we treat.
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  So this would be patients that will suffer from involuntary job movements and that can lead to,
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  you know,
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  situations in which they cannot open their mouth completely or they cannot close their mouth.
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  It's called mandibular dystonia.
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  And we manage those type of patients as well.
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  We also have other set of conditions that can be,
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  for example,
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  nerve pain conditions.
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  One of the most classic one is trigeminal neuralgia,
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  where our patients will refer that they suffer this very sharp electric shock,
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  like type of pain that just runs on their face.
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  Uh and last just for a few seconds and then goes away can also have,
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  you know,
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  patients that complain about constant pain that is felt on a tooth for example,
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  and it does feel like dental pain.
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  But when we look into the tooth and we have the dentist ruling out dental pain,
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  there's nothing wrong with that tooth.
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  And it's actually coming from the nerves that are innovating that tooth.
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  And we call those neuropathic pain conditions.
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  So that's what we also refer as dental pain that is not of autodegenic origin.
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  And aside that there's a lot of a very close correlation between neck pain and joint pain.
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  So it's not uncommon at all that when we have patients that complained about job pain,
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  we will find a lot of referral or pain also in the cervical area.
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  And very similarly we can have patients that come and complain about headaches.
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  Actually,
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  it's very interesting that when we look into the numbers of patients that we see in our clinic,
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  we see that three out of four patients will have a concomitant complaint of headache and in fact there is one type of headache that is actually attributed to temporomandibular disorders.
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  So when we suffer from jaw pain,
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  we can actually have a headache that is linked to that jaw pain.
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  So,
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  we also manage a lot of headaches in within our patient population.
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  And finally there's a very close correlation between pain and sleep.
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  So when you have a good health sleep quality,
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  that can also make us have a much more amplified experience of pain.
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  So we also address and manage some of the sleep disorders that are associated with chronic pain.
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  And specifically,
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  we also have a clinic that is dedicated to sleep related breathing disorders.
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  So these are those conditions where patients complain about sleep apnea and snoring because then this can play an important role as well in helping the management of these conditions.
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  So that's fascinating as well.
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  And I know that there are situations where you might,
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  I think that you have a dental pain or oral facial pain,
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  but when you actually go to the dentist and get examined,
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  you find that there is something else that's causing that pain.
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  And so then what do you do when you find that situation,
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  you are absolutely right.
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  So you know when we rule out that it's a dental pain for example and we rule out as well that it's not a temporomandibular disorder that is not maybe coming from the jaw muscles and we might find out that there are other structures that can cause face pain.
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  It could be sinusitis for example,
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  pain coming from the sinuses that is felt on the tooth.
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  We can have headaches that might be also referring or or being felt in the face.
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  We can have we talked before about the neck pain.
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  Sometimes we can have neck pain that yeah it's just referring to the face paint.
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  So when in our initial evaluation we find that there are other areas that might be referring pain,
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  it's very common for us to work with other specialties in medicine.
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  So if that would be the case we will refer for example to an E.
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  N.
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  T.
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  To rule out any sinus condition or any other associated conditions.
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  We might work very closely with our headache specialist.
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  We work also very closely with with other pain medicine specialist with physical therapists as well because you know these patients usually come with multiple conditions that might be concomitant and that we need to treat together,
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  it's really a full team that is required to take care of the head and the neck and all of the teeth that are involved.
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  Right?
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  Absolutely.
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  When we were talking before we started recording,
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  you told me that We have now been referred for the 12th specialty in dentistry.
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  So can you tell me a little bit more about that?
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  That's really great news for us.
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  You know,
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  up until a few years back orofacial pain was not necessarily recognized as a dentist specialty.
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  So even though we knew that there were patients out there that needed the care that we are able to provide,
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  it wasn't really recognized as a specialty.
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  And uh finally,
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  last year the American Dental Association recognized our orofacial pain as a dental specialty and it actually will be the 12th dental specialty.
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  So that is excellent news for our field because what that is going to mean is that a lot of our patients will improve access to care.
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  So they will have much more accessibility to find an expert in their area that can help them manage these conditions overall.
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  It's just gonna enhance you know,
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  our our specialty,
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  you know,
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  just to give you a little bit of an idea.
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  Many times we have patients that travel from other states just to come to see us to our clinic because they are not able to find providers in the area that can help them manage these conditions.
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  So hopefully with this recognition of the new specialty that's going to lead to,
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  you know,
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  new programs like the one that we have here at the University of Kentucky that will be responsible for training dentists in this field.
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  And when these dentists go back to the local communities,
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  our patients will have will be able to access care more easily than than what's than what we have currently.
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  Perfect segue into my next question because I was going to ask about the training program because we do have a teaching facility here at the University of Kentucky.
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  So that really just extends that learning opportunity I supposed and really makes us unique because not all states have the access to dentistry that our state does.
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  Is that right?
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  That's absolutely correct.
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  So nationwide we have 11 to 12 programs recognize in orofacial pain,
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  like the one that we have here at the University of Kentucky and that is definitely a low number to be able to provide the need of dentists trained dentists in this field.
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  So we are very unique in that sense that we are and probably we were one of the first programs to be established as well in this field.
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  So hopefully again with this recognition of the new specialty that will lead to the two new programs developing as well that will just help us,
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  you know,
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  train future dentists in this field which is very much needed for for our patients that suffer from from orofacial pain.
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  I really appreciate you taking the time to share with me today.
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  I know that having this resource here in the state of Kentucky is a definite benefit to us and having you to lead up the program in oral facial pain is also a benefit to all of us.
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  So thank you for taking the time to talk to me today.
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  Thank you.
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  Thank you for having me and to our listeners.
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  I hope you will join us again,
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  Kentucky Smiles is available monthly on the Talking FACS podcast,
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  which you can find on all major podcast providers.
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  Thank you for listening to Kentucky smiles on talking facts.
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  Our goal is to provide you with knowledge to support your oral health needs.
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  If you have suggestions for future topics,
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  please message us on the UK College of Dentistry facebook page at facebook dot com forward slash u ky dentistry or visit our website at UK healthcare dot u k y dot e d u forward slash dentistry for more information.