Presentation #1 (30-45 minutes):
The New Paradigm in Orofacial Pain (OFP), including TMD, and Dental Sleep Medicine
By: Stephen Harkins, DDS (Board Certified Specialist in Orofacial Pain/TMD/Sleep Disorders)
The purpose of this overview is to introduce the new specialty of Orofacial Pain (OFP), which was officially recognized by the ADA and the American Board of Dental Specialties and Certifying Boards on March 3, 2020. This overview will describe OFP Specialty requirements, as defined by the American Academy of Orofacial Pain (AAOP,) and the recognized board certification by the American Board of Orofacial Pain (ABOP). This presentation will also describe definitions of OFP, OFP Disorders, OFP Specialty "scope of practice", and the "scientific evidence-based" guidelines for OFP/TMD Specialty diagnosis, assessment and management protocols. The AAOP OFP/TMD guidelines encourage the integration with physicians, behavioral, and other healthcare providers in the multi-disciplinary management of OFP/TMD, "Sleep and Obstructive Airway Sleep Breathing Disorders". A brief description of innovative "Tissue Regeneration", "Oropharyngeal Soft Tissue Recontouring" and "Deep Pain" protocols, utilizing "Autologous Blood Injections (ABIs)" and Fotona SP Dynamis Laser: Erbium NightLase "Soft Tissue Recontouring" and Nd:YAG "Deep Pain Reduction" protocols.
A March, 2020 320-page consensus report, sponsored by the National Institute of Health (NIH) and National Institute for Dental and Craniofacial Research (NICDR), was published by the National Academies of: Science, Engineering and Medicine (NASEM) on "Temporomandibular Disorders: Priorities for Research and Care". This extensive report was highly critical of the past disparate, "unscientific, non-evidence based" assessment and management protocols, utilized by many TMD/OFP providers, especially when administered by untrained, poorly-trained and/or selective specialty-trained dentists and "invasive specialty" providers, that utilize "unscientific" and/or "poorly supported", expensive, unnecessary imaging and laboratory diagnostic protocols, coupled with aggressive, irreversible, high-risk protocols, as a "first-line" option in the assessment and management of TMD/OFP Disorders. The report was very supportive of increased TMD/OFP education in pre-doctorate dental, medical and healthcare programs, with increased NIH funding for research and TMD/OFP Specialty training programs in the US, that are trained and committed to conservative, "evidence-based" assessment, diagnosis and management of TMD/OFP Disorders.
Following presentation #1, participants should be able to:
1. Demonstrate awareness of the new OFP Specialty, OFP Specialty board certification, training, "scope of practice", "standard of care", and significant NIH/NIDCR/NASEM support for the new OFP Specialty and "scientific evidence-based" guidelines.
2. Recognize and screen for Orofacial Pain Disorders (including TMD, and Sleep-Breathing Disorders).
3. Recognize when to treat and/or refer to an OFP Specialist.
Presentation #2 (20 min):
Atypical Facial Pain and Pain Disorders That Mimic Dental Pain
By: Mitchell Halter, PhD, MD (Neurologist/Medical Pain Management Specialist)
The purpose of this presentation is to provide an overview of Orofacial Neuropathic Pain Disorders that masquerade as tooth, alveolar and/or periodontal pain. These complex, non-dental pain disorders, including "NICOs", often motivate patients to seek dental intervention. Dental intervention therapies, including restorative (fillings, crowns), endodontic (root canals, apicoectomies), periodontal (root/alveolar curettage, root resection, bone grafting, tissue regenerative protocols, dental implants) and oral surgical procedures (extractions, bone extirpation/grafting, neurectomies), will not resolve this type of pain, and may exacerbate the pain intensity. Awareness of OFP Neuropathic Pain Disorders, recognition of "red flags" / "warning signs" , and appropriate screening/assessment/diagnostic tools to evaluate these patients, and/or refer to an OFP Specialist, prior to irreversible therapies, will significantly assist the dental provider to avoid erroneous dental intervention, embarrassment, and associated liability issues that often accompany unsuccessful dental treatment protocols.
Following presentation #2, participants should be able to:
1. Demonstrate an awareness, knowledge and "red flags" / "warning signs", to assist in identification of non-dental OFP Neuropathic Pain Disorders.
2. Learn the appropriate screening/assessment/diagnostic protocols to avoid unnecessary irreversible interventions for OFP Neuropathic Pain Disorders.
3. Demonstrate an awareness, especially when in doubt, to refer to an OFP Specialist for an independent opinion, prior to irreversible interventions.
4. Avoid embarrassment and legal liability issues that often follow unsuccessful irreversible interventions for OFP Neuropathic Pain Disorder
Presentation #3 (20 min)
Orofacial Pain Imaging and Innovative Protocols for Complex Neuropathic Pain
By: Joseph Matthews, DDS, MS
The purpose of this presentation is to review indications and protocols for the imaging of OFP patients, including selected case presentations. Indications and "alternative" treatment / management protocols for OFP Neuropathic Pain Disorders, including indications, fabrication, and application of "Neurosensory Stents". Customized formulas for topical Neuropathic OFP medications will be presented, including formulas for management of "Post Traumatic Trigeminal Neuropathy (PTTN)" and "Burning Mouth Syndrome (BMS)".
Following presentation #3, participants should be able to:
1. State indications for 3-D CBCT imaging for OFP Disorders.
2. Describe immediate and long-term interventions for "PTTN".
3. Identify cases when MRI is indicated.
4. Describe the indications for "Neurosensory Stents"