The New Paradigm for TMD/Orofacial Pain- Sleep Medicine:

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"

  • CE Credit: 2
  • Audience:
Stephen Harkins

Stephen Harkins, DDS

Stephen Harkins, DDS graduated from the University of Wisconsin, Madison with a B.S. degree in Molecular Biology/Genetics. He received his Doctor of Dental Surgery degree from the University of Minnesota School of Dentistry and continued his interest in jaw orthopedics, temporomandibular joint disorders (TMD), orofacial pain (OFP), oral medicine, regenerative tissue therapy, sleep disorders and behavioral/psychology/stress management by completing several postgraduate educational training programs at the University of Minnesota, Harvard University, UCLA, the Mayo Clinic, with certifications in clinical hypnosis, biofeedback therapy, TMD/Orofacial Pain and Dental Sleep Medicine. Dr. Harkins moved to Tucson in 1981 and established one of the first private practice clinics in the world., limited to the diagnosis and management of TMD/Orofacial Pain, Headache and Sleep Disorders. Dr. Harkins has been a member of the research faculty at the University of Arizona College of Medicine since 1984 and has served as a consultant to the Veterans Administration Hospital in Tucson for since 1986. He has published several scientific research articles in dental and medical journals, authored two chapters in medical textbooks and edited/produced patient education brochures on TMD and OFP, which are used in dental, medical schools and treatment clinics around the world. Dr. Harkins has presented his research studies and lectured for continuing education programs throughout the U.S. and around the world. He has treated over 35,000 TMD/OFP/Sleep patients in his career and is still active, in patient care, education, writing and clinical research. Dr. Harkins has developed and patented the Twilite Appliance®, a novel, intraoral appliance to hold the oropharyngeal airway open during sleep, in patients that snore and/or suffer from Obstructive Sleep Apnea (OSA). After several years of development and application in several thousand OSA and snoring patients, the FDA cleared the Twilite Appliance ® for use by the general public. Dr. Harkins was certified by the American Board of Orofacial Pain in 1995 and maintains Diplomat status. He is a Fellow of the American Academy of Orofacial Pain, is lifetime member of the American Dental Association, Arizona State Dental Association, Southern Arizona Dental Society, and the American Academy of Sleep Medicine. Dr. Harkins has recently been appointed as the Commissioner to the American Dental Association to represent the new Orofacial Pain Specialty.

Conflict of Interest Disclosure: Licensor/Owner for the TWA, ThreeD Smiles

Mitchell Halter

Mitchell Halter, PhD, MD

Dr. Mitchell R. Halter, PhD, MD, completed his undergraduate studies at the University of Arizona, went on to receive a PhD in Immunology, an MD, residency in neurology and anesthesia pain management fellowship, all from the University of Arizona, Tucson, AZ. Dr. Halter practiced general body pain management for 12 years and joined Dr. Harkins in 2015. Dr. Halter evaluates and treats chronic pain in all areas of the body, but has a special interest in Chronic Headaches and Orofacial Pain. He developed an interest in sleep disorders when he joined the Harkins Pain & Sleep Management Group. Since joining the Harkins Group, Dr. Halter has treated several thousand chronic pain/sleep disturbance and OSA patients. He has utilized several hundred Twilite Appliances® to date in his patients and is impressed with the effectiveness and high patient acceptance of the device, compared to other intraoral devices, CPAP, BiPAP and AutoPap . Dr. Halter has pioneered protocols for the highly effective use of adjunctive medications for OSA patients that wear a Twilite Appliance®, but remain at risk because they continue to have too many apneic events with the appliance alone. Dr. Halter’s innovative combined intraoral appliance/medication protocols have been very effective in reducing residual apneic events to levels low enough to eliminate the need for additional treatment or supplemental oxygen while sleeping. Dr. Halter is the medical director of the Harkins Pain & Sleep Management Group and is a researcher, lecturer, educator and medical consultant.

Joseph Matthews

Joseph Matthews

Joseph Matthews, DDS, MS received his Bachelor of Science and Master’s Degree in Nutrition from Kansas State University, Doctor of Dental Surgery from the University of Missouri, and post-doctoral Master’s Degree in Evidence-Based Health Care from Oxford University, Oxford, England. He then received a post-doctoral certificate in Orofacial Pain from UCLA. Dr. Matthews joined the Harkins Pain & Sleep Management Group in 2018, after limiting his practice to TMD/Orofacial Pain, Headache and Sleep Disorders for the previous 5 years, after practicing general dentistry for 30 years in Las Alamos, NM. Dr. Matthews has numerous professional publications and has given presentations on pain and sleep management, and critical appraisal of research literature, domestically and internationally. He is a Diplomate of the Board of Orofacial Pain, Fellow of the American Academy of Orofacial Pain, member of the American Headache Society, and served on the board directors for The Academy of Integrative Pain Management. He has also been a consultant to the Council of Scientific Affairs of the American Dental Association.