“Do we need another term to describe temporomandibular joint disorders?” asks Sujay A. J. Mehta, DMD, MPH, in his introduction to a collection of articles in the Journal of the California Dental Association.
“On one hand, the term TMD is commonly used by health care providers and is a key search term,” Dr. Mehta continues. “On the other hand, critics note TMD is associated with poor diagnostic criteria that can include more than one condition, which negatively impacts data collection, research and clinical care.”
The CDA Journal collection Musculoskeletal Orofacial Pain addresses the ongoing debate about the term with four articles featuring experts in education, oral medicine and orofacial pain, public health, pharmacology, health economics, patient quality and patient safety.
Mehta adds that as a newly recognized specialty, “orofacial pain would benefit from help and support across various disciplines to advance our understanding to complex medical presentations and address patient care needs outside of traditional dentistry.”
The collection also includes new research from California dental students and an opportunity to earn C.E. credit. Plus, in a letter to the editor, a dentist reflects on his colleagues’ efforts to help the less fortunate during the Southern California wildfires and about the value of a dental community.
Pharmacotherapeutics of musculoskeletal pain
Medication management of musculoskeletal orofacial pain is challenging in complex patients who may be experiencing additional complicating factors such as depression, altered mood, sleep disturbance and other pain conditions.
In this narrative review, authors Brian E. Cairns, PhD, DrMed, ACPR, and Sujay A.J. Mehta, DMD, MPH, describe the appropriate, conservative and evidence-based use of pharmacology for musculoskeletal orofacial pain, concluding that “step-wise analgesic therapy in combination with education and other treatment modalities, such as cognitive behavioral therapy, should be considered in the management of patients with chronic musculoskeletal orofacial pain.” They summarize the mechanisms, evidence, clinical issues and adverse effects of, and provide recommendations for, the use of non-steroidal anti-inflammatory drugs, skeletal muscle relaxants, antidepressants, anticonvulsants and other analgesics.
Dentists can read “Pharmacotherapeutics of Musculoskeletal Orofacial Pain” and successfully complete an online quiz to earn .5 units C.E.
Patient safety and quality Improvement in MSK OFP
Oral and face pains are a primary motivator for health care consultations, yet authors Shannon L. Cole, PhD, and Sujay A.J. Mehta, DMD, MPH, discuss how features of dentistry, current modes and a lack of specialist training and cultural norms have inadvertently created barriers to improvements in care quality and “may even promote harms to patient groups with musculoskeletal pain.”
They call musculoskeletal orofacial pain a “keystone treatment area” and provide critical insights and recommendations from lessons learned in emergency and acute care settings and other areas of medicine to improve patient safety.
Read “Patient Safety and Quality Improvement in the Care of Musculoskeletal Orofacial Pain.”
Comprehensive cost-effectiveness studies needed in TMD
Davina Frick, PhD, and Anisha Paul-Ledesma, DMD, MPH, MHS, provide a health economist’s perspective in their commentary, concluding that there now exists an “urgent need for robust cost-effectiveness analyses in TMD research to provide clinicians, policymakers, and patients with reliable guidance on treatment selection.”
The authors reinforce concerns about the number of studies, the need for consistent terminology and poor appreciation of the specific economic burdens of orofacial pain —particularly with the historic search terms TMD and temporomandibular disorders.
They highlight key areas where research is lacking and propose a structured approach for future studies to better inform patient outcomes and policymakers’ decision-making and to better allocate funds for appropriate care.
Also on this collection’s theme, “An Overview of Diagnosis and Management of Temporomandibular Disorders,” by Elizabeth Hatfield, DDS, reviews the anatomy, etiology, diagnostic classification, clinical findings and management of TMD.
Dentist reflects on colleagues’ actions during Los Angeles wildfires
In a letter to the Journal editor, Christopher J. Smiley, DDS, reflects on his colleagues’ efforts to help the less fortunate during the Southern California wildfires. Their actions, he says, “underscore the value of a dental community.”
And in new dental student research: Loma Linda University School of Dentistry graduates and faculty assess the survival rate of direct posterior composite resin restorations at a Southern California dental school.
Read the CDA Journal collection, Musculoskeletal Orofacial Pain.
