Bio-Psychosocial Perspective

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Barry Cooper – An orofacial pain specialty An asset or liability to dentistry and the public

Bio-Psychosocial Perspective

• GNM is Not the Same as NM
• Barry Cooper – An orofacial pain specialty An asset or liability to dentistry and the public

The National Institute of Dental and Craniofacial Research (NIDCR) ignores that TMD may have not only a muscular component to this disease/dysfunction, but that it also may have an occlusal component as well is an over-site which only exemplifies its intent to ignore the bio-physiologic factors of the stomatognathic system and posture of the upper quarter of the bodies systems.

1. It suggests that medicine is the solution to TMD problems.
2. It suggests that TMD often resolves itself and is self-healing.
3. It emphasizes that TMD is a self-limiting disease and occlusal (bite) changes are to be avoided.
4. It does not acknowledge that TMD is a major component in the scope of dental practice nor does it recognize that the dentist has a major role in dealing with muscles, joints and teeth as it pertains to temporomandibular joint disorder and all the associated signs and symptoms that relate to the trigeminal system.

Taking a “wait and see” approach to disease based on unfounded, conflicting opinions that TMD is both innocuous and unaffected by preventative therapy lacks responsibility to the public. A support for pain medications that can lead to dependency and drug abuse in dealing with chronic pain rather than a philosophy of support toward prevention is irresponsible.

To improperly suggest that occlusion is not even remotely related to TMD when it has been well demonstrated that loss of posterior occlusal support and parafunction have a role, even if an indirect one, is fatuous.  If the latter is an unfair criticism, why then would one support the use of flat splints presumably to avoid parafunction?

To convey that jaw joint X-rays (transcranial/tomographic radiographs) are not generally useful in diagnosing TMJ disorders is unconscionable and confused as to the understanding and appreciation of the TM joint. Not having an ability to distinguish normal from abnormal, pathologic from physiologic affords the doctor no possible way to diagnose nor render appropriate therapy.  It is not customarily used as a first radiographic procedure, but rather for conditions of long-standing pain and limitation of jaw movement that have not been responsive to conservative treatment. MRI may be indicated in cases of direct trauma to the joints as an early diagnostic modality.

No mention of the American Dental Association’s granted Seal of Acceptance to three computerized measurement devices that aid in the management of TMD are mentioned in this philosophy.

• Psychosocial interventions for the management of chronic orofacial pain. –  [Cochrane Database Syst Rev. 2015].

• Weak evidence supports the use of psychosocial interventions for chronic orofacial pain. –  [Cochrane Database Syst Rev. 2011].

DATA SOURCES: Cochrane Oral Health Group’s Trials Register, Central, Medline, Embase, PsycINFO.

STUDY SELECTION: Randomised controlled trials of psychosocial interventions for chronic orofacial pain were included. Psychosocial interventions targeted towards changing thoughts, behaviours and/or feelings that may exacerbate pain symptoms through a vicious cycle were eligible. Primary outcomes were pain intensity/severity, satisfaction with pain relief and quality of life.

DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened studies, extracted data and assessed risk of bias. Dichotomous outcomes, were expressed as risk ratios with 95% confidence intervals, continuous outcomes as mean differences with 95% confidence intervals. Heterogeneity was assessed using the Cochrane test for heterogeneity and the I2 test. Meta-analyses were conducted using the random-effect or the fixed-effect models.

RESULTS: Fifteen of the 17 eligible studies were on temporomandibular disorders (TMDs), two on burning mouth syndrome. Psychosocial interventions improved long-term pain intensity (standardised mean difference (SMD) -0.34, 95% confidence interval (CI) -0.50 to -0.18) and depression (SMD -0.35, 95% CI -0.54 to -0.16). However, the risk of bias in these studies was high.

CONCLUSIONS: There is weak evidence to support the use of psychosocial interventions for chronic orofacial pain.