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Telehealth and the Orofacial Pain/TMD Practice

Author: Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain

Date: May 15, 2020

For years I have seen the impact of life’s worries and challenges in patients of all ages. Whether the origin was financial, family, relationship-driven, work-prompted, medical, or a daunting combination of many factors, the result is often the emergence or escalation of an orofacial or jaw pain/dysfunction problem.

With their muscles and associated sensory and motor nerves likely in trouble due to an upset brain, high levels of suffering motivate patients to seek care.

As a result, treatment directions for this specific population of patients has focused not just on the physical components of the problem, but the likely responsible risk factors that are unique to each patient, as well. In these scenarios, the goal has always been to reduce symptoms first and then to assist and encourage patients to actively participate in the process that is required for them to get better.

Then came the week of March 16th and the scary reality that life for the moment changed for all of us.

Even those who seemingly had their lives “under control” were suddenly faced with a threat for which they had limited skills to confront. As a result, I am not surprised about the volume of calls and emails from current and former patients seeking additional care strategies for their pain, and from those seeking consults for the first time.

As a result, the use of Telehealth for new patient consults or follow-up visits on platforms such as Zoom or Doxy has been an invaluable tool. And, it may just change how patient assessment is initiated in the future.

During these recent Telehealth sessions, one specific muscle fatiguing risk factor has emerged as a common theme. Excessively long and mentally focused hours on a computer day after day is taking a toll. The physical impact of hunching over a laptop or tablet on the head, neck, and jaw muscles is real – and often profound.

For many people, upset and worry about their isolation, health, and job as well as concern about family members is disrupting sleep and/or initiating or escalating pre-existing insomnia. As a result, their pain thresholds have dropped, and headache symptoms have escalated.

For others, the health crisis has prompted more frequent daytime breath-holding, jaw muscle-bracing, tooth-clenching, and other behaviors that overwork and fatigue the jaw and neck muscles. Aggressive tooth grinding and clenching during sleep have also been reported. Many have either purchased an over-the-counter night guard (many of which are on backorder) or now religiously wear the night guard they had received from their dentist, but hardly ever used.

As a result of these online consults over the last few weeks, I’ve discovered that Telehealth sessions have a real and valuable place in an Orofacial Pain/TMD/Sleep practice. They provide an opportunity in a non-stressful environment to meet the person behind the symptoms and allows spouses, partners, and other family members to be in attendance, as well.

With the reality of face masks being required during office visits, Telehealth sessions allow patients to meet me initially without my face being obscured by a mask, glasses, and a shield. And, as an added benefit, Telehealth sessions conducted one day before a patient’s scheduled visit eliminates at least 30-45 minutes that they have to be spent in my office.

The use of PowerPoint presentations and videos during these online sessions has also brought a high level of education to the experience. When combined with treatment recommendations, including custom exercise regimens, meditation options, breathing programs, TENS instruction, and other home remedies emailed to patients immediately after their online consult, both progress and optimism are realized.

So, as we all settle into our new normal, we must recognize and implement new strategies as we return to our offices. I clearly see that the use of technology, combined with imagination, and an ongoing commitment to providing safe and thoughtful care, will enable all of us to meet the challenges that lie ahead.

I suspect that our ingenuity and grit will enable us to help shape the future of the dental profession.

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