Orofacial pain is a relatively common complaint in general medicine and dental practice. Diagnosis and treatment of OFP originating from the oropharyngeal region, facial area, ears, sinonasal area, and neck is a complex process compounded by the density of anatomical structures and the prominent psychologic significance attributed to this region. Management of OFP thus demands the service of clinicians from various specializations such as Dentistry, Otolaryngology, ophthalmology, neurology, neurosurgery, psychiatry and psychology. Complex referral patterns to adjacent structures are common in OFP and, indeed, one person’s headache is another person’s facial pain. In clinical practice, the two types of pain are often intimately related. Consequently, a patient with OFP may wander from one specialty to another to try to find adequate help.

The quest to better manage pain problems involving the head and neck area such as headaches, facial pain, and temporomandibular disorders has led to the establishment of OFP as a discipline in the field of dentistry. A huge step in the recognition of OFP as a discipline in dentistry occurred in 2009 when the Commission on Dental Accreditation (CODA) approved OFP as an area of advanced education.

A vast variety of disorders fall under the umbrella of OFP disorders, to name a few, musculoskeletal pain disorders (Myositis, arthralgia, Myofascial pain, fibromyalgia, temporomandibular joint disorders), Neurovascular pain disorders (like migraines, tension-type headaches, trigeminal autonomic cephalgias), Neuropathic pain disorders (like trigeminal and glossopharyngeal neuralgia, burning mouth syndrome, postherpetic neuralgia, traumatic neuroma), Intraoral pain disorders (involving dental pulp, periodontium, mucogingival tissues, and tongue), Cervical pain disorders, Sleep disorders (like sleep bruxism, obstructive sleep apnea), orofacial pain emanating from the sinus, heart, malignancies, Psychologic conditions like mood disorders and anxiety disorders. Depression, anxiety and prolonged negative feelings are common among chronic pain patients and may make persistent pain more difficult to tolerate or manage.

The general assessment of the OFP patient is aimed at identifying the what, where, how and why of the presenting complaint. Diagnosis of OFP requires taking a detailed history, completing a comprehensive clinical examination and ordering appropriate diagnostic tests of established validity. All dental patients should be screened for TMD’s and positive screening findings should prompt a more comprehensive evaluation. The OFP clinician must then synthesize the information to determine pain etiology and establishes a diagnosis. The immediate goal after establishing the diagnosis is to initiate a treatment plan.

Given the complex nature of OFP conditions, treatment should involve multiple modalities including pharmacologic therapy, oral appliances, physical therapy, trigger point injections, behavioral modification, diet and exercises that emphasize proper breathing and increasing flexibility.

OFP remains a prevalent and debilitating condition with significant social and economic impacts. Clearly the task required is the integration of knowledge in this anatomically dense region, traditionally divided between many medical disciplines. Based on extensive clinical experience with patients suffering from OFP and headache, an Orofacial pain clinician is well equipped to fulfill this task of giving adequate relief to an OFP patient and improving his/her quality of life.

If you have been thinking of orthodontic treatment for yourself or someone you care about, you may be wondering: When is the right time to see an Orthodontist? It’s an excellent question. Though an Orthodontist can enhance a smile at any age, there is an optimal time period to begin treatment. Beginning treatment at this time ensures the greatest result and the least amount of time and expense.

Even though for most cases it is “the sooner – the better”, that is not a general rule for all patients. The best age to start wearing braces will vary from patient to patient, but is very important that an initial orthodontic evaluation is done early enough, immediately after a possible problem is noticed. The American Association of Orthodontist (AAO) recommends that all children have a check up with an Orthodontist no later than 7th year of age, for early detection of any potential problems. The child’s teeth may appear straight to the eyes of the parents, but there could a problem that only an Orthodontist can detect, like whether or not there will be adequate room in the mouth to accommodate the permanent teeth. By the age 7, some of the permanent teeth have erupted, so that most children have a mix of adult and baby teeth. At this stage of mixed dentition, an Orthodontist can spot potential orthodontic problem related to jaw growth and eruption of adult teeth. Some growth related orthodontic problems are easier to correct when they are identified early, while the facial bones are still growing.

When a problem is detected, the Orthodontist may not always recommend immediate treatment. In most of the cases, parents are advised to bring the child every 6 months for periodic monitoring of jaw growth and dental development. Prudent intervention guides growth and development, preventing serious problems later. In case of existing or potential malocclusion problem, an early orthodontic screening allows the Orthodontist to offer advice and guidance for the best age to start treatment and what kind of treatment will be appropriate.

In the past, orthodontic treatment was common only during adolescent or teenage years, when all permanent teeth had erupted. Until some years ago, it was unusual to start orthodontic treatment at age of 7 or after 20’s. But today the situation is different, because of changing trends and greater awarenes, you can meet patients of wide range of ages in an Orthodontist’s waiting room.

EARLY CHILDHOOD: Early Orthodontic treatment (also known as PHASE 1 or INTERCEPTIVE TREATMENT) helps to:

-guide jaw growth into favorable direction and size

-take advantage of jaw bones growth process to guide teeth to their correct position

-prevent more serious problems from developing (early or late loss of baby teeth)

-lower the risk of injury to protruded front teeth (Bugs Bunny teeth)

-reduce treatment time and complexity at later age

-minimize the need of jaw surgery

-minimize the need of permanent teeth extractions

– correct harmful oral habits (thumb sucking, tongue thrusting, mouth breathing)

ADOLOSCENT OR TEENAGE YEARS: If there are no problems that require an early intervention, treatment is most effective at this age when all permanent teeth have erupted and most of the jaw development has completed.

ADULTHOOD – ADULT ORTHODONTICS: You know when your child should come in for an orthodontic consultation. Now, how about you? Do you cover your mouth with your hand when you smile? Are you self-conscious around strangers because your smile isn’t as perfect as you want it to be? If so, then the best time to see an Orthodontist might be – RIGHT NOW !

People think that Orthodontics is just for kids. If so, then it’s time to think again. In fact, according to AAO, around 1 in 5 orthodontic patients today are adults.

Adult Orthodontics offers the opportunity of a better smile to all those who couldn’t get treatment in their teenage years. Orthodontic treatment can be successful at any age and in older patients, compliance isn’t usually an issue. Plus with the advanced technology and growing availability of clear aligners, transluscent ceramic braces, lingual braces (braces on the inner side of the teeth), it’s getting harder to tell whether or not you are wearing braces. So if adults worry that metal braces might clash with their professional image, be sure to ask your Orthodontist about less visible alternatives.

Also, if you clench or grind your teeth, your jaws seem to frequently shift in position or make sounds (Clicking) as they move or you find you are unintentionally biting your cheek, you have certain speech defects (lisping), you need to see an Orthodontist as well.

Ofcourse, it isn’t just about looks. Well-aligned teeth are easier to clean and maintain and less subject to abnormal wear. A better bite keeps you from having trouble eating and speaking and helps your teeth stay healthy – and healthy teeth can last a lifetime. So, why delay getting Orthodontic treatment? Ultimately, Orthodontists do much more than creating a beautiful smile – they create a healthier confident you !!!

DR SUMIT GUPTA

SPECIALIST ORTHODONTIST

Al Hafiz International Hospital

JLT, Abu Dhabi.