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TMJ SECTION MY TAKE
Dr Varun Kunte

This article speaks about
by different practitioners such as chiropractors, physiotherapists, registered a stepped approach
massage therapists, and naturopaths. towards management
Therapy can include education, joint specific exercises, intra and extraoral of Orofacial Pain. The
soft tissue therapies, and light joint mobilizations. Exercises targeted to authors have done a great
enhance jaw mobility and strengthen surrounding muscles often prove job of simplifying orofacial
pain and its management.
beneficial. Therapies using energy-based modalities such as shockwave or Conservative manage-
laser may not be considered conservative and are often not evidence-based. ment in most cases is
Further, therapies that do not involve an active care component are typically usually sufficient to alle-
unsuccessful. It is important to recognize and inform patients that therapy is viate painful conditions.
not a fast process, rehabilitation takes time, and the patient must recognize Surgical treatments are best reserved for cases who
the importance of their role in their own health. Injuries may have an acute do not respond to nonsurgical management. Arthros-
or insidious onset, which will dictate the length of time for rehabilitation. copy guided surgeries are minimally invasive and
should be preferred over traditional open joint surger-
Chronic TMDs will likely require ongoing self-management and exercise ies. In addition to that, a careful assessment may be
at home to maintain progress, and in some situations, manual therapist necessary to evaluate the root cause of pain causing
support to prevent painful relapses. In many cases where the history is not mechanisms. Treatment directed at solving root cause
complicated, TMDs can often resolve completely. in addition to pain management is likely to benefit
patients significantly. Corrections of structural and
BARRIERS TO CONSERVATIVE CARE functional problems associated with stomatognathic
There are many barriers that can impede a patients’ success with conservative system will require less adaptation from patient. We,
at our TMD practice, have adopted similar treatment
care. Patient expectations and beliefs about their condition and treatment methods for treating pain associated with TMD. This
options can either hinder or facilitate their response to conservative care. article is great for creating awareness of TMD among
Due to lack of awareness or education, many individuals with TMDs have fellow doctors and will benefit patients suffering from
already seen a diverse range of healthcare providers, or tried multiple orofacial pain.
ineffective interventions, which has led to continual frustration and a sense
of hopelessness. Dr Varun Kunte is the Founder and CEO at Arthrose
Quick fix solutions are often sought after by patients and providers; Craniofacial Pain and TMJ Centre, Mumbai. Arthrose
is a speciality clinic which focuses on treating patients
however, stopping pain is not the same as rehabilitating tissue from injury. with Orofacial pain, Headaches, Migraines, Obstructive
If patients and healthcare professionals are educated on and optimistic about Sleep Apnea and TMJ Disorders.
nonsurgical care treatments, patients are more likely to succeed (Dubois et
al, 2020). Accessing specialized care, such as qualified physical therapists
or dentists, may be limited in certain geographic areas. As well, some
conservative treatments may not be covered by insurance which can create ABOUT THE AUTHORS
a financial barrier that may deter individuals from seeking or continuing
conservative care. Dr. Amelia Edmonds graduated in
Conservative care often requires commitment from the patient, including 2018 from McMaster University with
adherence to exercise regimens, lifestyle modifications, and attendance to an Honours Bachelor of Science in
multiple appointments. Low patient compliance can diminish the effectiveness Kinesiology. She then achieved her
of conservative management. Finally, limited conclusive research on the Doctor of Chiropractic in 2022 at
efficacy of different conservative treatments for TMDs can result in patient the Canadian Memorial Chiropractic
and healthcare practitioner hesitancy in embracing these methods. College. After completing her
internship at the Jaw & Facial Pain
CONCLUSIONS Centre in Toronto, Dr. Edmonds
transitioned into the role of an
The prevalence of TMDs continues to increase, and as a result, education associate, dedicating her practice to
with respect to diagnosis and patient care becomes even more relevant. the rehabilitation of orofacial pain.
Conservative management strategies based on appropriate diagnosis within
a stepped care model stand at the forefront of care for TMDs. When you Dr. Sidney Lisser graduated in 1997 from York University
hear conservative management, it is often mistaken as a simple referral to a with an Honours Bachelor of Biology
manual therapist. In reality, it is a multifaceted approach that considers the from York University. He graduated
entire well-being of the patient. Patients will feel empowered with tailored from the Canadian Memorial
care which is rooted in providing a range of strategies to mitigate symptoms, Chiropractic College in 2002.
improve their jaw function, and enhance their overall quality of life. Following completion, Dr. Lisser
began focusing on the rehabilitation
By strengthening MSK diagnosis, embracing noninvasive methodologies of orofacial pain. Dr. Lisser is the
for specific diagnoses, addressing barriers to care, and fostering patient Clinical Lead and co-founder of the
education, we have an opportunity to make significant strides in alleviating Jaw & Facial Pain Centre in Toronto.
the burdens of TMDs and improving patient outcomes. n
46 Dental Practice I July-August 2024 I Vol 20 No 4