Reference & FAQs
What is an orofacial pain practitioner?
In short, an orofacial pain specialist is a board certified and residency trained doctor. Orofacial pain management requires a combination of medicine and dentistry to accurately diagnose, treat, and relieve chronic orofacial pain in muscles, joints, and nerves of the chewing system.
How can Raleigh Facial Pain Center help relieve your pain?
Our pain center:
- Is staffed by a doctor who takes time to listen to you and understand your pain
- Uses some of the latest modalities backed by research
- Incorporates a team of highly-skilled healthcare professionals
- Coordinates with the chronic pain team to give patients the best possible treatment
- Uses methods that are conservative and reversible
- Features a passionate coaching team to ensure success
What is the most gratifying part of being an orofacial pain patient at Raleigh Facial Pain Center?
We once treated a woman who suffered an oral burning pain for over six months. After initiating treatment and eliminating her pain, her husband came to us saying, “Thanks for giving my wife back to me.” There are many such occasions to celebrate at the Raleigh Facial Pain Center and these are also the most satisfying moments in our practice – to join with people to visualize and then realize a life that is pain free.
Where do most orofacial pain patients come from?
60% referred from dentistry, 40% referred from medicine; 70% referred by general dentists and doctors, 30% referred by specialists
What are the most common types of orofacial pain?
- Tension headache
- TMJ (previous term used to refer to joint damage)
- Joint-muscle damage
What does an orofacial pain doctor diagnose and manage?
- Atypical toothache
- Jaw pain
- Earache without infection
- Restricted jaw opening
- Tension headache
- Burning mouth, face, tooth
- Open lock (subluxation)
- Joint noise with pain
- Deviation on opening
Is my jaw problem covered by medical or dental insurance?
Medical insurance — joint muscle therapy is a part of the body like any other joint
Does medical insurance cover the chewing system orthopedic (TMD, TMJ) services provided by Dr. Yount?
Yes. Orofacial pain services are treated the same way as other orthopedic services (back, legs, neck, etc.).
Why are orofacial pain services considered medical treatment?
Court rulings, the insurance commissioner, and the law all declare services associated with joint, muscle, and nerve conditions be listed under medical care. Anything directly related to tooth treatment is listed under dental. Orofacial pain treats muscles, joints and nerves only.
What will happen if I ignore the pain or problem?
- Your pain could stay the same, get worse, or get better. The most likely answer is if the aggravators and initiators remain, it is quite likely it will get worse. Most people would not be seeking pain management if they were satisfied with the quality of their life at present.
- A new pain could add to this current pain. How much pain are you willing to endure and for how long? Months or years later you may find you could have been pain free all those years. How are you going to feel about not electing to participate in pain management now?
- Your pain system negatively adapts to long-term pain, making you more sensitive and more refractory to pain management.
Why does it seem more women have chronic pain than men?
The female predisposition to chronic pain is at a 3 to 1 ratio of female to male, according to double-blind random studies. The primary reasons are related to estrogen, hypermobility and stress.
- Hormonal: The estrogen receptor on female mast cells (not on male mast cell) creates a weaker cell wall on the mast cell. Thus, a weaker stimulus creates more inflammation chemical release from the mast cell. A clenching stimulus therefore creates more inflammation during estrogen fluxes.
- Hypermobility: The hypermobility creates a loose ligament attachment. Thus, trauma may cause more stretching and tearing of the ligaments in an already hypermobile joint.
- Demands of life: Women typically take on the responsibility of better schools, community, church, family, house, etc. They are the backbone of society. All these factors of life wear on the inner biochemistry and physiology.
How prevalent are the most diagnosed facial pain problems?
Why do orofacial pain specialists treat facial pain instead of doctors?
Why would an ENT not refer you to a general dentist? Unfortunately, the general dentist is inadequately trained in dental school for chewing system damage (TMJ or TMD). Even a general dentistry professional who has taken weekend courses will tell you that the complexity of the chewing system is too much for weekend training. For you see, chewing system orthopedics is more than mouthpieces, more than pain medication, more than simple home remedies. Trust me, while practicing dentistry in the mountains, after extensive weekend courses, I could not handle the complexity of TMD, TMJ or chewing system damage.
Dentists like Dr. Yount attend a 2-3 year orofacial pain residency and become board certified in orofacial pain. This two-three year residency provides extensive training in medical, dental, and allied health professions. The specialty of orofacial pain covers the areas of treatment that falls between the dental and medical fields. Orofacial pain is a blend of the medicine and dentistry sciences. The complexity of TMD-TMJ requires knowledge of all sciences as well as tooth and joint dynamics to ensure successful pain management.
Do general dentists or cosmetic dentists treat jaw pain cases?
General dentists provide care in the area of bruxing (tooth wear). A few general dentists will provide care for simple chewing muscle pain of short duration and low pain levels if there is little to no jaw joint involvement (deviation, restriction, facial asymmetry, painful click, etc) and no significant medical complications (fibromyalgia, lupus, sleep disorder, arthritis, etc). In other words, the general dentist with extra training can diagnose and manage early simple cases of MPD (inflammation of chewing muscles), as well as some early cases of partial disc displacement of short duration, but does not usually treat moderate or complex TMD. Some cosmetic dentists attempt to treat facial pain but have not been thoroughly trained or board certified. Be leery of procedures and therapies that are not reversible.
What is the difference between acute and chronic pain?
Over 95% of pain pathologies are acute pains, while the other 5% is chronic pain. Chronic pain is defined as pain lasting longer than one month with multiple aggravators or initiators sensitizing the pain reporting system. If you’ve tried a one-time treatment such as medication, bite appliance, or soft diet and it has not worked or worked well, it is time to consider that your pain may be chronic.
My dentist wants to try a soft biteguard for MPD/TMD. Should I try this?
This is a therapy for protecting teeth from grinding. However, it is not an appliance for TMD/MPD, and it typically makes MPD pain worse. Soft biteguards increase parafunction, load joints and increase muscle activity.
What will happen if I have braces to treat my MPD/TMJ?
In the past, dentists thought bite was the cause of MPD/TMD (TMJ). Now bite or occlusion is recognized as only one of the minor factors. Thus, braces will likely not help, considering the bite is only a small part of the problem. Based on a study, 1/3 of patients get worse, 1/3 stay the same, and 1/3 get better using braces to solve the TMD/TMJ problem. This means that 2/3 of patients do not get a pain reduction
Will crowning my teeth fix my MPD?
No. This open mouth procedure can make your pain significantly worse. The crown procedure is based on a patient’s bite being stable, but the bite is not stable with TMD/TMJ. The jaw joints are being stabilized on slick inclines and the muscles are in different contraction vectors and forces. The dentist will not be able to get the crown, bridge, partial or implant comfortable, while open mouth procedures can make TMD/TMJ far worse.
What percentage of TMD cases need surgery?
Less than 3% of TMD cases require arthroscopic surgery to rinse the joint out. The open joint surgery is not done at the present time because it failed us in the past.
Why is an orthotic appliance the proper appliance for treating TMD/MPD?
An orthotic is the only appliance that is backed by science for treatment of TMD/TMJ. It:
- Idealizes a person’s bite
- Is similar in its function to a back brace
- Reduces muscle activity
- Protects joints
- Is versatile (can be adapted to anyone’s bite irregularities)
- Reduces muscle and joint inflammation
- Protects the teeth
- Stabilizes the bite
- Protects bone support to the teeth
- Functions like a retainer
Is there a quick fix for TMJ/TMD?
Does the treatment of a bum knee, backache or neck ache take a short time? NO.
Yes, we want a quick fix, but we need proper chewing system orthopedic therapy.
As the old cliche says, you get what you pay for. All great services, from carpentry, to painting houses, to car repair have a cost and quality relationship. We are speaking of cost in terms of time more than money, but both are related. The comparison of time and cost is an old time relationship that all of us know too well. The more time a doctor spends with us, the higher quality of care. You will come to find out this truth more and more with changes in healthcare for tomorrow.
Some dentists have attended a weekend course at the Las Vegas Institute on using a TENS and Myomonitor to correct bite. This theory proposes that your bite causes TMJ/TMD. This old theory has been laid to rest with research saying the bite has little or nothing to do with your TMJ/TMD. The Myomonitor produces fancy graphs, charts, and other data. To an untrained person, this can be quite impressive. However, the theory uses a repositioning mouthpiece to place the jaw joint downward and forward on an incline, pulling the condyle away from inflamed tissue to create muscle bracing. This does not create a true centric relation. Eventually, most people will find this quick fix is irreversible and will cause major expensive dental work in the future. This method leads to false pain reduction. In fact, repositioning creates:
- Muscle bracing
- Post-open bite
- Redundant tissue back joint
- $30,000 cost to fix a bad bite created by repositioning
Facial Pain & Common Disorder References
Diagnosis and Management of Atypical Toothache
Causes of MPD/TMD
Visit These Links to Find Out More Information About Facial & Jaw Pain
Academy of General Dentistry (AGD)
American Dental Association (ADA)
North Carolina Academy of General Dentistry
North Carolina Dental Society
The Dawson Academy
The Pankey Institute for Advanced Dental Education
Raleigh-Wake County Dental Society (Sponsors Training Institute)
American Academy of Orofacial Pain (AAOP)
American Academy of Pain Management
American Academy of Pain Medicine
American Board of Orofacial Pain (ABOP)
American Chronic Pain Association
American Pain Foundation
American Pain Society
Australian/New Zealand Academy of Orofacial Pain
Center for Facial Pain & Dental Sleep Medicine
European Academy of Craniomandibular Disorders
Ibero Latin American Academy (Spanish)
National Pain Foundation
Parker E. Mahan Facial Pain Center
TMJ and TMD
American Academy of Otolaryngology – Head and Neck Surgery (TMJ)
National Institute of Health, National Institute of Dental and Craniofacial Research (NIDCR) – Publications
TMJ and Orofacial Pain Society of America