Episode #455: What You Need To Know About Orofacial Pain as a Specialty, with Dr. Mary Charles Haigler

A toothache may be more than a toothache. It could be TMD, TMJ, or even symptoms of a heart attack! Learning about orofacial pain can change and save your patients’ lives, and Kirk Behrendt brings in Dr. Mary Charles Haigler to encourage you to find out more. Dentists are the best professionals who can make a difference for these patients. And to do that, education is the key. To learn how you can help your suffering patients, listen to Episode 455 of The Best Practices Show!

Main Takeaways:

• Orofacial pain is broader than just TMD.
• There are many risk factors for pain symptoms.
• Listen to your patients and take good medical histories.
• For orofacial pain patients, opioids can make things worse.
• If you don't see anything wrong with the tooth, step back and reassess.
• Keeping up with CE and different fields is very important for this specialty.

Quotes:

• “Patients will come in and they’ll inform me that they’ve been diagnosed with TMJ. And so, I have to tell them, ‘Well, let's break it down a little bit more, because there can be a disorder that involves the articular disc being out of place. There can be arthritis, which can either be osteoarthritis or an autoimmune condition. There can be muscle pain or myalgia. There can be a combination of those, or they can be separate.’ So, it’s trying to figure out exactly what that patient has going on so that we can tailor the treatment or the management to whatever symptoms they're actually having.” (6:04—6:46)
• “You can learn a lot just from hearing what the patient has to say. Even if they don't fully know what's going on, they could still tell you, ‘Well, when I open, I can only open this wide now. I used to click, and now I don't.’ All of those are little key words that tell you maybe it’s a disc disorder. Or some patients will tell you that they have other joints that are achy and painful, so then that clues you in. So, getting a good history helps to start the process.” (7:15—7:48)
• “I look for comorbidities like mood disorders, anxiety, depression. I'll look for sleep disorders such as obstructive sleep apnea because those things can be correlated to jaw pain as well. And so, we like to look at the whole picture, the whole patient, to try to figure out the best treatment for them.” (7:50—8:09)
• “Looking at the whole patient helps you to be able to — I'm not going to necessarily treat every part of that if they have hypertension or they have a mood disorder. But I can help them to get that treatment, which then helps us to get them well.” (10:03—10:19)
• “I've heard people say, ‘Well, I'm concerned about working with [TMD and TMJ] patients because some patients will come in and say that they have a tooth that hurts. And you look at the tooth, and there's nothing wrong with the tooth, but they're convinced that it is.’ Well, that could mistakenly lead to a practitioner thinking that the person’s either making it up, trying to get something done that's not needed, or get medicine that's not needed. But the reality is that in a lot of those cases, they do feel pain in a certain tooth — but the pain is not coming from that tooth. There's a discrepancy in the site versus the source of the pain.” (10:38—11:24)
• “I'd like other dentists to be aware that if a patient has a toothache — and I know you're trying to help them — but you don't see anything wrong with the tooth, just step back and try to reassess.” (12:14—12:27)
• “We can only do the best we can with what knowledge we have. And so, that's why I feel like it’s really important for the orofacial pain community to reach out to dentists, reach out to ENTs too, because a lot of patients will have earaches that are actually pain from the temporomandibular joint as well.” (12:50—13:13)
• “With orofacial pain, I know I've mentioned TMD a lot because that seems to be the biggest overlap with general dentistry. But orofacial pain also, we manage pain that's related to the joint that also could be within the mouth. It could be headaches. It could be things in the region. So, there are also neuropathies, neuralgias that we help with, headache disorders. Also, because of the overlap with sleep apnea, especially the appliances if we’re able to use a mandibular advancement device in someone with TMD, we might need to manage it a little more carefully. And so, we do also help with obstructive sleep apnea management as well.” (15:01—15:57)
• “Stress is another risk factor for different pain symptoms. And we do know that there is a relationship between anxiety and depression and pain modulation because they're both controlled with serotonin and norepinephrine. And so, if those are out of balance, then people can have more difficulty suppressing pain signals as well. So, people that experience anxiety at an elevated level may be experiencing more pain, even if it’s not just the muscle tension that is referring that pain.” (17:23—18:01)
• “The best part is, you may have a patient that comes in, the first time you meet them — they’ve been to several places before — they're a little pessimistic or not feeling well because they're in pain, so they're a little irritable. And as long as you remember that you're here to help that person and you really listen and you really try to help them, when you see benefits that they're having, say at a post-op when they're feeling better, even if you don't get all the pain to diminish but it’s helping them, you can tell a change in a person’s whole outlook and their demeanor, that's probably the most rewarding thing, is to see that you're making a difference in someone’s life.” (19:12—19:57)
• “One misconception is that opioids are the answer to pain. And for these patients, for chronic pain, it can make things worse, make the pain more intense.” (21:27—21:43)
• “Sometimes posture, so if we’re working on a computer all day, your forward-head position, that puts a strain on your neck, changes your airway. So, that can also affect the positioning of the jaw. So, everything is related. It’s all one body, so that's why we try to look at the big picture of things.” (23:32—23:56)
• “We’re learning about neuropathy, neuralgia in the mouth. So, different nerve conditions. We also are learning all the time about migraines. A lot of us are also members of the American Headache Society so that we can understand the migraine patterns, because migraines are also a condition of the trigeminal nervous system, which we know is also what gives us the pain signals from the face as well. So, a lot of times when patients are having even TMD type of pain, that pain could be a trigger for a person that gets migraines. So, just keeping up with what's going on in other fields is also very important.” (26:11—27:04)
• “If you can't find something wrong with the tooth, step back and see what else could it be.” (29:09—29:15)

Snippets:

• 0:00 Introduction.
• 2:20 Dr. Haigler’s background.
• 3:03 Why Dr. Haigler is passionate about this topic.
• 5:49 Orofacial pain goes beyond TMD.
• 6:47 Review your patients’ medical histories.
• 8:31 Dentists are best positioned to help people be healthy.
• 10:20 Find the source of your patients’ pain.
• 12:32 Know the questions to ask.
• 13:13 Challenges with being recognized as a specialty.
• 14:52 What people get wrong about orofacial pain.
• 16:05 Stress/anxiety/depression and pain modulation.
• 18:04 The future of the orofacial specialty.
• 20:00 The role of pharmacology.
• 21:56 Systemically understanding how the body works.
• 25:27 The moving target of CE.
• 27:06 Last thoughts on orofacial pain as a new specialty.
• 29:56 More about Dr. Haigler and how to get in touch.

Reach Out to Dr. Haigler:

Carolinas Center for Oral, Facial Surgery: https://mycenters.com/

Dr. Haigler’s Facebook: https://www.facebook.com/MaryCharlesBrownHaigler

Dr. Haigler’s social media: @drmarycharleshaigler

Resources:

American Headache Society: https://americanheadachesociety.org/

American Academy of Orofacial Pain: https://aaop.org/

American Board of Orofacial Pain: https://www.abop.net/

Dr. Mary Charles Haigler Bio:

After her graduation from Laurens District 55 High School, Dr. Mary Charles Haigler, DMD, MS, attended Winthrop University, where she graduated with a BS in Biology. Dr. Haigler went on to the Medical University of South Carolina’s College of Dental Medicine, earning her Doctorate. While attending, she was an active member of the American Student Dental Association, Psi Omega Dental Fraternity, and the American Association of Women Dentists. She received honors, including the National Council Scholastic Achievement Award from Psi Omega, and membership in Omicron Kappa Upsilon, the national dental honor society.

Dr. Haigler completed the Essentials Courses at the Pankey Institute and embraces their dental philosophy that focuses on knowing each patient and providing the best care she can. This level of focus also helps to ensure that every patient is treated with individual care and attention.

Dr. Haigler has made learning about the many sources and types of orofacial (head and neck) pain a priority so that she can better serve patients with TMD (TMJ disorder), headache, sleep disordered breathing (obstructive sleep apnea/hypopnea), bruxism (clenching/grinding), neuropathic pain, and other oral pathologies that are causing patients to suffer.

She completed a Continuum in Orofacial Pain at Louisiana State University’s Dental School, as well as a postdoctoral Master’s degree in Orofacial Pain and Oral Medicine from the University of Southern California’s Herman Ostrow School of Dentistry.