As surges of the Delta variant alarm officials and citizens in this country and around the world, while the cases of COVID-19 have reached more than 200 million worldwide, a less visible threat re-emerges.
If health care professionals are not allowed to perform non-emergency procedures, as was the case in 2020, patients suffering with chronic pain such as jaw pain, may be left helpless.
The COVID-19 pandemic challenged health care systems and patients’ personal economic capacity, leading to approximately six million adults losing their dental insurance. Additionally, the World Health Organization and the American Dental Association recommended dentists to limit their practices to emergency and urgent dental care.
In the list of these diagnoses requiring emergency care, jaw pain (temporomandibular disorder (TMD) that includes several clinical problems involving the temporomandibular joint and group of muscles that help with chewing and other associated structures), was not included.
This is not acceptable.
As a craniofacial orthodontist, in the past few months — more than ever in my career — I have met patients contemplating ending their life because they are unable to seek appropriate care because of chronic facial-jaw pain. Frustrations stemmed from the fact that their loved ones or people around them were unable to perceive the intensity of pain and its effect on the quality of their life.
Research shows when some people suffering pain don’t see a way for their pain to end, suicide may seem the only route to freedom from pain. According to a study from the U.S. National Center for Injury Prevention, 54 percent of suicide victims who had reported chronic pain died of gun-related injuries, and 16 percent died of opioid overdose.
A 2017 study shows chronic pain patients are at double the risk of suicide compared to others not in chronic pain. Chronic pain can negatively affect one’s life and further accentuate the deleterious effects due to limited access to medical care, social support. The choices to find effective analgesia can seem overwhelming.
New research reveals some jaw pain is possibly precipitated by stress and anxiety during the pandemic. The most common psychosocial responses patients reported were anxiety, stress, and depression.
Based on one pre-pandemic analysis of 2017–2018 data, an estimated 4.8 percent of U.S. adults (an estimated 11.2 to 12.4 million U.S. adults) had pain in the region of the temporomandibular joint that could be related to TMDs.
During COVID, many estimate these numbers have increased significantly. TMD is ranked as the second major cause of skeletal muscle pain. This ranks the disorder as a public health problem because it is the most prevalent type of chronic orofacial pain. It is comparable in prevalence to other chronic pain conditions such as fibromyalgia, chronic low back pain and migraine disease.
Pain associated with TMD can often be misdiagnosed as orofacial pain due to dental problems. Because research shows patients suffering from orofacial pain are misdiagnosed and poorly managed in primary health care centers, treatment and referrals are delayed. More than one-third of patients reporting positively to at least one of the three TMD screening questions report they are being untreated.
But treatment is possible including conservative types that are more often indicated because they are less aggressive and reversible. The main aims of these treatments are to relieve symptoms, reduce pain, and re-establish lost functions. Management of TMD involves using medications, splints (orthotic appliances), physical therapy, counseling and surgical therapy. Currently, manual therapy /myofascial release with massages and photobiomodulation are being researched and under review.
A variety of occlusal splints have been reported in the literature for treatment of TMDs, and in a recent systematic review, it was observed that patients who received occlusal splints did better than patients who did not receive care.
But cost and insurance consideration is a major factor as the cost of TMJ splints may range up to $5,000. Often there are questions about whether the splints are covered by medical insurance or dental insurance. Medical and dental plans can be verified for benefits and exclusions regarding “temporomandibular joint (TMJ) orthotics, splints, appliances” or TMD/TMJ treatment in general.
Treatment and solutions for this chronic pain are accessible, and those suffering need the reassurance of treatment for their pain emergencies—even as surges in the Delta variant present new challenges.
Along with other medical specialists, including surgeons, physical therapists and neurologists, I provide collaborative care with the intention of improving the quality of life of patients. Treating patients’ pain cannot wait.
Soumya Padala is a craniofacial orthodontist.
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