TMJ is not a Diagnosis

An Evidence-Based Approach to Diagnosing Muscle, Nerve, Joint, and Headache Pain in Dental Practice

About the Course: In the past, if a doctor could not determine the source of a patient's pain, treatment was still provided, including root canals and/or extractions. If the pain did not resolve, it was assumed the patient was crazy or that the pain was not related to the scope of dentistry. The patient was then referred to a physician or continued to live with their pain. During Dr. Hirschinger's presentation, you learn about the five treatment areas of orofacial pain: muscle pain, nerve pain, TMJ, primary headaches, and a brief overview of sleep apnea. You will see videos of patients Dr. Hirschinger has treated, and you will understand the diagnoses and treatment plans each received. You will learn how to diagnose non-odontogenic pain so you can then decide if you want to treat it or be able to recognize what is causing your patient's pain so you can refer them to an appropriate specialist.

For the hands-on portion: You will learn how to administer many of the extraoral injections used by orofacial pain specialists. These include trigger-point injections of the head, neck, and shoulders, trigeminal nerve blocks (supratrochlear, supraorbital, infraorbital, and auriculotemporal), and occipital nerve blocks. Dr. Hirschinger will also review the Botox injection sites for patients with jaw pain. You'll need to agree to being injected so that each participant can give injections. The anesthesia lasts less than 2 hours, so you won't be numb very long. Botox treatment is optional. Botox must be supplied by the course participant.

Course Objectives:  After taking the course, the participant should be able to:

• Identify the muscle referral patterns of the head and neck so you can understand referred pain.
• Understand the rationale behind trigger point injections, and when lidocaine and Botox are and are not indicated.
• Recognize the signs and symptoms of trigeminal neuralgia, and other neuralgias and intraoral neuropathies.
• Learn why most TMJ pain is not related to the joint.
• Learn why the site and source of a patient with orofacial pain is usually never the same.
• Learn how to diagnose a migraine based on the International Classification of Headache Disorders (ICHD-3) criteria.
• Localize pain and be more certain of a diagnosis before undergoing irreversible dental treatment.
• How to quickly rule out occlusion as a cause of a patient's pain.
• See and possibly receive a trigger point, trigeminal nerve, and occipital nerve injections.
• Learn about occlusal dysesthesia.

Hands-On Clinical Training

During the hands-on portion of the course, participants will learn many of the extraoral injection techniques commonly used by orofacial pain specialists, including:

• Trigger-point injections of the head, neck, and shoulder muscles
• Trigeminal nerve blocks
• Supratrochlear
• Supraorbital
• Infraorbital
• Auriculotemporal
• Greater occipital nerve blocks
• Dr. Hirschinger will also review Botox injection sites used for patients with jaw muscle pain.

Participants will practice injection techniques on one another under supervision. Local anesthesia is used, and the numbness typically lasts less than two hours.

Botox injections are optional. Participants who wish to receive Botox treatment must supply their own product.