Louis Malcmacher, DDS, MAGD
One of the great things about having a strong membership organization is the ability to share cases that can help other dentists treat their patients. Let me tell you about a clinical case that came into an American Academy of Facial Esthetics (AAFE) member's office, BriAnna Schraw, DMD, whose live-patient AAFE training helped her achieve remarkable results for this long-suffering TMJ/orofacial pain patient.
What's special about Dr. Schraw is that when she learns a new skill, she immediately implements the training and skills into her everyday practice. The most successful dentists I've seen in almost 40 years of training them are those who integrate their newfound skills into the office as soon as possible. Dr. Schraw uses the AAFE resources to help her treat patients and build her practice.
Case report
The patient is a 47-year-old female nurse practitioner who has been plagued with orofacial pain, headaches, TMJ syndrome, and migraines for decades. This patient found Dr. Schraw via an online search for facial pain and headache treatment. The patient is aware of her teeth grinding both day and night. This patient currently wears an occlusal guard at night but reports this has never provided pain relief even though her previous dentist insisted it would help her. She takes many different muscle relaxers and pain medication and gets little relief. Over the years, dentists, orthodontists, oral surgeons, neurologists, a neuromuscular holistic doctor, an ENT, and her primary physician have all treated the patient. The most invasive recommended treatment has been a TMJ condylectomy, which the patient declined. She decided to live with the pain and try to manage it with medication and regular deep-tissue massage therapy. Any relief she's gotten has been very short-lived.
Using the skills she learned at the AAFE live patient TMJ/orofacial pain and Botox course, Dr. Schraw performed a head-and-neck muscle trigger point examination, which is crucial to establishing a diagnosis and for treatment success. Trigger points that elicited moderate to severe pain that radiated along traditional pathways were found in the occipitalis, splenius capitis, and trapezius, masseters, temporalis, and sternocleidomastoid muscles. Many of these trigger points were also accompanied by easily palpable muscle knots.
The treatment plan consisted of ethyl chloride spray of the known trigger points as well as trigger point injections with a mixture of .5 cc of 1% lidocaine with botulinum toxin (Botox), with the appropriate dosages for each muscle. At the four-week follow-up appointment, the patient was very excited with her results. Today, she no longer takes any pain medications and is pain- and symptom-free for the first time in years. Her facial esthetics have also dramatically improved.
When Dr. Schraw first reported this case on the AAFE forums, she called this patient her "Botox" miracle patient. Actually, the use of Botox in trigger points is not magic; it is about muscles. If a dental clinician is properly trained in the relationship between the head and neck muscles and their involvement in TMJ, bruxism, dental sleep medicine, facial esthetics, and orofacial pain, and the clinician learns how to treat these muscles with minimally invasive trigger point injections and chemotherapeutics, the symptom relief and long-term pain-free results will seem like magic to both patients and dentists.
Membership benefits
Too often there is a lack of camaraderie between dental professionals. The value of a high functioning membership organization such as the AAFE is to create a nurturing atmosphere so that all dental professionals can benefit from their collective experiences. As an AAFE faculty member, Dr. Schraw shares her talents with many dentists in their use of botulinum toxin for esthetics and TMJ and orofacial pain treatment. It is this ability to change the lives of dentists and patients that motivates and inspires Dr. Schraw and other AAFE members. All dentists have the ability to deliver the best treatment for their patients; all it takes is skills-based training. Get some training today and you can make magic for your patients by making them feel and look great!
Louis Malcmacher, DDS, MAGD, is a practicing general dentist and internationally known lecturer and author. Dr. Malcmacher is president of the American Academy of Facial Esthetics. Contact him at (800) 952-0521, or email [email protected]. Visit www.FacialEsthetics.org for more information about live-patient frontline TMJ/orofacial pain training, frontline dental sleep medicine, bruxism therapy and medical insurance, and Botox and dermal fillers training. You can also download his resource list and sign up for a free monthly e-newsletter.
