Stop Ignoring Your Patients!

Dec. 1, 2012
Hey you! Yes you, the one reading this article. Right now you are ignoring your patients.

By Louis Malcmacher, DDS, MAGD

Hey you! Yes you, the one reading this article. Right now you are ignoring your patients. Specifically, you are ignoring one major clinical complaint that your patients have on a regular basis, and you are doing nothing about it. Remember Mrs. Jones who came in last week holding the right side of her lower jaw and complaining about pain in that area? You meekly touched the muscle she was pointing to, told her that she must be clenching her teeth, and suggested a night guard, only to find out that she has been wearing a bruxism appliance that you had already made for her.

Or how about Mr. Smith, who came in a couple of weeks ago and pointed to his left TMJ area and complained that sometimes he can barely open his mouth, and he wants you to do something about it. You responded that you will just watch the area for a while and hope the problem goes away. Mr. Smith gave you a strange look, considering that he is in your office, has a specific complaint, and you are either not taking him seriously or you have no idea how to approach the problem. This does not inspire great confidence in your abilities to say the least.

Let’s be brutally honest here — most dentists are scared of TMJ and facial pain patients. We think they’re crazy or will become a pain in our behinds that won’t go away, and we’re unaware that there are successful treatments available. The bottom line is that most general dentists have very little understanding and training of TMJ and myofascial pain, and they lack any real practical systematic frontline approach to help patients with these problems. Many dentists think that treatments for myofascial pain must be very complicated and that these people will never get better.

Nothing could be further from the truth. Most patients with mild to moderate TMJ and myofascial pain are easily treated. They do get better when their dentist learns some basic skills on how to properly diagnose them, come up with a treatment plan based on symptoms and the diagnosis, and then deliver the treatment in a timely manner. By the way, you don’t have to know anything about occlusion (even though you should). Most myofascial pain has little or nothing to do with a patient’s occlusion. I know that may send some of those in the “occlusion business” into a panic, but anyone like me who has been treating TMJ syndrome and facial pain for the last 30 years, and those trained in oral-facial pain residencies, can testify to the fact that most of the time, myofascial pain has nothing to do with the occlusion.

Myofascial pain occurs in many of your patients, and if you don’t believe me, try doing this for the next week in your practice — ask your patients if they ever have TMJ and facial pain. Then observe carefully when they subconsciously raise their hand to the area that is bothering them. I often use this technique when I’m lecturing to dentists, and I ask them if they ever have a problem with head, neck, or shoulder pain. You should see the hands that move to the sides of their face, neck, and upper back. These are all dental professionals who experience these symptoms, and who haven’t the faintest clue how to get rid of their own facial pain, when this should be a vital part of every dental practice.

There are many simple treatments available for myofascial pain. These include bruxism appliances, trigger point injections, Botox injections, spray and stretch techniques, and numerous other methods that can be used successfully in the dental practice. What it requires is training to learn and perform these frontline treatments for TMJ syndrome and myofascial pain. I have trained dental professionals in these techniques for years. Stop ignoring your patients, friends, and even family members who suffer from TMJ syndrome and myofascial pain. Every dentist has the ability to provide consistent and predictable therapeutic outcomes for patients with facial pain, once they learn the basics of frontline diagnosis and therapy.

Louis Malcmacher, DDS, MAGD, is a practicing general dentist and internationally known lecturer, author, and dental consultant. An evaluator emeritus for CLINICIANS REPORT, Dr. Malcmacher is the president of the American Academy of Facial Esthetics at Contact him at (800) 952-0521 or email [email protected]. His website is, where you can sign up for a free monthly e-newsletter.

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