Concepts Editorial: Is It Time To Get Back To Basics?

Editorial:

The first couple of years of our professional training are probably a blur to most of us that have been in practice for more than a few years. We most likely remember that it was an intense time with lots of hours spent pouring over our text books and many hours spent in labs. This was the basic science portion of our professional training. We spend hours learning biochemistry, every branch of every nerve and artery in gross anatomy, peering for hours through a microscope studying microbiology and histology and pouring over our physiology to attempt to understand the intricate and complex workings of the human system. 
We labored long and hard to pass our exams and as soon as the exam had passed, most likely forgot most of it unless you were a biology nerd like me. Why?  Simple, it had no clinical relevance. Most of our schools barely let us think about seeing a patient, let alone engage in their evaluation and treatment during this period of our training. It was really a catch 22. We needed to understand the basic sciences to properly understand our patient, but we also needed the patient to understand, as well as appreciate, the whys and wherefores of the basic sciences.
Even when we began to interact with patients, the majority of what we did was procedure oriented. We were less concerned about where the temporal tendon was, or the distribution of the greater occipital nerve, than how to make that margin so smooth that our instructor could not find it with their loops and a really sharp explorer. Our conversations were not about the prevalence of trigeminal neuralgia in a population or the clinical findings associated with myofascial pain dysfunction (heck, we probably did not even know what that meant . . .) After all, muscles were the stuff you had to get through in anatomy lab to see the really good stuff). Instead, discussions were on the best casting technique to get a fitter (although some felt they all fit . .  . just some better than others), or what generation of bonding agent made those pesky tubules stand up and take notice. 
Most of us who are reading the CRANIO Journal have directed our attention to a greater or lesser degree to the craniofacial pain patient. In this arena, the setting characteristics of gypsum products or shrink characteristics of resins have reduced relevance. We are now presented with patients who are experiencing craniofacial pain and/or temporomandibular disorders. We are being sought out by people who are suffering from disorders of the temporomandibular joints, muscles, ligaments, tendons, as well as a variety of neuropathic pain syndromes. Most of these topics were not even discussed in our professional training. Sometimes, these problems occur independent of each other but all to often, concomitantly. Our patients present with pain, emotional distress, and dysfunction, and we often have to become detectives to weed out the genesis of their problem.
We make appliances that affect the neuromuscular system of the upper quarter, we perform injections for diagnosis, as well as treatment, to nerves, muscles, tendons, ligaments, and the TMJ. Electrotherapies, i.e., ultrasound, electrical stimulation, iontophoresis, and infrared are routinely applied to treat muscle and joint disorders, as well as control painful neuropathic pain syndromes. Manual therapy and exercise therapy are performed and prescribed to help resolve muscle
disorders.
For those of us who were trained as dentists, this is a far cry from restoring or replacing teeth for which we were all well trained. It has taken us out of the oral cavity and given us a global perspective of our patients.  That is not to imply that performing traditional dental therapies are less important but they are, by their intent, different in their orientation.
It is the feeling of this editor that for those of us who wish to practice in this arena, we need to base our techniques and therapies in the basic sciences–we need to go back to the basics. If you are going to perform extra-oral injections, deliver physical medicine, change the orthopedic relationship of the craniomandibular complex, a review program in basic head and neck anatomy is in order. If the last time you evaluated a dissected specimen was your freshman year of dental school, it is time. In addition, if you have not reviewed the pathophysiology of intracapsular disorders of the TMJ, neuropathic pain syndromes, masticatory muscle disorders, cranio mandibular and cranio cervical biomechanics, how to adequately perform a complete examination, including history, physical examination (including cranial, cervical nerve and otologic screening), or how to properly evaluate an MRI of the TMJ, it is time to get back to the basics.
The American Academy of Craniofacial Pain Institute offers a head and neck dissection course as part of its educational programs. The Medical College of Georgia likewise offers review dissection programs as part of their continuing education programs as does the University of Florida. The American Academy of Craniofacial Pain Institute offers an intensive evidence-based 12 day mini residency program. The University of Kentucky and the University of Florida also offer excellent training program in this area. Tufts Dental school offers a distance learning masters of science program through the Tufts Craniofacial Pain Center. These programs and others are available to get you back to the basics.
This area of dentistry can be a truly rewarding and fulfilling discipline in which to practice. But, it requires commitment, dedication, and most fundamentally, training. If this is the direction that you wish your practice to take, or if you simply want to truly integrate this area into you existing practice, take the time and go back to the basics. The discipline of craniofacial pain has evolved to the level that a weekend seminar is simply not sufficient to provide the background, both didactic, as well as hands on, to adequately prepare an individual to be conversant with the complex nature of the disorders with which our patients present.
To become a student again is rewarding and fulfilling. And, with clinical experience currently offered from which to draw, the educational experience will be truly meaningful.