Orofacial spcialists are lacking across the US

Anisha Hall Hoppe, Dental Tribune International

Tue. 18. June 2024

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NEWARK, New Jersey, US: The specialty of orofacial pain (OFP) has been officially recognised by the American Dental Association (ADA) for over four years. However, it remains under-recognised and under-utilised by dental and medical professionals, according to a group of clinicians in the US. For this reason, they have penned a recent guest editorial in the Journal of the American Dental Association in which they define OFP, explain the training and role of the OFP specialist, and draw attention to the significant lack of access to OFP clinicians and the factors contributing to this dearth.

The piece highlights that 85% of facial pain cases are odontogenic, but the remaining 15% are non-odontogenic in origin, requiring specialised care from OFP experts. Non-odontogenic OFP has various aetiologies, including musculoskeletal, neuropathic and neurovascular disorders.

“Patients may feel lost searching for relief and are caught in the gap between medicine and dentistry. The OFP specialist fills that void,” the editorial authors wrote. They explained that a lack of awareness of the role of the OFP clinician and a lack of appropriate referral pathways for OFP specialists contribute to the under-utilisation of this specialty.

OFP specialists undergo rigorous training and certification, including a two-year programme accredited by the Commission on Dental Accreditation (CODA), making them adept at diagnosing and managing complex pain conditions. However, only 13 out of the 75 dental schools in the US and Canada offer CODA-accredited OFP programmes, resulting in a limited number of specialists and thus hindering adequate access to care.

“Patients may feel lost searching for relief and are caught in the gap between medicine and dentistry. The OFP specialist fills that void.”

Beyond the designation of specialist, “The pinnacle achievement within dentistry and medicine is the designation of diplomate,” wrote the authors. Prospective diplomates must have completed a CODA-accredited OFP programme and thereafter complete the board examinations successfully. According to the authors, there are 287 OFP diplomates in the US, meaning that there are roughly one in 175,000 such specialists for the 15% of the population that requires OFP treatment. Additionally, there is a significant disparity in the availability of OFP specialists across different regions, and many states do not have a single OFP diplomate, creating a gap in care for patients with chronic pain. The article provides detailed statistics on the distribution of OFP specialists relative to the population and the estimated number of patients requiring treatment by state.

The editorial calls for increased awareness and integration of OFP into general dental practice. It emphasises the importance of evidence-based treatment and the need for more CODA-accredited programmes to train specialists. Additionally, it advocates for policy changes to improve access to care, such as incentivising specialists to work in underserved areas and utilising telemedicine solutions.

The guest editorial, titled “Access to care: Is the specialty of orofacial pain underrecognized and underused?”, was published in the June 2024 issue of the Journal of the American Dental Association.