The Role of Physical Therapy in Dentistry
The role of physical
therapy in the treatment of chronic and acute pain has been well established.
As pain management has assumed an expanding role in dentistry, physical therapy
has also experienced a more prevalent role. It is important for the attending
clinician to develop an understanding of the positive aspects that physical
therapists can provide for his or her patients.
In acute cases of pain and inflammation from
nonodontogenic origins, physical therapy modalities can generally be utilized
by an experienced, well-trained dental team. These treatments may include
ultrasound, electrotherapy (electrogalvanic shock/stimulation, transcutaneous
electrical nerve stimulation, etc.), vapocoolant spray and stretch,
iontophoresis, thermal treatment (ice and heat), and localized massage. When
treating patients with acute temporomandibular joint dysfunction or patients
suffering from sprains/strains of the facial supporting structures that produce
a cycle of pain, dysfunction, and inflammation, these modalities can be of
There are instances, however, when comprehensive
rehabilitation is necessary and the skills of a specialized therapist are
required. In the truest sense of rehabilitation, the purpose of therapy is
altered from the management of pain to the development of pain-relieving,
functional behaviors. The physical therapy is generally determined by the type
and etiology of pain, tissue trauma, and stage of healing.
As a rule, physical therapy should be active and
functionally oriented. Restoration of the affected tissues can only be attained
by attempting to achieve natural form and function. When injury or disease
leads to permanent dysfunction, compensatory measures may be necessary. A
physical therapist can provide assistance in determining and documenting this
requirement, eg, restoration of a pain-free vertical and/or anterior-posterior
mandibular position following head and neck trauma. Due to permanent damage of
the supporting structures of the head and neck, dental procedures such as soft
tissue and osseous surgery, crown and bridge restoration, and implant therapy
must often be completed to restore masticatory function. These restorative
procedures should be considered as an integral part of the physical
rehabilitation of the patient.
Dental restorative procedures required for head and
neck stability are merely extensions of physical medicine rehabilitation.
Except for procedural differences, the overview of treatment goals for physical rehabilitation for the replacement
of a lost limb (eg, a leg) is no different from that of replacing the natural
dentition with manufactured prosthetics such as osseointegrated implants, crown
and bridge restorations, or removable prostheses. This is especially true if
the rehabilitation is required to restore the patient to proper pain-free
Most states require a written prescription from the
treating physician that includes the diagnosis, frequency, and length of
recommended treatment, as well as precautions and contraindications for its
completion. It is often helpful to include a general order to evaluate and
treat as well. The dentist should recognize the physical therapist as an
extremely well-trained and equal member of the treatment team. One of the most
exciting - although sometimes frustrating - aspects of pain management is the
development of a "team" that can work together in harmony.
It should be noted that communication between the
therapist and the treating dentist is the key to achieving a successful outcome
for the orofacial pain patient. The therapist often sees the patient more frequently
than the dentist and, as a result, may be able to provide valuable insight into
the emotional as well as the physical aspects of the patient's condition.
As in any health care profession, different levels of
skill and training exist in the field of physical therapy. It is often
beneficial for the dentist, the staff, and the therapist to attend continuing
education courses together. In this manner, each member of the management team
can add his or her own dimension of understanding to the comprehensive
treatment, resulting in highly effective care for their mutual patients.
Physical Modalities for Pain Management and Rehabilitation
(EGS, TENS, etc.)
and Stretch Massage