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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 vital importance.

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 function.

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  

  • Ultrasound
  • Iontophoresis
  • Electrotherapy (EGS, TENS, etc.)
  • Cold and Heat
  • Vapocoolant and Stretch Massage


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