S03_E18 - Face It, It Hurts...Understanding Orofacial Pain

Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health healthcare and what matters to you. And now here's our host, Dr. David Hilden.

Speaker 2: 0:18

Hey everybody. Welcome to episode 18 of the Healthy Matters podcast. I'm David Hilden, your host, and today we are gonna talk about oral facial pain. What is that you say? Well, we're gonna find out, we are gonna talk to a colleague of mine here at Hennepin Healthcare. Dr. Maam Taima . She is a dentist, but more importantly, she is a specialist in what oral facial pain is. So maam , thanks for being on the show. Thank

Speaker 3: 0:42

You for having me. She's

Speaker 2: 0:43

One of my newest colleagues here at Hennepin Healthcare has been here since December of 2023. So just a little while. But she's an expert in oral facial pain and actually did academic research in this topic. So if you could start us off, please explain to our audience what does that term mean? Oral facial pain.

Speaker 3: 1:01

Oral facial pain is a new specialty. It has been just recognized by the American Dental Association as a specialty in Marsh of 2020. It's mainly pain in the head, neck, mouth, jaw , region. It focuses on diagnosing and management treatment of these pain. Although it's a recent addition to the dental Specialties, university of Minnesota is one of the pioneers in this field. It's been there for a long time and that's where I got my training actually.

Speaker 2: 1:31

Okay. So what are the most common causes that you see in your practice of pain? In the face,

Speaker 3: 1:36

Number one, of course, it's the tooth pain. I'm still a dentist . <laugh>. Mm-Hmm

Speaker 2: 1:40

<affirmative> .

Speaker 3: 1:40

But the other thing, the famous one is T-M-D-R-T-M-J, which is temperament joint disorder is the jaw joint having pain in the jaw joint and the surrounding muscles. And 50% of the head and neck pain is usually re related to myofascial pain, which again, muscle pain. Muscle pain in the jaw region. Uh, another cause of pain and a prevalent type of pain is headaches.

Speaker 2: 2:06

Yeah. I have a headache all the time. Oh,

Speaker 3: 2:09

I'm giving you a headache. Yeah .

Speaker 2: 2:10

No <laugh> . No, you're not giving one. I think it's the caffeine or maybe the withdrawal of the caffeine. No, but lots of headaches. Yeah.

Speaker 3: 2:18

After stroke and dementia, headaches are the third highest cause of disability of years lost for disability. Wow.

Speaker 2: 2:26

That's a ton of people. That is a lot. A lot of people

Speaker 3: 2:29

Unfortunately.

Speaker 2: 2:30

Yes. So you've talked about tooth pain, you've talked about the muscles of , of your jaw. You've talked about headaches.

Speaker 3: 2:35

And there's other causes that are not that common, but they're still existing and they affect the patient tremendously. Like one of them is neuropathic pain, nerve pain, whether it's because of a nerve injury related to trauma, tumor lesion or we don't know. It just happens

Speaker 2: 2:53

Like lots of things with neurology. We know the nerves. We can, we can usually tell you what nerves causing the problem. We just , uh, can't always figure out the why or what to do about it sometimes.

Speaker 3: 3:03

Exactly. Exactly. One of the famous things is neuralgia,

Speaker 2: 3:07

Right? Neuralgia all the time. People

Speaker 3: 3:09

Get this . Yeah . It's sharp sudden pain that just exists . It's triggered maybe by touch or something. Another thing is like something called burning mouth syndrome, which is seen

Speaker 2: 3:18

Burning mouth

Speaker 3: 3:19

Syndrome. Yeah. The patient is literally having burning mouth and it also lead to a distorted sense of taste. Like they always complain of a metallic taste. Actually autoimmune disorders. Autoimmune disorders can lead to pain in the orofacial region. Whether it's , uh, like a neuropathic pain with , it's seen with multiple sclerosis, whether it's in lupus with oral lesions or DRE syndrome that's causing dry mouth. Dry mouth. Again, it , it's multifactorial. It has a lot of causes, but it increases the risk of dental decay. Dental decay can cause pain. It increases the oral soft tissue infection, which also can lead to pain.

Speaker 2: 3:57

Did you know you were gonna go on into all this when you were doing your dental school <laugh> , which you told me was back in in Egypt. Yeah . That's , did you know you were gonna do oral, oral facial pain,

Speaker 3: 4:06

<laugh> ? I never thought about it. <laugh> . Yeah. Yeah, exactly. Dentists are mainly , uh, when they see a problem, they want to fix it with pain. If there is a dental problem, I will fix it. If there is not a dental problem , I don't know what to do.

Speaker 2: 4:20

Yeah, that's an interesting little split there.

Speaker 3: 4:22

Yes, exactly. We consider orofacial pain, the bridge between the medical and the dental world.

Speaker 2: 4:27

You know, I do primary care in internal medicine. I see people all the time with, with jaw pain, with face pain all the time. I mean, it is exceptionally common. And you mentioned headaches as well. Let's go through with some of those common ones. If you could, people would know if they're having tooth pain. But if you could talk to us about what some of the most common causes of dental pain are. So

Speaker 3: 4:49

Causes of dental pain. Either it is related to the heart tissues, like a tooth problem, a dental problem. There is a decade , there is a cavity. It can lead to pulp irritation or it is soft tissue. It's related to the gums. It's related to a gingival irritation, tooth sensitivity. Tooth sensitivities actually because like receding gums, dentists are well trained to treat this kind of pain. And usually most of the patients, when they have a dental pain, they already seen a dentist. It is when it's something else. What's something else as you , we were discussing it's the other jaw pain headaches.

Speaker 2: 5:24

Exactly. What I tell patients is, you know, you gotta take care of your teeth to prevent this. Because once you get a dental problem that has led to pain, that's when you have to go to what I used to call the torture chamber. That's the dentist chair <laugh> , that's the dentist chair where they start breaking out the drills and start chipping out your teeth and taking teeth out and doing root canals. So before you get to all that stuff, and I'm kidding, the dentist chair is not the torture chamber, but that little drill sound does kind of get me on, set me on edge. Is it a true statement that all the home cares of your teeth are preventive? I mean, is that the best way to protect your teeth? Like , you know, flossing and all that stuff? Of

Speaker 3: 6:04

Course prevention is the best cure.

Speaker 2: 6:05

Brush your teeth, floss your teeth. And so then you don't have to see , uh, <laugh> Dr . Dima for , to take out your teeth. So that's the dental causes. Let's shift. Um , and, and I think most people are fairly familiar. You know, you're gonna have to have your teeth extracted, you're gonna have have root canals, you're gonna have to have all that done. But let's talk about some of the other pain causes that you've mentioned. You mentioned temporal mandibular joint, your jaw joint. Could you talk more about that one? First of all, why does your jaw lead to pain?

Speaker 3: 6:34

The jaw joint exactly like any other joint. Why are you having pain in your knees? Why are you having pain in your back? It can be overload. It can be a trauma. It can be a genetic predisposition. Maybe like you are having some autoimmune disorder affecting this joint. It can arthritis like any kind of joint it is acting the same.

Speaker 2: 6:56

And those usually get worse when you use them too much. So are you trying to say that that TMJ pain causes from using your jaw too much? What he supposed to do is stop talking, stop eating.

Speaker 3: 7:06

No, of course not. Please continue eating, continue talking. But the other,

Speaker 2: 7:10

No one has ever told me to continue talking ever before in my life. It's usually will that guy ever shut up? <laugh>, <laugh> .

Speaker 3: 7:18

So it's the other part of functional habits, the habits that doesn't really have a function. Like for example, why are we chew gum? Oh

Speaker 2: 7:24

Yeah. Yeah. It's,

Speaker 3: 7:26

It's with some people it's like a , a stress coping mechanism. Mm-Hmm.

Speaker 2: 7:29

<affirmative>. Is it , it's not good for your joint. It's

Speaker 3: 7:31

Not. Yeah. It's not at all. Yeah. Imagine again, these muscles are created to be working when you are eating and talking. Other than that, they're supposed to be resting. Mm . Imagine you are not giving them this time to rest. I've

Speaker 2: 7:43

Never thought about gum chewing in that way before. Yeah.

Speaker 3: 7:46

It's not only gum chewing as well, it's like clenching your teeth or we call it prox clenching or grinding your teeth.

Speaker 2: 7:53

Bruxism. Yeah. What can a person do on those kinds of things? Like clenching your teeth, tight jaw. What advice do you give to people to not do that? Because I bet most people don't intentionally say, I'm gonna clench my jaw now. It's sort of a response, isn't it?

Speaker 3: 8:08

Exactly. Exactly. What do

Speaker 2: 8:09

You tell people?

Speaker 3: 8:10

You are not aware that you're clenching your teeth, but you're still doing it. It's a habit. We need to break this habit. So our habits, usually they start at the subconscious level. I'm just doing them until someone point them out. Like, are you clenching your teeth? The awake part? Like when you are awake and you're clenching your teeth, this you can control controlling a habit. 50% of controlling a habit is actually being aware that it exists. Mm-Hmm . <affirmative> . So I need more of a mind body connection to try to stop this habit. Another 50% of stopping a habit is replacing it with another one. The new habit usually I give to my patient is learning how to relax these areas. How to relieve the tension from these areas.

Speaker 2: 8:50

I think I'm, I'm guilty of this, Mara . I really am. I think I clench my jaw a lot and probably daytime, nighttime, I probably don't have any idea I'm doing

Speaker 3: 8:59

That . <laugh> . Most of us it's the modern life. We are the go, go go .

Speaker 2: 9:03

So we , right. So how do you tell, what do you tell people to do about it? Okay , so I'm aware I do it now . What am I supposed to do? Oh,

Speaker 3: 9:09

Let , let's do together actually. Okay. So that relaxed two position is when the teeth are slightly apart.

Speaker 2: 9:15

Okay. I'm doing that.

Speaker 3: 9:16

Okay. Teeth are slightly apart and tongue up. How to remember this position is by simply saying letter N.

Speaker 2: 9:22

Okay. My new favorite letter is n <laugh> . It is, that is perfect. 'cause that is exactly what what you're describing.

Speaker 3: 9:28

Exactly.

Speaker 2: 9:29

And most of us during the day, your jaws are literally together. Your teeth are together,

Speaker 3: 9:32

Just trying to relax this area.

Speaker 2: 9:34

Oh , that's really good. Do we know why people do that? Why do they clench their jaws? I mean, yeah . Is it all just stress and is this like what , what should you do?

Speaker 3: 9:43

Yes, exactly. It , it's mainly related to stress. But again, it can be just a habit that we can break stress when we are stressed out. We tend to hold the tension in the jaw and the neck area. Right.

Speaker 2: 9:55

So that can lead to pain in your jaw, pain in all the muscles. And , and a little bit later I do wanna talk about the muscles. 'cause most people don't think about that. What's, what's the effect of bruxism or clenching your jaw on your teeth?

Speaker 3: 10:06

One of the , uh, signs I see on my patient when I'm evaluating them is the amount of the wear on the teeth. And it's one of the treatment strategies is trying to protect this teeth. You only get one set of teeth per life. So I

Speaker 2: 10:19

Know that's a bummer.

Speaker 3: 10:20

Try to protect them. No ,

Speaker 2: 10:21

You can't keep any secrets from your dentist. If you don't floss, they're gonna know. 'cause they're gonna tell your gums are bad. And if you,

Speaker 3: 10:27

I know it all <laugh> ,

Speaker 2: 10:28

You grit your teeth, you can hide it from you guys. Kenya . Okay. So we've been talking about clenching your jaws during the day, but when I'm sleeping, I don't feel like I'm under a whole lot of stress. What about nighttime jaw clenching and teeth grinding? What causes that?

Speaker 3: 10:41

Yes. This is another cause called sleep prom . So there's two types of clenching your teeth awake, which I can control and sleep, which unfortunately I cannot. When I'm sleeping, I'm sleeping, I'm unconscious, I'm doing whatever. Uh , sleep m can also be related to a lot of other stuff, but to be honest, we don't really know why an individual is doing that. It can be related to stress tension. It can be a side effect of some medications. It can be also related to some sleep disorders like sleep apnea. People with clinch their teeth trying to take this breath. So we try to evaluate all or diagnose all the causes that's causing this sleep. Prox . Sometimes we don't really know and we would just have to protect the teeth when the patients are sleeping.

Speaker 2: 11:25

I wonder if there's any known connection with daytime stressors and that, or is can the most chill, relaxed, zen-like person in the world still have teeth grinding at night? Or is it all kind of the high strung tense people? We

Speaker 3: 11:39

Have seen actually , uh, sleep pro in children as young as five years old and we don't know why it's happening.

Speaker 2: 11:46

So do you deal with this in your dentistry clinic?

Speaker 3: 11:48

Yep . We deal with , uh, the effects of the sleep aism . We talk about the sleep prom and some of the patients with report like I'm having the worst pain when I wake up. It's because they have been clenching their teeth all through the night.

Speaker 2: 12:01

So I think we've earned a break. I'm gonna go floss my teeth. I do indeed have a dental visit. Yay . Coming up <laugh> , we're talking with Dr. Maram Taima . She is a dentist and a specialist in oral facial pain here at Hennepin Healthcare in downtown Minneapolis. Stay with us. We will be right back

Speaker 4: 12:17

When Hennepin Healthcare says we are here for life. They mean here for you, your life and all that it brings. Hennepin Healthcare has a hospital HCMC and a network of clinics both downtown and across the west metro. They provide all the primary care and specialty care you would expect to find. But did you know they also have services like acupuncture and chiropractic care available at many of their primary care clinics and at their integrative health clinic in downtown Minneapolis? Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 12:55

And we're back talking about oral facial pain syndromes with a colleague of mine in Hennepin Healthcare. Dr. Maram Taima . She's a dentist and a specialist in such kinds of conditions. I want to talk to you a little bit about the psychological effects of pain in the facial structures. Talk to us if you could, about some of the stressors or the anxieties or effects on people's lives that you're seeing

Speaker 3: 13:17

Or facial pain is like any sort of pain. It'll negatively impact the quality of life of the patient. But the significant problem with orofacial pain is the patient will avoid any social interaction. It's difficult for them to engage in a conversation, difficult for them to speak. It's difficult to chew and avoiding their beloved ones. Avoiding these social interaction. They start building this guilt that they are harming their beloved ones. That they are not there for them. They are letting them down. And this pain related guilt actually can turn into a shame. They tend to feel more down, more depressed, and of course having such a mood. It's not optimum for treating their pain. And they go into this cycle of pain leading to depression. Depression leading to more pain. And in 2020 , uh, in Sweden there was this studying the association between oracal pain and depression. And they found patients with chronic oracal pain. 77% of them are experiencing depression. Mm . Pain can also affect the patient's sleep. It affected greatly, tremendously in patients having sleep disturbances. They have found that they have increased risk for new onset of chronic pain. And that's why in every time I'm seeing a patient, I'm screening them for any sleep disorder, whether it's insomnia, sleep related , apnea, whatever it is. And then we have a, a quite a connection with our sleep physicians here.

Speaker 2: 14:41

I'm curious as to what, what you tell your patients who have chronic daily facial pain about some of those other things that you started this, this segment talking about the, it's hard to go out for dinner with your friends. It's hard to hold a conversation with your loved ones in the effect it has on relationships. What do you tell people to give them some hope that there's something, some relief available to them? First

Speaker 3: 15:05

Step of treating a patient with orofacial pain is just listening. They get to list their pain in their own words after that patient education. What is happening? Why is it happening? And patients are super smart actually. They can get it super fast. And when I list the causes and what is the scientific research, what's the literature saying about this pain ? They understand it. They just want someone telling them what to expect. Mm-Hmm . <affirmative> with realistic expectations, I tell them it's a chronic pain. Don't expect to feel better until in three to six months you will notice small improvement, but it's there and you will gather , give yourself time and treating their pain. We have a team. It's not only me. You'll be seeing several providers. Who

Speaker 2: 15:51

Else is on your team? Not just dentists?

Speaker 3: 15:53

No, no it's not , it's not just dentists. Actually, neurology, our psychological , uh, clinic, sleep medicine, as I told you about it actually ENT sometimes we have to deal with the ENT because it's a complicated pain.

Speaker 2: 16:05

You know, that's something when the dentist is saying you have to deal with the EMT doctors, <laugh> , that's a , that's an inside thing. <laugh> . So it's a team based , it's a team based model. Yeah. So let's shift a little bit to some of the treatments. What are the steps to diagnosis?

Speaker 3: 16:20

First up, tell me everything. Tell me everything regarding your pain, regarding your medical history, your family history, your sleep hygiene, your uh , habits, your stress levels. What happened to initiate this pain? What makes it better? What makes it worse? Then I start doing my clinical examination. My clinical examination. I'm still a dentist, right. So I'll do a dental evaluation.

Speaker 2: 16:43

Yeah, but you're looking at the teeth

Speaker 3: 16:44

<laugh> . Exactly. That's my first step. I will do a ortho dental examination, then I'll go for a nerve assessment. I will start palpating all the facial and the head and neck muscles. I'll palpate all these joints and try to duplicate their pain. You ,

Speaker 2: 16:59

You try to reproduce the pain they're having. Exactly.

Speaker 3: 17:01

Exactly. I check the range of motion, how they're opening and closing. Even their posture can play a

Speaker 2: 17:07

Role. I would flunk the posture exam just like I flunk the flossing exam .

Speaker 3: 17:11

Like any physician

Speaker 2: 17:12

<laugh> . Yeah, exactly. I would , I would flunk the posture exam. Oh gosh. So you tell you , you do all that kind of stuff. Do you ever have to do things like um, x-rays or , or of course . Or

Speaker 3: 17:22

FLA test or anything? It's my third eye. I called my third eye. I would do like a panoramic X-ray just to check the teeth. Yeah. I would do , uh, a CT for the jaw joints. An MRI , whether it's an MRI for the jaw , for the muscles for a brain MRI , sometimes I need to do an brain MRI ,

Speaker 2: 17:37

Especially if I bet if they have headaches,

Speaker 3: 17:39

Headaches or uh , some other type of nerve pain. I want to make sure that there is , uh, the nerve pain is not caused by a tumor or something like that.

Speaker 2: 17:45

Okay. What about what a lot of people come to me with is that clicking sensation in your jaw? Is that a problem?

Speaker 3: 17:52

I love this question. Thank you

Speaker 2: 17:54

<laugh> . I get it a lot. And I don't know the answer always. So yeah. When I open my, my jaw clicks that at that temporal mandibular joint or TMJ. Exactly. What does that mean?

Speaker 3: 18:03

Yeah . You know the disc you have in the back and people would say the disc slipped out

Speaker 2: 18:06

Place. Yes, I had it . Yep .

Speaker 3: 18:08

It is the same. Our drill joint has a disc that slip out of place. So whenever you're opening your mouth, the disc has to go back in place and you hear the Yep . It's the click.

Speaker 2: 18:17

Right.

Speaker 3: 18:17

There's no problem with the click. Actually, most of the population have clicking joints . I have a clicking joint . Mm-Hmm . <affirmative> . Do you have a clicking drawing ? I

Speaker 2: 18:23

Don't think I do. You and I talk more than any living human being . I you're the lucky ones. But nobody talks more than me as and as people who know me. If they're listening to this, they're laughing about that. 'cause that's a true statement. So I think I , I think I was blessed with good with good T . That's good . Genetic .

Speaker 3: 18:39

Thank , thank you for your mother and father.

Speaker 2: 18:40

I've never thought of that in my whole life. No. But I know a zillion people who do Exactly . It clicks

Speaker 3: 18:46

If it's just the noise, we don't treat noises really. But if it is painful or it's causing any limitation in function, that's when I need to see you.

Speaker 2: 18:54

Got it. Got it. Okay. So let's talk specifically about jaw pain for the moment. What kind of treatments do you do when, when you've diagnosed somebody with either a joint or a muscular problem in their jaw?

Speaker 3: 19:06

Usually the treatment approach depend on the patient's condition . Why are you having this pain? Can I eliminate the cause ? If I can eliminate the cause , then it'll get better. And that's what we usually start with is patient education. Why did this happen? Can you keep , uh, a pain diary of why this is happening? When does it get worse? When does it get better? What helps with that? Because the next step will be a lifestyle modification. I need to get rid of these harmful habits I'm doing. We'll try to personalize a treatment plan to reduce our harmful habits and to try adopting new beneficial one can . Can we have some psychological assistance to reduce our stress? Is there some stress reduction techniques? Can we have better sleep hygiene? We don't usually go for invasive treatments. Most of our treatment is a conservative treatment. We try to avoid any invasive treatments.

Speaker 2: 20:00

So when you say invasive treatments, does that, is that sometimes necessary? Do like surgeries?

Speaker 3: 20:06

Yes. They are not the bad guys. <laugh> sometimes

Speaker 2: 20:08

We need , well you're a surgeon so <laugh> sometimes

Speaker 3: 20:11

We need them. Yes.

Speaker 2: 20:12

So what other treatments are available? If

Speaker 3: 20:14

I'm clinching my teeth while I'm sleeping, I need something to help. It'll be a dental appliance protecting my teeth, forcing me to go to the end position while I'm sleeping. So it relax

Speaker 2: 20:23

The end position. So that one that you taught us earlier? Yeah.

Speaker 3: 20:26

Where the teeth are slightly apart to relieve the tension over the jaw joint and the muscles when

Speaker 2: 20:30

You wear the , the , the dental appliances when only at nighttime or also when

Speaker 3: 20:33

You cannot control your habits. It's when you're sleeping, when you are awake, I'd rather have you control your habits. I'd rather have you having your mind body connection, trying to stop your habits.

Speaker 2: 20:43

Got it, got it. So dental appliances mostly at night control your habits during the day. What else is there for treatments?

Speaker 3: 20:50

Physical therapy is a valuable option. Uh, helps patients understand how their bodies function properly and the impact of poor posture on their pain.

Speaker 2: 20:59

Okay. So when people think of physical therapy, including me, you often think of, well, I'm working on my legs or I'm doing squats, or I'm stretching my arms. How do you do physical therapy of your face?

Speaker 3: 21:09

Actually in Hennepin we have some wonderful physical therapist just specialized in jaw pain or orofacial pain. Mm-Hmm <affirmative> . And they can help with greatly with jaw pain, with headaches. And we have also in the integrative physical therapy , uh, some of them who work on the body as a whole. And part of it is the artificial pain.

Speaker 2: 21:29

I wanna direct listeners to a recent episode with Catherine Justice. She is an integrative physical therapist here at Hennepin Healthcare . Um, because you just mentioned and she

Speaker 3: 21:38

Is great. She is

Speaker 2: 21:39

Great. Okay. So we've got through almost this whole episode talking about pain. And I love that we have not yet really talked about medications because so many things in our medical field, it's the first thing we talk about is medications. But there must be a role for medications at some point, right? Yeah,

Speaker 3: 21:54

You're right David. You're right. Most of the patients prefer to avoid medications because of it's side effects. There . It has some potential side effects. And I share this concern. However, we still sometimes need to use them. They are sometimes they are necessary. And our philosophy is start low, go slow to just check how it's affecting the patient, how's the side effects, and we can always adjust the medication as needed or change it. It's a wide range starting from uh , painkillers like non-steroidal anti-inflammatory drugs like an ibuprofen or Tylenol to uh, some kind of steroids to muscle relaxants. We can go for actually nerve pain medications like , uh, some anti-convulsant medication antidepressants. Actually, you can also go for the neu trend . Botin toxin. Botox.

Speaker 2: 22:43

Botox. Yes . Oh, well as long as you brought that up, <laugh>. How does botulinum toxin work for pain?

Speaker 3: 22:51

That's a great question. And

Speaker 2: 22:52

Who should get that? So

Speaker 3: 22:54

Botox actually is approved for headaches and migraines. Mm-Hmm. <affirmative> . And that's how it started entering the pain world. So , uh, Baltic was used for I think ple of spasm and when they used it, they found that the wrinkles are gone.

Speaker 2: 23:08

Right. To get rid of wrinkles around your eyelids. Exactly . And your forehead.

Speaker 3: 23:11

Exactly. And they started injecting it into forehead and people who have headaches started reporting that they don't get headaches when they have their cortic injections. Oh,

Speaker 2: 23:21

They were getting it for the cosmetic appearance. Exactly. And it also helped their headaches.

Speaker 3: 23:25

Yep . And then they started using it for headaches and people with headaches reported that they, it's helping with other kinds of pain, which is the jaw pain. It helps to relax. Botox is a potent muscle relaxant, so it helps to relax these muscles. It helps, it prevents it from , uh, over contracting.

Speaker 2: 23:42

So if you have muscle spasms of your jaw muscles, the masser muscles as you've , um, uh, named them, that's what they're called. Is it safe? Let's see . It just feels like, so you stick a needle in someone's jaw and it , it , it , and it relaxes the muscles. I mean, do you kind of slur your speech and drool a lot after getting that done ?

Speaker 3: 24:00

It can affect the facial muscles. Like when you're smiling, you're not smiling that white . Right? Yeah, that can happen. But we still, we know with the proper anatomy not to do that. But it still happened in some of the patients. It is safe. Yes, it is actually safe in most of the patients. Usually it's a local anesthesia, so it will , any effect will be just localized. But the thing is, we can also use it with some of neuropathic pain, like some of neuralgia, something called persistent into ular pain, which is patients who have like root canal and still have pain, we can actually inject it so it reduces the pain at this area. So

Speaker 2: 24:35

There is a role for Botox and a number of other medications as you've just said, so thank you for that. Okay. Maram , what messages would you like to leave with our listeners before I let you go today?

Speaker 3: 24:45

I would say a healthy body encompasses both physical and mental wellbeing. With stress playing a large role, then often recognized. Um , like if you are having some intellectual stress such for preparing for an exam, you will start studying and acquiring knowledge. If you're having physical stress like uh , sports competition, you will start training and strengthening your body in the same way. When you're facing emotional stress, it's essential to develop some coping mechanism to manage your stress properly. Uh, whether it's surrounding yourself with individuals you trust, finding someone to support you, finding professional help, it's very important. Another important point is trust yourself. When you are experiencing pain, seek help. Don't just say like, oh, I'm not quite sure it's that painful or not. Pain is really a personal experience. Trust yourself. If you're having pain, it's real pain. You need to see someone. And if you are having some minor pain just started , usually it's muscle pain. As we said, 50% of the pain in this area, it'll be muscle pain. So maybe we can use a little bit of , uh, a heat pack or an ice pack . Just get like a wet towel, throw it in the microwave for 10 seconds or put it in the freezer for 30 minutes and then just put it uh , as a hot compress over your face. It can help. A gentle massage after that will help a lot. Start observing your habit. Be mindful. Have this mind to body connection. Are you clenching your teeth? Are you grinding your teeth? When is your pain worse? When is your pain better? How is your sleep? You can keep a pain diary actually, which will help you a lot. We understand that our patients are not just a mouth or head with pain. You are a full whole individual with unique experience, abilities, and dreams. A personalized treatment plan tailored to each individual is crucial and that's what we would like to do. Treating patient holistically defines our success.

Speaker 2: 26:38

What great tips. I especially like that you said trust yourself, manage your stress. Some home and self-care. So I guess I better go brush and floss. Now, in addition to some of the other things you've suggested, <laugh>, we've been talking to Dr. Maram Taima . She is a dentist here at Hennepin Healthcare in downtown Minneapolis and a specialist in oral facial pain. Maam , this has been a great discussion. I have learned so much from this, so thank you for being on the show. Thank you for having me. It's been great having you here. And listeners, I hope you've picked up a little bit of tips beyond just brushing and flossing. There's a lot of causes and a lot of help available to you if you're living with oral facial pain . That's all we have for today. I hope you'll join us for our next episode in two weeks. And in the meantime, be healthy and be well.

Speaker 1: 27:22

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show, email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At highball Executive producers are Jonathan, CTO and Christine Hill . Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.