By FDC2025 Speaker Dr. Erienne Blanchard, PT, DPT, OCS, CMPT, CFC, Cert. DN, CCTT
Have you encountered a patient with tooth pain, yet the tooth appears healthy, with no fractures, infections or decay? It’s important to recognize that tooth pain may not always originate from the tooth itself, even though it is the site of discomfort. Before considering a referral to endodontics or oral surgery, a thorough screening for potential cervical or musculoskeletal causes of the pain should be conducted. These patients would benefit from a referral to physical therapy.
Physical therapy can play a significant role in addressing musculoskeletal contributors to dental pain. For example, patients with forward head posture may experience changes in occlusion due to jaw protrusion. Additionally, pain originating in the upper cervical spine can radiate through the trigeminal nerve, potentially causing referred pain in the ear, face, teeth and sinuses. Degenerative changes in the temporomandibular joint (TMJ) may lead to alterations in the condyle, ligaments and even disc displacement. While occlusal guards may help align the jaw and reduce strain on the teeth, they do not address underlying issues such as muscle coordination, cervical alignment, or tongue positioning.
If a dental issue is ruled out, a few simple assessments can help identify potential musculoskeletal or TMJ-related causes of pain. The TMJ Screener — a pre-appointment questionnaire — can help identify signs of TMJ dysfunction or muscle-related issues. A quick evaluation of the cervical range of motion may reveal restrictions contributing to the patient’s discomfort. Palpation of the oral and cervical musculature can assist in identifying specific patterns consistent with temporomandibular disorders (TMD), according to the DC/TMD classification system.
If any of these assessments indicate a musculoskeletal issue, a referral to a physical therapist with expertise in craniofacial and orofacial therapy is recommended. Early intervention with physical therapy can lead to better outcomes by addressing the root cause of the pain and improving the patient’s overall function. Physical therapy compliments the dental practice to ensure good pre and post-operative outcomes for all procedures.
Erienne Blanchard, PT, DPT, earned her doctorate in physical therapy from the University of Florida. She earned a craniofacial certification from the University of St. Augustine. She is a certified cervical and temporomandibular therapist from the American Academy of Orofacial Pain. Dr. Blanchard maintains a private practice in Gainesville, FL.
Dr. Blanchard will present the course “Screening and Treating for TMD and Headache Workshop: Physical Therapy and Dentistry Collaboration” on Thursday, June 19, 8-11 a.m. at the Florida Dental Convention. Learn more and register at www.floridadentalconvention.com.
Beyond the Bite 