- Email: [email protected]
ADA ANNUAL SESSIONS
COMMENTARY
LETTERS
failed treatment attempts should raise red flags. For the private practitioner, it is important to recognize PBS as a complex condition before initiating further dental treatment. Finally, the proper referral of patients with PBS for psychological evaluation is not unethical. Although for some clinicians it may be difficult to make these referrals—the lack of assessing for PBS in the differential diagnosis for patients with these types of complaints contributed to the excessive dental intervention that these patients received before being properly identified. Unfortunately, it also leaves the primary, root condition of PBS untreated. The principle of nonmaleficence in the ADA Code (Section 2.B) clearly states that one of our obligations is to know our own limitations and when to refer to a specialist.5 As suggested in our article, we believe that in patients of chronic pain
with comorbid behavioral and psychosocial contributing factors, such as the patient with PBS, the proper referral includes psychological and/or psychiatric evaluation and, if indicated, treatment. Since the direct referral to these professionals may put the dentist and patient in an uncomfortable situation, the initial referral may be to a pain center that has a multidisciplinary team. Vladimir Leon-Salazar, DDS, MSD
136
February 2013
JADA 144(2)
http://jada.ada.org
Senior Resident Division of Orthodontics Department of Developmental and Surgical Sciences
Leesa Morrow, PhD, JD, LP Clinical Assistant Professor
Eric L. Schiffman, DDS, MS Associate Professor and Division Director Division of TMD and Orofacial Pain Department of Diagnostic and Biological Sciences School of Dentistry
University of Minnesota Minneapolis 1. Management of temporomandibular disorders: National Institutes of Health Technology Assessment Conference statement. JADA 1996;127(11):1595-1606. 2. Koh H, Robinson PG. Occlusal adjustment for treating and preventing temporomandibular joint disorders. Cochrane Database Syst Rev 2003;(1):CD003812. 3. De Leeuw R, American Academy of Orofacial Pain. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. 4th ed. Chicago: Quintessence; 2008:316. 4. Edwards RR, Cahalan C, Mensing G, Smith M, Haythornthwaite JA. Pain, catastrophizing and depression in the rheumatic diseases (published online ahead of print Feb. 1, 2011). Nat Rev Rheumatol 2011; 7(4):216-24. doi:10.1038/nrrheum.2011.2. 5. American Dental Association. American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012. www.ada.org/1379.aspx. Accessed Dec. 17, 2012.
ADA ANNUAL SESSIONS
2013 Oct. 31-Nov. 5, New Orleans 2014 Oct. 9-14, San Antonio 2015 Nov. 5-8, Washington 2016 Oct. 20-23, Denver 2017 Oct. 19-22, Atlanta 2018 Sept. 27-30, San Francisco
Copyright © 2013 American Dental Association. All rights reserved.
LETTERS
failed treatment attempts should raise red flags. For the private practitioner, it is important to recognize PBS as a complex condition before initiating further dental treatment. Finally, the proper referral of patients with PBS for psychological evaluation is not unethical. Although for some clinicians it may be difficult to make these referrals—the lack of assessing for PBS in the differential diagnosis for patients with these types of complaints contributed to the excessive dental intervention that these patients received before being properly identified. Unfortunately, it also leaves the primary, root condition of PBS untreated. The principle of nonmaleficence in the ADA Code (Section 2.B) clearly states that one of our obligations is to know our own limitations and when to refer to a specialist.5 As suggested in our article, we believe that in patients of chronic pain
with comorbid behavioral and psychosocial contributing factors, such as the patient with PBS, the proper referral includes psychological and/or psychiatric evaluation and, if indicated, treatment. Since the direct referral to these professionals may put the dentist and patient in an uncomfortable situation, the initial referral may be to a pain center that has a multidisciplinary team. Vladimir Leon-Salazar, DDS, MSD
136
February 2013
JADA 144(2)
http://jada.ada.org
Senior Resident Division of Orthodontics Department of Developmental and Surgical Sciences
Leesa Morrow, PhD, JD, LP Clinical Assistant Professor
Eric L. Schiffman, DDS, MS Associate Professor and Division Director Division of TMD and Orofacial Pain Department of Diagnostic and Biological Sciences School of Dentistry
University of Minnesota Minneapolis 1. Management of temporomandibular disorders: National Institutes of Health Technology Assessment Conference statement. JADA 1996;127(11):1595-1606. 2. Koh H, Robinson PG. Occlusal adjustment for treating and preventing temporomandibular joint disorders. Cochrane Database Syst Rev 2003;(1):CD003812. 3. De Leeuw R, American Academy of Orofacial Pain. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. 4th ed. Chicago: Quintessence; 2008:316. 4. Edwards RR, Cahalan C, Mensing G, Smith M, Haythornthwaite JA. Pain, catastrophizing and depression in the rheumatic diseases (published online ahead of print Feb. 1, 2011). Nat Rev Rheumatol 2011; 7(4):216-24. doi:10.1038/nrrheum.2011.2. 5. American Dental Association. American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012. www.ada.org/1379.aspx. Accessed Dec. 17, 2012.
ADA ANNUAL SESSIONS
2013 Oct. 31-Nov. 5, New Orleans 2014 Oct. 9-14, San Antonio 2015 Nov. 5-8, Washington 2016 Oct. 20-23, Denver 2017 Oct. 19-22, Atlanta 2018 Sept. 27-30, San Francisco
Copyright © 2013 American Dental Association. All rights reserved.