Orofacial disorders are defined as disorders of the orofacial structures including headache disorders, temporomandibular disorders, orofacial pain disorders, dental sleep disorders, neurosensory and chemosensory disorders, oromotor disorders, and other orofacial disorders (Table 1). Because the orofacial structures have more density of innervation and vascularity of tissues than other areas of the body, the prevalence of these disorders is high at over 40% of the general population. Head, jaw, and orofacial structures also have close associations with functions of eating, communication, sight, and hearing as well as form the basis for appearance, self-esteem and personal expression. As a result, any persistent pain or disease in this area can deeply affect an individual both psychologically and systemically requiring more complex care.1-5 A national poll found more adults working full-time miss work from head and face pain than any other site of pain.6

Table 1. Orofacial disorders that require special diagnostic and treatment needs with estimated prevalence. 1-6
Orofacial Pain Disorders Estimated prevalence
Temporomandibular disorders 5-12%
Headache disorder (tension-type headaches, migraine, mixed, cluster) 15-20%
Orofacial pain disorders (burning mouth, neuropathic, atypical pain, neurovascular) 2-3%
Orofacial sleep disorders (e.g. sleep apnea, snoring) 3-7%
Neurosensory and chemosensory disorders (e.g. taste, paresthesias, numbness) 0.1%
Oromotor disorders (e.g. bruxism, occusal dysethesias, dystonias, dyskinesias) 4%
Total Estimated Prevalence in General Population 30% to 40%

These issues highlight both the complexity and the need for high quality evidence-based care for patients with these problems. However, the lack of practical training in these disorders within both medical and dental specialty training programs motivate most health care providers to refer these patients to a specialist. A survey of 405 health professionals found that 95% either do or would like to refer these patients to an orofacial pain specialist because of their complex nature. 7 Patients often doctor shop with array of medical and dental specialists and end up on multiple medications, opioid addiction, surgeries, and other treatments that may not help long-term and increase health care costs dramatically. Currently, there only less than 100 full-time orofacial care specialists provide care in clinical practice for a population of over 100 million people with orofacial conditions. That’s more than a million patients per specialist. Furthermore, there are virtually no specialists in outreach areas. These access to care problems for patients with orofacial disorders highlight the need for more effort by the health care system to improve access to care for patients with these problems by both training all health professionals in orofacial care and then dramatically expand the number of Specialist in Orofacial Pain.

Thus, the overall purpose of this presentation is present the need and opportunity to recognize and understand the new specialty of Orofacial Pain with the following learning objectives;
1. Understand the need and opportunity due to the high prevalence, poor access to care, and opioid crisis
2. Review the barriers to specialty recognition including the ADA Commission’s specialty recognition process
3. Identify recent policy challenges and change in state laws to allow recognition of Orofacial Pain
4. Review the importance of recognition of Orofacial Pain by the American Board of Dental Specialties
5. Review steps to improving access to evidence-based care and economics of Orofacial Pain practice
6. Review responsibility of each orofacial pain specialist in making the public aware of your specialty services

References
1. Lipton, J.A., J.A. Ship, and D. Larach-Robinson, Estimated prevalence and distribution of reported orofacial pain in the United States. Journal of the American Dental Association, 1993. 124(10): p. 115-21.
2. Petti S. Pooled estimate of world leukoplakia prevalence: a systematic review. Oral Oncology 2003; 39: 770-780.
3. Lozada-Nur F, Miranda C: Oral lichen planus: Pathogenesis and Epiemiology. Seminars in Cutaneous Medicine and Surgery 1997; 16:290-295
4. Ruhnke M. Skin and Mucous Membrane Infections. In: Calderone RA: Candida and Candidiasis. Washington, DC: ASM Press, 2002, pp 307-326.
5. Bailey, D, Attanasio, R, (editors): Sleep Disorders: Dentistry’s Role, Dent Cl N Am, Oct 2001;45(4)
6. Taylor, H. and N.M. Curran, The Nuprin Pain Report, 1985, Louis Harris and Associates: New York
7. Look, J and Fricton, J Access to care for patients with orofacial pain: a survey of dentists. AAOP, 1999
8. Ferreira J, Fricton J, Rhodus N. Orofacial Disorders: Current Therapies in

James Fricton DDS, MS is a Professor Emeritus in the University of Minnesota Schools of Dentistry, Medicine, and Public Health, a Senior Investigator for HealthPartners Institute, and a Pain Specialist at the Minnesota Head and Neck Pain Clinic. He was trained in Dentistry at the University of Iowa and in Anesthesiology and Pain Management at UCLA School of Medicine. He has 40 years of experience in patient care, University teaching, and NIH-sponsored research on relieving and preventing chronic pain and use of health information technology in patient care, With over 100 publications and books with his most recent NIH-sponsored research on Personalized Activated Care and Training (PACT) that helps health professionals integrate patient self-management training with treatment using a telehealth team and technology. He has held top leadership positions in the American Academy of Orofacial Pain, American Board of Orofacial Pain, the American Board of Dental Specialties, the American Pain Society, and is currently President of the International Myopain Society. He was one of the original authors on the Specialty Application for Orofacial Pain, the American Academy of Orofacial Pain’s Clinical Guidelines for Temporomandibular Disorders and Orofacial Pain, and the Commission on Dental Accreditation Guidelines for Advanced Education Programs on Orofacial Pain. He had taught many courses on chronic pain with his most recent On-line Course on Preventing Chronic Pain: A Human Systems Approach at www.coursera.org/learn/chronic-pain with over 50,000 participants from 176 different countries. He also recently co-authored the textbook, Orofacial Disorders, by Springer in 2017.