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Resolving Pain at the Root

A doctor's approach to diagnosing and treating chronic facial pain

Imagine taking for granted countless muscle actions you don’t think twice about – yawning, laughing, chewing, swallowing and even talking. But if you’re one of as many as 12 million people in the United States who experience discomfort in this area, you know just how disruptive it can be to daily activities. You’ve likely seen multiple doctors and dentists, and maybe even tried at-home remedies, but nothing seems to work. 

Those with frequent or relentless facial pain are often dealing with a temporomandibular joint disorder, or TMD. This is an umbrella term for more than 30 conditions that affect the temporomandibular joint (TMJ) and surrounding tissue, which connects your jaw to your skull. Aside from being painful, it’s often misunderstood and difficult to find relief from.

Dr. Abigail Schimdt of the Michigan Center for Facial Pain and Sleep knows how this can disrupt daily life – and the urgency for treatment and answers. 

“It can distract your attention, interfere with work, with parenting, …  it affects your day-to-day and it doesn't matter if it’s minimal or extreme. The question becomes ‘what’s your quality of life?’ This pain is normal because you’ve learned to just live with it,” she says. 

A board-certified orofacial pain specialist, Dr. Schmidt opened the MCFPS in October 2022 following 11 years in the U.S. Navy. Here, she provides reliable, evidence-based treatment for patients who suffer from acute and chronic pain conditions in their head, neck, face, and jaw, as well as sleep apnea and snoring. 

“Part of my job is to educate patients so they can understand how we approach the complaint. I provide an accurate diagnosis and explanation of what’s going on or why it’s happening. Then they can take that and move forward,” she says. 

Dr. Schmidt’s journey in facial pain care first began in dentistry. Following graduation from the University of Michigan School of Dentistry, she joined the U.S. Navy and spent four years as a general dentist on military bases in Parris Island, South Carolina and Yokosuka, Japan.

During that time, she began to see a prevalence in cases that traditional, mechanical dentistry couldn’t fix, within a military community that was never settled in a place long enough to get to the root of the problem.

“Chronic pain is different but can present in and around the teeth. I had patients in pain and did the appropriate workup – ordered various images, did extensive testing on a variety of teeth – but there was no indication for the go-to dental procedures,” says Dr. Schmidt. “General dentistry doesn’t know enough about chronic pain –  it’s prevalent, but not a standardized curriculum in most dental programs.” 

Fortunately for Dr. Schmidt, the Navy had developed an orofacial pain program after realizing the need was so great for their servicemen and women. And she was being pulled toward a specialty. 

“In general dentistry, you can do a variety of things in a day,” she says. “But I wanted to be really good at something. I wanted to focus on something specific.”  

While completing her 3-year residency in orofacial pain at the Naval Postgraduate Dental School in Bethesda, Maryland, Dr. Schmidt worked closely with medical specialties, including rheumatology, orthopedics, neurology, psychology, and sleep medicine. That extensive crossover with other medical fields helps Dr. Schmidt be most effective at evaluating the complexities of her patients. 

Dentists are experts of the oral cavity, but often, orofacial pain conditions including TMDs are outside a general scope of practice. The tooth-directed treatments that are suggested or completed may offer temporary hope but rarely a solution to the pain complaint. 

“That causes hesitation for me because patients can end up paying for treatments to fix their teeth or change their bite but it doesn’t resolve their pain and they’re out thousands of dollars,” Dr. Schmidt says. “but you don’t know what you don’t know.”

There is no one-size-fits-all treatment for orofacial pain. Rather, it depends on any number of factors, from jaw strain or trauma to numbness following a dental procedure, systemic arthritis or even tension in the neck.

Some people experience symptoms without obvious explanations. Orofacial pain can be caused by problems with nerves, muscles or joints. People can develop subconscious habits like jaw clenching and teeth grinding. Even poor posture can contribute to a chronic condition.

In an initial visit, Dr. Schmidt thoroughly explores a patient’s history and then offers different tools, each with its own benefit. There’s a place for orthotic appliances, like custom-made bite splints and night guards, as well as medications that can reduce tension and improve jaw function. However, much of her approach is through musculoskeletal health.

She employs various needle therapies, which can precisely pinpoint pain triggers. She also prescribes at-home remedies, like massage, heat and ice therapy and stretching. By increasing perfusion and improving jaw range of motion, these can give patients almost immediate relief – and a glimpse of a new normal. Other treatments are based on whole body health, including sleep hygiene, breathwork and even prescribing yoga, which promotes mindful awareness of the body in time and space.

“So much of our physical, mental, and emotional environment influences pain. I help patients appreciate those influences and address factors within their control,” says Dr. Schmidt. “Most orofacial pain conditions are not cured but managed; Patients can live predominantly pain-free but if it comes back, we don’t have to panic. We know what to do.”

Her goal is to establish a long-term relationship built on trust. “I not only see them as the provider, but I have also been the patient bouncing from office to office seeking answers,“ she said. “I understand the frustration they may be feeling or the skepticism they carry as they walk through my door. Chronic pain patients are their own champions.” 

Dr. Schmidt also treats sleep disorders, including sleep apnea and snoring. Research has found that poor sleep has a direct relationship with pain. While these ailments are often addressed with dental appliances, Dr. Schmidt additionally helps patients focus on getting quality sleep each night. 

Based on symptoms and concerns, patients may prefer to see Dr. Schmidt more frequently on a month-to-month basis or feel comfortable with an extended 3, 6, or 12-month follow-up. Patients are individually assessed to determine the most optimal treatment timeline.

“Ideally, I’m not just treating TMD, a headache, or sleep disorder,” she says. “I’m educating and providing the tools to benefit a patient’s overall wellness helping them to feel better and live their best life. It’s what I enjoy and I know I'd want the same.”

Last year, Dr. Schmidt moved back to the Great Lakes with her husband and two young children. Aside from pride in her personal and professional life, Dr. Schmidt carries with her the memory of being let into one of the three most difficult places in the world – Iwo Jima, Japan. During an exclusive excursion for military members, she was afforded the unforgettable experience of biking around the volcanic island.  

If you would like to finally conquer pain, visit www.michigancenterforfacialpainandsleep.com or follow them on Facebook and Instagram @mifacialpain 

“So much of our physical, mental, and emotional environment influences pain. I help patients appreciate those influences and address factors within their control.”

"I understand the frustration they may be feeling or the skepticism they carry as they walk through my door. Chronic pain patients are their own champions.”