Chiropractic + Naturopathic Doctor

Let’s face it: Opportunities to ‘specialize’ in practice

By Dr. Sidney Lisser With files from Dr. Chris Oswald, Colby Bucci (PT) and Dr. Brett Guist   

Features Clinical Case Studies Patient Care collaboration facial pain jaw pain orofacial pain TMD TMJ

Dr. Sid Lisser treating a patient with facial and jaw pain. Photo: Courtesy of The Centre for Fitness, Health and Performance

Prior to writing this article, the question presented to me was: “How, as a chiropractor, do you make inroads with dental professionals?” But, there is no answer to that. Instead, the question should be: “How, as a chiropractor, do you differentiate yourself so that other health professionals will want you to be part of their patient care team?” This comes with a bit of a story.

In 2002, I began my chiropractic career in “chiropractic general practice.” I use the term “general practice” as that is what we see and hear in the medical and dental communities – general practitioners and general dentists. This often confuses me because as chiropractors, we are all general practitioners. While we do have some specialties, like rehabilitation, sports injury, research, etc., there are no true specialists focusing on a specific part of the body, or a specific subset of the population with the exception of the chiropractic radiology specialty.

So I made myself into a true “specialist.” My focus is in the mechanical rehabilitation of jaw and facial pain, even though I can’t use “specialist” as an official title. I use the phrase “special interest in” when discussing my work in with jaw and facial pain patients. I currently operate The Jaw & Facial Pain Centre and have treated over 7,000 jaw and facial pain cases to date. Our team works and inter-refers with many of the hospitals, dentists/dental specialists, otolaryngologists and varying other medical professionals in the greater Toronto area to support patients with these conditions. During our process of growth, we integrate these professionals into an allied health clinic targeted solely towards the treatment and rehabilitation of jaw and facial pain.


A patient success story
I saw my first facial pain patient in 2002. She was a patient referred for chronic mid back pain from a dental specialist that our clinic had successfully helped with his own pain. In her history she noted she had seen 56 health professionals for her pain, and I was number 57. She had had short term relief, but little long-term success. Fortunately, I was able to help her where others had failed. The real issue was not that she had a complicated problem, but that many of the rehabilitation practitioners who treated her initially failed to use the best practices available and relied on non-researched and incomplete treatments. As a result, the cascade of referrals began, she was pigeonholed as a pain patient with somatic disease, and she bounced around the system until she was referred to my office.

Following the success of her back treatment, the dental specialist asked me to look at her jaw/face and wondered if we could apply the same practices to the chronic pain she was feeling in her jaw/face that we used on her back. I coupled the dental specialist’s support and knowledge with my ability to research and became more educated on the topic. I am happy to say that we, as a team, were able to successfully resolve her long-standing jaw and facial pain.

I asked the dentist, “Since we had such great success, would you be willing to refer me other patients so I could try again?” I took this opportunity to refine my methods for treatment and continue to grow my knowledge. Subsequently, the dental specialist continued to refer more and more patients.

Picking up speed
When letters of referrals were sent to me with other dental/medical professionals copied, I always made sure to respond, not only to the referring dentist, but to all those copied. I did this to ensure communication was transparent and shared to all those involved in the patient’s care. This also enabled me to get my name out in the dental/medical community, network and build a reputation.

As my experience grew, I asked the dental specialist if he would introduce me to others in his field. I also reached out to those I had corresponded with and told them they could refer those who they believed had pain that was non-odontogenic, but mechanical in nature, directly to the clinic. I would track results and findings to make sure when I met or spoke with those who referred, or those I was trying to convince to refer, that I would have empirical evidence to make sure I could prove my results. I also carried some patient testimonials with me as well to further support my treatment success. Slowly, the health professionals that I copied on my letters and communicated with started to refer and further tell their peers about what I was doing.

There was very much a parallel trajectory in my research, knowledge and reputation. As I had established a good reputation, I subsequently reached out to more hospitals, clinics and specialists. I quickly learned that no one was specializing/focusing in the “conservative, mechanical rehabilitation of jaw and facial pain,” and that the void for this type of care was enormous. Most health professionals I spoke with would say they had no place to send these patients. Our clinic became a place to send them and they were thankful. There were some bumps along the way, but as I had defined, developed and further refined treatment protocols and guidelines for the treatment of these patients, I knew I could continue to recreate the patient successes in a safe and conservative manner.

As the patient referrals grew, so did my experience. I learned to apply safe, conservative mechanical treatment to a wide range of conditions and pre-define successful outcome measures. I set new standards for care and criteria for success where manual/mechanical therapy had not been previously used as the standard for care. With all the research and time invested I would share the knowledge I had gained with those who referred in the forms of scholarly articles, provide working group sessions and give back in an informative manner to educate those around me in the health profession. This stimulated more research, collaboration and commitment to patient success among those practitioners I worked with and the team expanded and evolved.

Instead of attending chiropractic courses, I would attend dental and TMJ/TMD courses so I could collaborate with others interested. Being the only chiropractor at an otolaryngology or dental lecture was often questioned, but well received and sparked interest as to why I was there. It became an effective networking tool to grow my jaw and facial pain practice and a place to hone my knowledge.

With all the patient success, research, protocols and knowledge, Dr. Chris Oswald and I decided to open a specific centre in 2016 (the Jaw and Facial Pain Centre), which solely focused on the conservative, mechanical treatment of jaw and facial pain. It is an allied health clinic targeted solely towards the treatment and rehabilitation of jaw and facial pain. After the success for the clinic, we are now opening our first satellite clinic and will be adding more allied health professionals to our main centre in Toronto.

Staying connected
Even after all this, one of the things I work very hard on is staying connected to the network. To this day I continue to drop in randomly with coffee and snacks to say thank you for the kind referrals and ask for feedback and pick their brains for information to apply to my treatment. I partake in sponsor talks and symposiums on the topic so we can all share knowledge. For example, just this past week I stopped in to see a referral source and I ended up with a dental specialist spending time with me to discuss the consequences of super eruption of teeth and jaw pain, which I’m now avidly researching.

I believe this story brings us to ask the question, “How as a chiropractor do you differentiate yourself so that other health professionals will want you to be part of their patient care team?” The simple answer is hard work, but the more complicated answer is multifactorial:

Do your research. The more the better. I learn something new every day. Make sure when it comes to the special interest practice you are interested in and the type of health professional you approach, that you are the most well-read and researched person in the room.

Don’t be afraid to network or worry what others might think of you. It is not so easy to be rejected, but if you put yourself out there with the right preparation, people will want to work with you. Just make sure what you are saying is well-researched, ethical and puts the patient’s interest first!

Don’t be afraid to challenge the conventions and apply the amazing functional, structural, anatomical, and physiological education you have received and apply it to the rehabilitation and treatment of any part of the body. We are finding more and more that CONSERVATIVE is the right care. There is nothing more conservative than manual therapy, exercise therapy or active rehabilitation. We as chiropractors have the tools to be leaders in conservative care for the musculoskeletal system.

Lastly, be brave. Step outside your comfort zone. Don’t forget with rejection comes acceptance, with failure comes success and most importantly with innovation and research comes better patient care.

Dr. Sidney Lisser is a Chiropractor with a special interest practice in jaw and facial pain. He is the Clinic Director of The Jaw and Facial Pain Centre in Toronto, ON.

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