LEARNING TO RELIEVE PAIN
Words by Merry Sue Baum
It was 1994 when Brazilian Paulo Conti, DDS, PhD, came to the U.S. looking for answers.
A professor of prosthodontics at
the Bauru School of Dentistry at the
University of Sao Paulo at the time,
he had been searching for new and
better methods of diagnosing and
treating patients with orofacial pain, defined as
chronic facial pain disorders unrelated to dental
problems. In Brazil a diagnosis in the early 1990s
was based solely on a patient’s occlusion, or how
the teeth come together. The only treatments
were correcting misaligned bites, using mouthguards
to alleviate pressure on the jaws from
bruxism, or teeth grinding, and prescribing analgesics.
Often none of these remedies helped.
“Patients would describe their pain as, ‘agonizing,
piercing, squeezing, dreadful and torturous,’
and I couldn’t offer relief,” Conti says. “It was
frustrating. I knew there had to be other ways I could help.”
Since there were no orofacial pain programs or experts in Brazil, and the Internet had yet to be invented, Conti read every academic journal he could get his hands on. It was in the Journal of Orofacial Pain that he learned of a year-long program in temporomandibular joint disorders (TMD) at UMDNJ-New Jersey Dental School (NJDS). He immediately contacted clinical professor Gary Heir, DMD, and applied.
After spending a year at NJDS, Conti returned to his native country with what he describes as “a new world of knowledge.” For the first time he and his colleagues took a comprehensive approach to diagnosing patients. They began assessing musculoskeletal, neurovascular and neuropathic systems, movement disorders and intra- and extra-oral systemic disorders. “Simply understanding the co-morbidity of orofacial pain and headaches made a huge difference,” he says. “We also completely shifted and enhanced our research program. NJDS opened up a whole new era in pain management for us.”
Upon his return, Conti developed and implemented an orofacial pain curriculum at Bauru for pre-graduate dental students, a master’s program and several continuing education programs. He is now a fulltime professor of neurology and biology, a prolific orofacial pain researcher, author and speaker, most of which he credits to his stint at NJDS. “Orofacial pain is an emerging specialty in Brazil, and that means we will be able to help the many people who need it most.”
He explains that poor people in the rural areas of the country sometimes have to wait up to five months to see a neurologist. “When you have a severe headache, or debilitating pain, five months seems like forever,” Conti says. “Now these people have another option. They can come to us, and we can help them right away.”
The TMD program that Conti completed has evolved since its inception in the early 1980s. NJDS now offers a one-year Fellowship and a four-to-five year PhD program in orofacial pain; and the school’s two-year Master of Dental Science requires the completion of a research project in orofacial pain. These programs have attracted students from every continent except Antarctica, and approximately 300 people have completed the Fellowship and PhD programs. The ADA has recognized orofacial pain as an advanced area of dental education and is now requiring accreditation. NJDS is in the process of becoming accredited.
Dentists like Heir and Conti find the field challenging and rewarding. There are untold causes for orofacial pain; some fairly simple to diagnose, others not. And, incorrectly diagnosing a patient who has, say, an aneurism or brain tumor, could be deadly. “This region of the body is comprised of a vast, complex network of nerves and blood vessels that are intertwined among muscles, bones and joints in the head, face and jaws,” explains Heir. “Malfunctions can occur in any combination of these systems, so pinpointing the source of pain can be quite difficult.” In fact, often these patients spend years going from physician to physician and dentist to dentist looking for relief. Many endure misdiagnoses, which can result in unnecessary procedures, such as root canals and extractions. Some patients even become so frustrated, they have all of their teeth removed or agree to complex, painful surgeries.
Conti recalls such a patient. “A young woman with excruciating temporomandibular joint pain tried a number of treatments that failed,” he says. “Finally one dentist recommended a highly radical surgical procedure. Out of desperation, she agreed to the procedure, which resulted in a severe jaw deformity and even greater pain. By the time she came to us, she could barely open her mouth. She had absolutely no life.” With a combination of therapy and medication, Conti’s team slowly began to reverse the situation. The woman can once again eat and speak clearly. “We gave her her life back,” says Conti. “And that’s what makes this profession so rewarding.”