AAOP 2020 Virtual/Subscription CE Program Outline
All Times are Eastern Daylight Time
Live Virtual Meeting Portion of Program – September 4, 2020
- 10:00-10:15 am - Welcome Remarks
- 10:15-10:30 am - AAOP Tribute to a Pillar of Orofacial Pain: Dr. Henry Gremillion : Ron Auvenshine, DDS
PLENARY SESSIONS:
- 10:30-11:15 am - Plenary 1 – The Evolving Dental Specialty – James Fricton, DDS
- 11:15 am-12:00 pm - Plenary 2 – The Evolution of a Specialty: The Facts and Fantasies from a Historic and Personal Perspective – Jeff Okeson, DMD
- 12:00 – 12:45 pm - AAOP Membership Meeting*
- 12:45-1:30 pm - Plenary 3 – Part 1: What’s New in Bruxism? – Daniele Manfredini, DDS, MSc, PhD
- 1:30-2:00 pm - Questions and Answers: Drs. Fricton, Okeson & Manfredini
- 2:00-2:45 pm - Plenary 4 :Identifying Obstructive Sleep Apnea Patients Responsive to Oral Appliances – Ali Azarbarzin, MD
- 2:45-3:30 pm - Plenary 5 – Orofacial Pain is the Newest Recognized Dental Specialty – A Roundtable Discussion About How Sleep Medicine Fits In. – Jonathan Lown, MD; Steven Bender, DDS; Ali Azarbarzin, MD; Dennis Bailey DDS
- 3:30-3:35 - Meeting ended: Presentation on 2021 meeting
Online Learning/CE Subscription Portion of the Program
Presentations Currently Posted and Available on the AAOP Online Learning Subscription
Session Synopses and Faculty Bios
These Sessions will be presented during AAOP’s Live Virtual Event on September 4, 2020
CE Hours: 0.75, Identifying Obstructive Sleep Apnea Patients Responsive to Oral Appliances - Ali Azarbarzin, PhD
Bio: Ali Azarbarzin is an Associate Scientist at Brigham and Women’s Hospital and an Instructor in Medicine at Harvard Medical School. Dr. Azarbarzin received his undergraduate and Master’s degrees from Iran and his PhD in Biomedical Engineering from the University of Manitoba in Canada. Dr. Azarbarzin pursued his postdoctoral fellowship under Dr. Magdy Younes and joined Sleep Disordered Breathing Lab at Brigham and Women’s Hospital in 2015. His research is on the pathophysiology of sleep apnea and its clinical consequences. He is particularly focused on identifying physiological and prognostic markers of OSA that more strongly link with health outcomes and provide a physiological basis for identifying those individuals most responsive to treatment.
Synopsis: Obstructive sleep apnea (OSA) is a common disorder, with roughly 1 in 5 adults estimated to have at least mild OSA and 1 in 15 estimated to have at least moderate OSA (Young 2002). OSA causes a number of adverse cardiovascular and neurocognitive consequences, including stroke, heart failure, excessive daytime sleepiness, and car accident. While it is possible to splint the airway open during sleep with positive airway pressure (PAP) therapy, only half of the patients tolerate PAP. Past research provides compelling evidence regarding efficacy of Mandibular Advancement Splints. However, routine clinical variables obtained from polysomnography (PSG), such as apnea-hypopnea index (AHI) poorly predict the success of these non-PAP therapies, mainly due to the differences in endotypic traits that cause OSA. In my lecture, “Identifying Obstructive Sleep Apnea Patients Responsive to Oral Appliances,” I will be presenting our recent work aiming to identify the physiological markers that predict responses to mandibular advancement therapies.
Employee Brigham & Womens Hospital/Consult Somnifix LLC-Apnimed Corp/Grant American Heart Assoc,. NIH, Somnifix
CE Hours: 0.75, The Evolving Dental Speciality - James Fricton, DDS
Bio: Dr. James Fricton is a Professor Emeritus in the Schools of Dentistry, Medicine, Public Health, and Health Informatics at the University of Minnesota Academic Health Center. His past research has resulted in 6 textbooks and over 150 journal and book publications and abstracts. As a principal investigator and co-investigator, he has received many grants from National Institutes of Health and industry with a principle focus on chronic pain and health informatics. His most recent NIH-sponsored research developed and testing the Personalized Activated Care and Training (www.PACTforPain.com) to help health professionals and patients prevent chronic pain, disability, and addiction. He graduated with a B.S. and D.D.S. from the University of Iowa, graduate studies in computer science, and completed postgraduate residency training in pain management in the Department of Anesthesiology at UCLA School of Medicine. He also received a M.S. in research from UCLA during the same period. 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 the International Myopain Society. 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 has several textbooks on TMJ and Craniofacial Pain; Myofascial Pain and Fibromyalgia; Orofacial Disorders: Current Therapies in Orofacial Pain and Oral Medicine; and a fiction novel entitled; The Last Scroll. He is married to Dr. Delia Dall’Arancio, an orthodontist at Minnesota Orthodontics and has 4 children and 4 grandchildren. His hobbies include spending time with his family, golf, swimming, and running as well as writing fiction and non-fiction, making stainglass windows, and traveling.
Synopsis: The National Commission for Recognition of Dental Specialties and Certifying Boards (NCRDSCB) was created by the American Dental Association for independent assessment and recognition of new dental specialties to expand the profession of Dentistry into new fields of healthcare. In response, the American Academy of Orofacial Pain (AAOP) submitted a proposal to establish Orofacial Pain as a new dental specialty. To best understand this new Orofacial Pain specialty, it is helpful to review the definition and rationale for the dental specialty and how it can both improve care for patients and expand the profession of Dentistry.
Definition of Orofacial Pain. Orofacial Pain is the specialty of Dentistry which includes the assessment, diagnosis and treatment of patients with orofacial pain disorders, including temporomandibular disorders including masticatory muscle and joint disorders, oromotor and jaw behavior disorders, neuropathic and neurovascular pain disorders, orofacial sleep disorders, and chronic orofacial, head and neck pain, as well as the pursuit of knowledge of the underlying pathophysiology and mechanisms of these disorders.
Rationales for a Specialty in Orofacial Pain. Chronic pain is the most significant problem in health care today. It is the leading reason to seek care, the dominant cause of disability and addiction, and the primary driver of healthcare utilization, resulting in greater expenditures than for cancer, heart disease, and diabetes. As a result, the nationwide chronic pain and opioid crisis is having a devastating personal effect on individuals, families, and communities, and imposing enormous financial costs on federal, state, and local governments. While, the estimated costs to our communities and governments is at least $80 billion annually, the personal toll on individuals and families is enormous and lamentable. The 3 rationales for this specialty include;
1. Improving Access to Care to Orofacial Pain Care. These issues highlight both the complexity and need for high quality evidence-based integrative care for these problems. However, the lack of practical training in the care of these disorders within both medical and dental training programs motivate most health care providers to choose to refer these patients to a specialist. Nationally, there is less than 100 full-time board-certified Orofacial Pain Specialists in private clinical practice to care for a population of 27.4 million people with orofacial conditions. Furthermore, there are virtually no specialists in many states and outreach areas.
2. Improve Standards of Care in Orofacial Pain. Support for clinical practices in the specialty of Orofacial Pain will ensure that clinicians will be properly trained, knowledgeable, experienced, and provide the highest quality standards of care in this field. In turn, successful practices will attract sufficient number of high quality candidates to apply for advanced education programs and receive training beyond that which is provided in the undergraduate dental curriculum. This in turn will improve access to quality care and provide a referral source for professional colleagues.
3. Improve Business Model of Orofacial Pain Clinics. Access to quality evidence-based care for orofacial pain disorders is often limited because of the complex business model presented to an orofacial dental specialist who bills through medical health plans. The inconsistent coverage by health plans, the lack of awareness of the specialty among both consumers and health professionals, and the lack of a defined clinical model with economic success motivate few Orofacial Pain Specialists to go into clinical practice.
As the new Specialty of Orofacial Pain evolves, these goals will be addressed by both leadership in the field and individual specialists. This presentation discusses how this can occur within evolution of the new Specialty in Orofacial Pain and how it will both improve care for patients and expand the profession of Dentistry.
Owner of Minnesota Head and Neck Pain Center/Stockholder - Seven Realms Solutions/Grant Support NIH
CE Hours: 0.75, The Evolution of A Speciality: The Facts and The Fantasies From a Historic and Personal Perspective - Jeffrey Okeson, DMD
Bio: Dr. Okeson is Professor, Division Chief and Director of the Orofacial Pain Program, which he established in 1977. Dr. Okeson has more than 240 publications in the area of occlusion, TM disorders and orofacial pain in various national and international journals. He has authored two textbooks on TM disorders and orofacial pain, which have been translated into twelve different languages. Dr. Okeson is a very sought after lecturer on the subject of TMD and orofacial pain and has presented more than 1300 invited lectures on the subject of TMD and orofacial pain in all 50 states and in 59 different countries. He has received the campus wide University of Kentucky “Great Teacher Award”, the Provost’s Distinguished Service Professorship, the American Academy of Orofacial Pain’s Service Award, the Acorn Award for the outstanding professor in the state of Kentucky and the first ever “Distinguished Alumni Award” from the College of Dentistry. Dr. Okeson has also received “The International Dentist of the Year Award” from the Academy of Dentistry International. This is the highest award recognized by this Academy and was given to him in recognition of his worldwide efforts in providing education in the area of temporomandibular disorders and orofacial pain.
Synopsis: Dental occlusion is defined by the Glossary of Prosthodontic Terms as “The static relationship between the incising or masticating surfaces of the maxillary or mandibular teeth or tooth analogues.” while gnathology is defined as “The study of the biology of the masticatory mechanism.” This evidence-based presentation will explore the relationship of dental occlusion and the stomatognathic system gnathologically. Practical multi- and interdisciplinary recommendations for TMD/orofacial pain practitioners will be offered.
Learning objectives:
1. occlusion: what it is and is not
2. gnathology as related to:
a) restorative dentistry/prosthodontics/orthodontics
b) parafunction
c) orofacial pain/TMD
d) orthotics
CE Hours: 0.75, Orofacial Pain is the Newest Recognized Dental Specialty - A Roundtable Discussion about How Dental Sleep Medicine fits in. - Ali Azarbarzin, MD; Dennis Bailey, DDS, Steve Bender, DDS, Jonathan Lown, MD ,
Bio:
Synopsis:
CE Hours: 0.75, Whats New in Bruxism? - Daniele Manfredini, DDS, MSc, Phd
Bio: Daniele Manfredini received his DDS from the University of Pisa, Italy in 1999, a MSc in Occlusion and Craniomandibular Disorders in 2001 from the same University, a PhD in Dentistry from the ACTA Amsterdam, The Netherlands, in 2011, and a Post-Graduation Specialty in Orthodontics from the University of Ferrara, Italy, in 2017. He was a clinical fellow at the Section of Prosthetic Dentistry, Department of Neuroscience, University of Pisa, Italy until 2005. Since 2006, Daniele Manfredini has been Assistant Professor and coordinator of the research projects at the TMD Clinic, Department of Maxillofacial Surgery, University of Padova, Italy, and he held teachings in Prosthodontics and TMJ Physiopathology, and in Bruxism and Parafunctions at the School of Dentistry, University of Padova until 2016.
Currently, Daniele Manfredini holds teaching in Oral Physiology and in Clinical Gnathology at the School of Dentistry, University of Siena, Italy. On January 2017, the Italian Ministry of University and Research (MIUR) appointed him as a Full Professor by scientific merit at the age of 41. Daniele Manfredini authored more than 190 papers in the field of bruxism and temporomandibular disorders in journals indexed in the Medline database (Scopus H-index=34). He also edited, among the others, the book “Current concepts on temporomandibular disorders” (Quintessence Publishing, 2010), including contributions from 45 world-renowned experts, and co-authored several textbooks on the same topics.
Synopsis: Approaches for assessing bruxism can be distinguished as non-instrumental or instrumental. Non-instrumental approaches for assessing bruxism include self-report (questionnaires, oral history) and clinical inspection, both for sleep and awake bruxism. Instrumental approaches for assessment are currently available for both forms of bruxism. Measurement of jaw muscle activity via polysomnography (PSG) or electromyography (EMG) is the standard of reference for sleep bruxism. Ecological momentary assessment (experience sampling methodology [EMA/ESM]) app-based assessments for real time subjective information about masticatory muscle activities at certain time points during the awake phase can also provide evidence of awake bruxism. For various reasons, it must be remarked that using standard cut-off points for everyone for the ‘gold-standard’ assessment of sleep bruxism or non-sleep bruxism should not be considered optimal for clinical use in otherwise healthy individuals. This issue is best exemplified by the still inconclusive literature on the polysomnographic assessment of sleep bruxism and its clinical consequences. Within these premises, this workshop will also discuss the most recent literature on management of bruxism in adults. Currently, there is not enough evidence to define a standard of reference approach for treatment, especially considering the reigning confusion about the treatments oriented to eradicate bruxism causes and those aiming to manage the consequences. Thus, future studies on the indications for bruxism treatment are recommended. Until that, a so-called “Multiple-P” approach including Pep Talk (i.e., counseling), Plates (i.e., oral appliances), Psychology, Physiotherapy, and Pharmacology, is the best available, good-sense, option to manage bruxism and its consequences in the clinical setting.
Presentations Currently Posted and Available on the AAOP Online Learning Subscription
CE Hours: 1.5, The Critical Role of Oral Health in Heart Attack and Stroke Prevention - Bradley Field Bale, MD
Bio: Bradley Bale, M.D. is a Clinical Associate Professor WSU College of Medicine, Assistant Professor University of Kentucky College of Dentistry, Adjunct Professor at Texas Tech Health Science Center, and runs a private practice in Gallatin, TN. Dr. Bradley Bale is one of the nation’s leading specialists in preventing heart attacks, stroke and diabetes. Since 2001, he’s given numerous presentations to medical and dental groups in the US and abroad.
Convinced that standard of care wasn’t doing enough to identify early stages of CVD and avert recurrences in heart attack and stroke survivors, he cofounded the BaleDoneen Method with Amy Doneen in 2001. This personalized approach of CV risk assessment and management evolved to an effectiveness level sufficient to allow them to attach a ‘guarantee’ to their clinical practices.
Their research on CVD prevention has been published in such respected medical journals as Atherosclerosis, Post Graduate Medicine, Journal of the National Medical Association, Journal of Clinical Lipidology, Frontiers in Cardiovascular Medicine, Physician’s Weekly, Alternative Therapies in Health and Medicine, International Journal of Clinical and Experimental Cardiology, Archives of Medical Science, Journal of Cardiovascular Nursing and ADVANCE for Healthy Aging. Dr. Bale is on the editorial board for the medical journal: Healthcare in Low-resource Settings. Dr. Bale has also served as a reviewer for American Journal of Cardiology and the CDC’s Preventing Chronic Disease. Co-author Bale BF, Doneen AL (2014) Beat the Heart Attack Gene. Wiley General Trade, New York, NY.
Synopsis: Evidence will be provided demonstrating the BaleDoneen Method halts, stabilizes and regresses arterial disease. This course will elucidate essential elements for establishing and maintaining cardiovascular wellness. The dental profession is positioned to play a profound role in this regard. Oral health staff and providers will learn concurrent health issues and physical traits their patients may have which heighten CV risk. Attendees will be informed about the wisdom of utilizing technology to detect asymptomatic CV disease (CVD). This course will provide education regarding inflammation as the cause of CVD. A special focus will be directed toward oral health as a cause of arterial disease and potential trigger of CV events. The Bale/Doneen Method bridges the gap between medicine and dentistry to promote arterial wellness. Students of this course will be in position to enhance their own CV health as well as their patients.
Objectives:
1.Recognize health issues identifiable in a dental practice that are associated with increased CV risk.
2.Analyze the difference in determining CV event risk based on risk factors versus presence of atherosclerosis.
3.Comprehend inflammation as causal of arterial disease.
4.Appraise oral health as a potential driver of arterial inflammation.
5.Synthesize the above components into a method focused on assessing CV risk.
co founder of the BaleDoneen Method
CE Hours: 0.5, Musculoskeletal Ultrasound in the Orofacial Pain Practice - Stan Farrell, DDS
Bio: “Dr. Stan Farrell received his training in Orofacial Pain at UCLA, in California. He graduated from the School of Dental and Oral Surgery at Columbia University in 1991, and has also received training at the University of Chicago and Albert Einstein Medical College. For years, Dr. Farrell has combined treatment of facial pain with his dental practice. For over 10 years now, he focuses on the treatment of headache, TMJ disorders, and sleep apnea treatment at the Head Pain Institute in Scottsdale, Arizona. Dr. Farrell is a Diplomate with the American Board of Orofacial Pain.”
Synopsis: My 2020 AAOP meeting breakfast lecture will present Ultrasound Imaging in the Orofacial Pain practice. The goal will be to educate the attendees on the technical aspects of how this imaging works, and how it differs from other forms of imaging. I will show how this technology is not only useful diagnostically but also with guiding injections. This will include what medical codes to use and expected reimbursement. Individuals should walk away with a new understanding of Ultrasound Imaging and have enough information upon which they can explore further interest in this area.
CE Hours: 0.75, Botulinum Toxins; What Happens to Muscles and Bones After Temporary Paralysis? - Susan Herring, PhD
Bio: Sue Herring was trained at the University of Chicago (B.S. Zoology, Ph.D. Anatomy) where she studied the comparative cranial anatomy of pigs and their close relatives. Feeling the need to work with live animals, she moved to the College of Dentistry, University of Illinois at Chicago as an NIH postdoctoral fellow, where she developed techniques to record masticatory muscle activity and jaw movement from unrestrained animals. She remained at UIC until 1990, rising to Professor of Oral Anatomy and Anatomy. In 1990 she took up her current position in Seattle as Professor of Orthodontics and Oral Biology (now Oral Health Sciences) at the University of Washington. Her work on the biology of the craniofacial musculoskeletal system has been continuously funded by NIH for over 35 years. She has served on the editorial boards of multiple journals and held office in several societies, including the Society for Integrative and Comparative Biology (chair, Vertebrate Morphology, 1983-4), International Association of Dental Research (Craniofacial Biology Group, president 1997-8), International Society of Vertebrate Morphology (president, 1994-7), and AAAS (member-at-large, Section R, 2008-12). She became a fellow of AAAS in 1992 and of AADR in 2018. She is the recipient of the Craniofacial Biology Research Award from IADR (1999) and the Rothwell Lifetime Achievement Award from UW Dentistry (2015). Her work on the effects of botulinum neurotoxin injection into the muscles of mastication received the Watson Award from the Am. J. Orthod. Dentofac. Orthop. in 2016.
Synopsis: The use of paralytic botulinum toxins in muscles of mastication has vastly expanded in recent years. In addition to cosmetic facial shaping, these toxins are intended to relieve spasm and reduce pain. However, such treatment removes the major forces applied to the jaw, which like other bones requires loading for maintenance. The functional effects on muscle are temporary, but evidence on structural changes is lacking. This presentation will center on a comprehensive series of rabbit studies which reveal severe bone loss in the TMJ and show further that return of muscle force is due to compensation rather than recovery.
Learning objectives:
1. Understand the mechanism by which botulinum toxins (Botox, Dysport, Xeomin, Myobloc etc.) affect muscle.
2. Explore the time course of functional recovery after single and multiple injections of toxin into the masseter muscle.
3. Learn how botulinum toxin changes the structure of the masseter muscle and how it affects bone in the mandible.
4. Evaluate whether the effects of botulinum toxins are truly temporary.
Off Label- Botulinum toxins are not FDA approved for masticatory muscles althouh they are widely used. My work was investigational with animals
CE Hours: 1.25, Extra Oral Injections and Prolotherapy - Larry Lockerman, DDS
Bio: Dr Larry Lockerman DDS has been treating face pain, TMJ disorders and Obstructive Sleep Apnea since the early 1980’s. He attended a 2 year program in Orofacial Pain Management in the University of New Jersey Dental School in 1985 and 1988. He has been a member of the medical staff of several hospitals and has lectured to many physicians and dentists about pain management and sleep disorders. He has published articles in peer reviewed journals and has written book chapters in neurology and physical medicine books. He has lectured to dentists and physicians about his work.
Synopsis: It is impossible to call your patient care comprehensive without diagnostic and therapeutic injections in the head and neck muscles, tendons and in the TMJ. A review of what’s old, what’s new will be discussed. How and where to do injections including dry needling, lidocaine and prolotherapy will be reviewed. Is it evidence based? When my license board demanded an explanation about my injections, I’ll tell you what my response was. P.S. I am still doing the injections.
Off Label - Location of Injections Do Not have FDA Studies but is in literature
CE Hours: 1, Cone Beam at the Edge - Dale Miles, DDS, MS, FRCDc
Bio: Dr. Miles is Adjunct Professor of Oral and Maxillofacial Radiology in the Department of Comprehensive Dentistry at the University of Texas Health Science Center at San Antonio. He was Chair of the Department of Oral Health Sciences at the University of Kentucky, the graduate program director of Diagnostic Sciences at Indiana University, and has held positions at the University of Connecticut and Dalhousie University, and the Arizona School of Dentistry & Oral Health (ASDOH). He was the first Associate Dean of Clinical Affairs at ASDOH. A diplomate of the American Board of Oral and Maxillofacial Radiology and the American Board of Oral Medicine, Dr. Miles has been selected as one of the “TOP CLINICANS IN CE” for the past 15 years by Dentistry Today. He has authored over 135 scientific articles, 6 radiology textbooks and the best-selling atlas on cone beam imaging, "Atlas of Cone Beam Imaging for Dental Applications". He has a web site for teaching the dental team about digital imaging at www.learndigital.net and cone beam imaging at www.doctorconebeam.com. Dr. Miles has a full-time practice in Fountain Hills, AZ. To date he has read close to 24,000 cone beam scans.
Synopsis: As dentistry continues to shift towards oral-systemic wellness, more dental procedures are being recognized as medically necessary and being covered under major health insurance plans and policies. Dental practices are recognizing the significant benefits to offering medical insurance reimbursement such as increased case acceptance, expanded referral networks and increased revenue. Cross-coding practices that utilize the patient's medical insurance are maximizing the patient's benefits and giving them easier access to much needed care. In this lecture, attendees will learn how to incorporate cross-coding and medical billing into their office. Discussion will include the services that can potentially be covered by medical insurance, including procedures such as frenectomies, mucositis and pain conditions. Also covered will be the requirements for receiving reimbursement and a step-by-step guide for how to get started.
CE Hours: 1.25, The Use of Arthrocentesis in the Treatment of Temporomandibular Joint Disease - Andrew Read-Fuller, DDS, MS
Bio: Dr. Andrew Read-Fuller is Clinical Assistant Professor of Oral and Maxillofacial Surgery at Texas A&M College of Dentistry. He received his certificate in oral and maxillofacial surgery from UT Southwestern Medical Center in 2017, after receiving his MD degree in 2014 from the UT Southwestern Medical School and graduating Magna Cum Laude from the UCLA School of Dentistry in the concurrent DDS/MS program. Dr. Read-Fuller is certified by the American Board of Oral and Maxillofacial Surgery, and has been awarded the Faculty Educator Development Award by AAOMS in 2018 for his dedication to postdoctoral education in OMS. He has held numerous national and international leadership positions in oral and maxillofacial surgery including serving on the OMS Foundation Board of Directors, the American Association of OMS Committee on Continuing Education and Professional Development, the Board of Directors of the Dallas County Dental Society, and the North American Representative to the NexGen Committee of the International Association of OMS. Additionally, as a resident Dr. Read-Fuller was President of the Resident Organization of the American Association of OMS (ROAAOMS). Dr. Read-Fuller is interested in the broad scope of oral and maxillofacial surgery, with particular interest in the treatment of temporomandibular joint disease, obstructive sleep apnea, pathological lesions of the face and jaws, peripheral nerve repair, and facial trauma. You can email Dr. Read-Fuller at readfuller@tamu.edu.
Synopsis: Cross-sectional studies demonstrate positive associations between occurrence of migraine and painful temporomandibular disorder (TMD). However, few prospective studies have investigated the relevance of the association for the purpose of predicting TMD risk or providing treatment for TMD. One exception was our “OPPERA” prospective cohort study of 2,410 initially TMD-free adults who were followed for 3 years, during which time 199 of them developed first-onset TMD. At baseline, presence of migraine, but not tension-type headache, predicted significantly increased risk of developing TMD. Migraine’s contribution to risk of TMD raises the possibility that facial pain in TMD patients might be mitigated using propranolol, an established preventive medication for migraine. In our “SOPPRANO” randomized controlled trial of 200 patients with chronic TMD myalgia, subjects were randomized 1:1 to either extended release propranolol hydrochloride (60 mg, b.i.d.) or placebo and treated for 10 weeks. The primary endpoint was change in a facial pain index of pain intensity (0-100 scale) multiplied by pain duration (0-100% of waking day). Nine weeks after randomization, there was a statistically non-significant greater reduction in facial pain in the propranolol group compared with placebo. However, propranolol achieved a ≥30% reduction in the greater proportion of patients than placebo (number needed to treat = 7, 95%CI = 4, 56). Furthermore, efficacy was greater in 104 (52%) TMD cases who, at baseline, had definite or probable migraine. These results give emphasis to the importance of migraine and the migraine-preventive medication, propranolol, for management of painful TMD.
At the end of the presentation, attendees will:
• Review evidence for migraine and TMD comorbidity
• Learn results from the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study for the first time demonstrating in a prospective cohort design that migraine is a risk factor for the TMD onset
• Evaluate data for efficacy and safety of propranolol treatment for TMD myalgia from the Study of Orofacial Pain and PropRANOlol (SOPPRANO) clinical trial
CE Hours: 0.75, CGRP Medications for Headache: A New Treatment Approach - Rebecca Wells, MD, MPH, FAHS
Bio: Dr. Rebecca Erwin Wells is an Associate Professor in the Department of Neurology at Wake Forest Baptist, where she founded and directs the Comprehensive Headache Program and is the Section Head of Headache. She also serves as Associate Director of Clinical Research at the Wake Forest Center for Integrative Medicine. She graduated from the University of North Carolina-Chapel Hill with highest honors, Brody School of Medicine-East Carolina University, and Harvard School of Public Health where she obtained her Master’s in Public Health. She completed Internship and Neurology residency at University of Virginia, a three-year Harvard Medical School research fellowship in Complementary and Integrative Medicine, and a second fellowship in Headache Medicine at Harvard’s Brigham & Women’s Faulkner Hospital. Dr. Wells has Headache medicine certification from the United Council for Neurological Subspecialties (UCNS), is a Fellow and actively involved in the American Headache Society, and has been a “Best Doctor of America” since 2015. She is a Board Member and Treasurer of the Southern Headache Society. Her research investigates the mechanisms and efficacy of mind/body treatments for headache and she has an NIH Career Development award to conduct her research, which receives frequent media attention, including interviews with Time magazine, NPR, BBC News, Boston Globe, and Prevention magazine. She has published many articles and presented frequently to national audiences as an expert in headache, mind/body, and integrative medicine.
Synopsis:
CE Hours: 1, Complimentary and Integrative Medicine for Headaches - Rebecca Wells, MD, MPH, FAHS
Bio: Dr. Rebecca Erwin Wells is an Associate Professor in the Department of Neurology at Wake Forest Baptist, where she founded and directs the Comprehensive Headache Program and is the Section Head of Headache. She also serves as Associate Director of Clinical Research at the Wake Forest Center for Integrative Medicine. She graduated from the University of North Carolina-Chapel Hill with highest honors, Brody School of Medicine-East Carolina University, and Harvard School of Public Health where she obtained her Master’s in Public Health. She completed Internship and Neurology residency at University of Virginia, a three-year Harvard Medical School research fellowship in Complementary and Integrative Medicine, and a second fellowship in Headache Medicine at Harvard’s Brigham & Women’s Faulkner Hospital. Dr. Wells has Headache medicine certification from the United Council for Neurological Subspecialties (UCNS), is a Fellow and actively involved in the American Headache Society, and has been a “Best Doctor of America” since 2015. She is a Board Member and Treasurer of the Southern Headache Society. Her research investigates the mechanisms and efficacy of mind/body treatments for headache and she has an NIH Career Development award to conduct her research, which receives frequent media attention, including interviews with Time magazine, NPR, BBC News, Boston Globe, and Prevention magazine. She has published many articles and presented frequently to national audiences as an expert in headache, mind/body, and integrative medicine.
Synopsis: This is an exciting time in the field of Headache Medicine, as an entirely new class of drugs has been developed that specifically targets the pathophysiology of Headache. Historically, preventive medications for headache have been borrowed from other drug classes (such as antidepressants, anti-epileptic medications, and blood pressure medications). Recent advances have demonstrated that Calcitonin Gene Related Peptide (CGRP) is released with the stimulation of trigeminal sensory nerves during migraine attacks. Inhibiting CGRP has resulted in significant migraine and cluster headache improvements. We now have three FDA approved preventive CGRP medications for migraine, one of which is also FDA approved for cluster headache. More are anticipated to receive FDA approval. This presentation will provide an overview of migraine treatment options and the significance of the new CGRP treatment options as being the first migraine preventive options developed to directly target migraine pathophysiology. Potential benefits, risks, and side effects will also be discussed, with a conversation balancing the excitement with the clinical reality of these new treatment approaches.
Learning objectives:
• Provide an overview of migraine medication treatment options
• Explain Calcitonin Gene Related Peptide (CGRP) & its role in migraine
• Understand different CGRP treatment options
• Recognize potential benefits, risks, & side effects of CGRP medications
• Discuss excitement & clinical reality of these new treatment options
CE Hours: 0.75, A Piece of Mind for Piece of Mind - Risk Management Strategies - Kevin Huff, DDS , MAGD
Bio: Dr. Kevin Huff is a practicing general dentist and an orofacial pain specialist in Dover, Ohio. He is a Diplomate of the American Board of Orofacial Pain and holds the status of Master in the Academy of General Dentistry and has earned the AGD’s Lifelong Learning and Service Recognition Award. Dr. Huff holds or has held visiting faculty positions at the Case School of Dental Medicine in Cleveland, the Mercy Hospital GPR Program in Canton, OH, and Spear Education in Scottsdale. He has presented various continuing dental education courses around the United States and in Canada on various topics about clinical practice and ethics in dentistry, risk management, digital security, and compliance issues. Among his previous speaking engagements of notoriety are the Greater New York Dental Meeting, multiple state AGD Mastership Programs, The Paragon Program Year-End Event, and the International Dental Congress. Dr. Huff has authored refereed and non-refereed articles on various topics in oral health, serves as a reviewer for General Dentistry, and is a contributing author to SpearTalk. Dr. Huff brings an interesting perspective to the topic of risk management having served as a consultant for the dental board in his state as well as having endured a lawsuit in which he also was subjected HIPAA and board investigations simultaneously.
Synopsis: Preservation of the information in a dental record and documentation of treatment and outcomes is paramount to protecting the rights of our patients, maintaining the integrity of healthcare providers, and it is required by various aspects of the law. The generalized usage of digital record keeping adds additional security challenges to protecting this information.
The use of technology should enhance adherence to standards of practice, as the public tends to expect a higher level of care from technological advances. Following a logical decision-making process with the patient provides a solid foundation for the informed consent process through discussion between the clinician and the patient. Compliance with federal and local guidelines provides further protection for the patient and creates peace of mind for the clinician as well, physically and legally.
In the litigious age in which we live, it is of tremendous value for healthcare providers to be abreast of the rules and regulations governing their activities as business people and as clinicians. Knowledge of and adherence to good compliance practices is a most effective means to securing peace of mind. This course is designed to provide an overview of compliance issues including understanding basic HIPAA best practices, data protection, and records management.
Upon the completion of this course, attendees should be able to:
• Understand the basic tenets of HIPAA and HITECH
• Understand the principles of appropriate clinical record keeping
• Describe the Informed Consent process
Dynamic Dental Safety - Consult
CE Hours: 0.75, Dental Occlusion: When Does It Matter? What does the Evidence Tell Us? - Mike Racich, DMD
Bio: Dr. Racich practices in Vancouver BC, emphasizing comprehensive restorative dentistry, prosthodontics, TMD/orofacial pain. He is a Fellow of the Academy of General Dentistry and the American College of Dentists, and a Diplomate: American Board of Orofacial Pain and the International Congress of Oral Implantologists. Dr. Racich has published in peer-reviewed scientific journals such as the Journal of Prosthetic Dentistry, has written 4 Books (The Basic Rules of … Oral Rehabilitation, Occlusion, Facially Generated Treatment Planning, Being A Dental Patient) and lectured nationally and internationally on subjects relating to patient comfort, function and appearance.
Synopsis: Arthrocentesis is an invaluable procedure in the management algorithm for temporomandibular joint disease, particularly in the early Wilkes stages. This objectives of this course are to understand the appropriate workup and indications for the procedure, review the proper technique and discuss the potential complications as well as important pearls and pitfalls to maximize clinical outcomes and improve patient satisfaction. Additionally, the relevant literature supporting the use of arthrocentesis will be used throughout the presentation to help the practitioner determine when best to recommend the procedure in the context of other non-surgical and surgical treatments for TMJ disease.
Scheduled Presentations that will be Posted Next
CE Hours: 0.75, Practical Screening for Sleep Disordered Breathing in Clinical Practice - Steve Bender, DDS
Bio: Dr. Bender is a clinical assistant professor in the department of oral and maxillofacial surgery at Tex-as A & M College of Dentistry in Dallas Texas and serves as the director of facial pain and sleep medicine. He is a Diplomate of the American Board of Orofacial Pain and has earned Fellowships in the American Academy of Orofacial Pain, the American Headache Society, the International Acade-my of Oral Oncology and the American College of Dentists. He earned his Doctor of Dental Surgery degree from Baylor College of Dentistry in Dallas, Texas in1986 and practiced general and compre-hensive restorative dentistry for 14 years. He then studied orofacial pain and temporomandibular disorders at the Parker E Mahan Facial Pain Center at the University of Florida College of Dentistry. From 2000-2015, Dr. Bender maintained a private practice limited to pain management of the head and face, as well as sleep disorders before transitioning to a full-time faculty member at the College of Dentistry. He is a past president of the American Academy of Orofacial Pain as well as the Fourth District Dental Society of Texas and the Dallas Academy of General Dentistry. In addition, he serves as a consultant for the United States Army.
Synopsis: Sleep disordered breathing, which includes obstructive sleep apnea, is one of the most under recognized and untreated group of disorders experienced in the general population. Dentist, by the nature of the well care model of practice, are in the perfect position to help identify and treat these suffering individuals. This presentation will provide valuable tools and methods to efficiently and effectively identify these patients in their practices
Learning objectives:
• Learn to use validated questionnaires as part of your routine health history.
• Learn to incorporate pulse oximetry as an additional screening tool.
• Understand the important components of the physical exam to identify at risk patients.
CE Hours: 0.75, Epigenetics & Wellness - Paul Durham, PhD
Bio: • Paul L. Durham, PhD, is Distinguished Professor of Cell Biology at Missouri State University and Director of its Center for Biomedical and Life Sciences, a multidisciplinary laboratory utilizing cellular/molecular, microbiological, biochemical, and chemical techniques. A major focus of his research has been to elucidate the cellular/molecular mechanisms by which novel drugs and nutraceuticals modulate the excitability state of neurons and glial cells under pathological conditions. More recently, his laboratory has been investigating epigenetic changes in response to changes in diet, sleep pattern, early life stress, and chronic inflammation. Another focus has been on understanding the mechanism of action by which non-invasive vagus nerve stimulation modulates the excitability state of neurons and glia in episodic and chronic models of migraine and TMD. A frequently invited guest lecturer and the author of > 80 peer-reviewed research articles and > 130 published abstracts. Dr. Durham has served on numerous NIH study sections and pharmaceutical company advisory boards and is currently a reviewer for more than 10 journals. Dr. Durham is a member of the Society for Neuroscience, American Headache Society, American Pain Society, and American Academy of Orofacial Pain.
Synopsis: We are now coming to appreciate the notion that both nature (genetics) and nurture (epigenetics) play key roles in disease progression and the development of chronic pain states. Recent advances in the fields of genomics and bioinformatics are providing strong evidence of the fact that changes in our genetic code (mutations) alone cannot explain how the genome regulates the development and function of complex multicellular organisms. Rather, epigenetic changes that involve controlling how our DNA is packaged and, thus determining which genes are turned on or off, allows for adaptive evolution and a new way to view human health and disease. Hence, while we might have a genetic predisposition towards a particular disease, our lifestyle choices involving diet, sleep, exercise, and our environment play an important role in maintaining and restoring a healthy physiology. Dr. Paul Durham will provide a comprehensive view of how lifestyle choices and environment impact disease progression and our overall well-being, and present strategies to help your patients maintain a healthy epigenome.
Objectives:
1. Know the difference between one’s genome and epigenome and the relevance to understanding human health and disease progression.
2. Appreciate the dynamic nature of our epigenome which allows for adaptive evolution and the ability to prevent expression of genes that predispose one to a particular disease.
3. Understand the importance of a patient’s environment and life style choices with regard to sleep, exercise, and diet in the development of chronic orofacial pain conditions.
4. Gain new insights into the pathology of orofacial pain conditions and new treatment strategies to help modulate sensitization of the trigeminal system and minimize risk factors.
Grant Support: Electro Core, CBD Life Science, Xoc Pharmaceuticals, Teva Pharamaceuticals, Interanation Dehydrated Food
CE Hours: 0.75, Research Update: Vagus Nerve Stimulation - Paul Durham, DDS, PhD
Bio: • Paul L. Durham, PhD, is Distinguished Professor of Cell Biology at Missouri State University and Director of its Center for Biomedical and Life Sciences, a multidisciplinary laboratory utilizing cellular/molecular, microbiological, biochemical, and chemical techniques. A major focus of his research has been to elucidate the cellular/molecular mechanisms by which novel drugs and nutraceuticals modulate the excitability state of neurons and glial cells under pathological conditions. More recently, his laboratory has been investigating epigenetic changes in response to changes in diet, sleep pattern, early life stress, and chronic inflammation. Another focus has been on understanding the mechanism of action by which non-invasive vagus nerve stimulation modulates the excitability state of neurons and glia in episodic and chronic models of migraine and TMD. A frequently invited guest lecturer and the author of > 80 peer-reviewed research articles and > 130 published abstracts. Dr. Durham has served on numerous NIH study sections and pharmaceutical company advisory boards and is currently a reviewer for more than 10 journals. Dr. Durham is a member of the Society for Neuroscience, American Headache Society, American Pain Society, and American Academy of Orofacial Pain.
Synopsis: There is a need for novel therapeutic approaches for orofacial pain conditions and reducing opioid dependency. Electrical stimulation of the vagus nerve, which modulates pain transmission, is beneficial in the treatment of neurological diseases and has FDA approval for the treatment of seizures in refractory epilepsy and depression, and most recently for chronic migraine. The pain associated with migraine and TMD pathology involves activation of trigeminal ganglion nerves, which provide sensory innervation of the head and face and relay nociceptive signals to the spinal trigeminal nucleus. Vagus nerve stimulation has been shown to inhibit nociceptive signaling within the trigeminal system in animal models of migraine pathology and orofacial pain. Results from clinical trials have provided evidence that transdermal non-invasive vagus nerve stimulation (nVNS) is a safe and well-tolerated method in the acute treatment of episodic migraine and episodic cluster headache. Importantly, the efficacy of nVNS in treating episodic migraine is reported to be similar to that of the triptans and thus is proposed as a novel non-pharmacological therapeutic alternative to the triptan class of abortive migraine drugs. Although similarly effective to triptans, nVNS functions via different physiological and cellular mechanisms to modulate pain signaling in response to trigeminal nerve activation. The inhibitory effect of nVNS is proposed to meditate multiple distinct cellular changes within the brain and spinal cord to facilitate descending pain modulation, an inhibitory pathway activated by opioids. Dr. Paul Durham will review the use of nVNS as a migraine therapy and provide recent information on the cellular activities regulated by nVNS. Furthermore, data will be presented to support the use of nVNS as a novel therapy for TMD and other orofacial pain conditions and as a novel nonaddictive alternative to opioids to manage acute and chronic pain.
Learning Objectives:
1. Know that nVNS is a safe and effective alternative or adjunctive therapy to triptans for episodic and chronic migraine.
2. Understand how nVNS functions to inhibit trigeminal pain signaling via a different mechanism than triptans in models of migraine and other trigeminally-mediated diseases.
3. Recognize that the multimodal mechanism of action of nVNS to facilitate descending pain modulation supports its use in the treatment of other orofacial pain conditions such as TMD and possibly trigeminal neuralgia.
4. Appreciate that nVNS functions via an inhibitory pain pathway activated by opioids and therefore, why this technique may offer a nonaddictive therapy for pain management.
CE Hours: 0.75, Artificial Intellegence and Augmented Reality for Orofacial Pain - A (Human) Brainstorm on How They are Revolutionizing Pain Research, Education, and Treatment - Alex DaSilva, DDS, DMedSc
Bio: Alex F. DaSilva, D.D.S., D.Med.Sc., is an Associate Professor in the Department of Biologic & Materials Sciences, University of Michigan School of Dentistry. Dr. DaSilva received his Doctorate in Medical Science degree in Oral Biology with clinical training in Orofacial Pain at Harvard University. He is the Founder and Director of H.O.P.E. (Headache & Orofacial Pain Effort) laboratory, a multidisciplinary collaborative effort to investigate the brain as a research and therapeutic target for pain. The H.O.P.E. Lab focuses on the development of clinical and neuroscience-driven tech-innovations for human neuroimaging (PET, MRI, fNIRS, EEG), neuromodulation, mobile technology, artificial intelligence, augmented/virtual reality, and their integration for pain research, education, and treatment. His multiple NIH-funded research projects focus on the evaluation and modulation of opioid mechanisms in the brains of chronic pain patients in vivo. His publications have received broad media coverage by national and international venues, for instance, Discovery Channel, San Francisco Chronicle, Scientific American Mind, and others.
Synopsis: Dr. Alex DaSilva will discuss the new frontiers in artificial intelligence (AI) and augmented/virtual reality (AR/VR) for headache and orofacial pain. During the lecture, he will exhibit novel neuroscience-based AI/AR/VR technologies for pain research, education, and treatment. The live demonstrations will include real-time brain activity navigation and decoding using neuroimaging for the clinical environment, AI-enabled mobile technologies to track pain, learning health systems for the classroom, and other advanced AI/AR/VR projects for pain.
Employee-Univ. of Michigan School of Dentistry/Consult for MoxyTech Inc/Stockholder MoxyTech Inc/Grant support NIH Prinicipal Investigator for NINDS, NIDCR and NCCIH grants/ I am a co founder/co owner of MoxyTech, a startup/spinoff that licences pain tech
CE Hours: 0.75, Placebo Effects in Medicine, Mechanisms and Acceptable Clinical Applications - Nkaku Kisaalita, PhD
Bio: Nkaku Kisaalita is a clinical health psychologist in Orlando Florida and works in chronic pain management. He is a national consultant for the Veteran Affairs’ Cognitive-Behavioral Therapy for Chronic Pain (CBT-CP) treatment protocol. Dr. Kisaalita obtained his Ph.D. in clinical psychology from the University of Florida Clinical & Health Psychological Department and obtained his Bachelors Degree from the University of North Carolina at Chapel Hill. Dr. Kisaalita’s clinical and research interests include placebo analgesia, biopsychosocial factors in pain management, pain coping skills, and pain rehabilitation/functional restoration. Dr. Kisaalita has published peer-reviewed articles in leading pain journals including The Journal of Pain© and PAIN©, and has presented his research at national and international scientific meetings.
Synopsis: The placebo effect is a term used to describe a variety of beneficial responses with different mechanisms and biological substrates dependent on the outcome and context of administration. The effectiveness of most interventions, including those in dental medicine, are derived partially from these nonspecific or contextual factors. While these effects may vary in magnitude, placebo effects for pain relief have demonstrated particular efficacy - at times comparable to established treatments. Placebo analgesia is one of the most well-understood placebo models, with clearly defined neurobiological and psychological mechanisms. While the ethics of therapeutic placebo use are debated, survey research suggests that medical providers frequently utilize placebo treatments. Moreover, recent studies suggest that patients may be open to placebo interventions in certain situations. As such, there has been a shift towards investigating ways in which placebo effects can be ethically and acceptably applied to improve patient health outcomes. This presentation aims to: (1) highlight the role of placebo effects in medicine; (2) provide dental professionals with an in-depth understanding of the neurobiological and psychological mechanisms underling placebo effects for pain; (3) provide dental professionals with empirically-informed recommendations on how to ethically and acceptability utilize placebo effects to improve patient health outcomes; and (4) highlight future direction for applied placebo research.
CE Hours: 0.75, Its All in Your Head? Or Face? Somatization Disorders in Facial Pain - Ronald Kulich, PhD
Bio: Dr. Kulich is a Full Professor and clinical psychologist at Tufts School of Dental Medicine, and holds a Lecturer appointment at Harvard-MGH, Department of Anesthesia, Critical Care and Pain Medicine. He has published multiple peer reviewed papers on pain assessment and management. His responsibilities include development and management of opioid risk assessment protocols for the Massachusetts General Hospital Pain Center and Facial Pain/Headache Center at Tufts School of Dental Medicine. Other academic responsibilities include treatment guideline development for work injury with Massachusetts Department of Industrial Accidents, training committee for the MA Prescription Monitoring Program, multiple opioid risk guideline committees, and he has been co-chair of the Massachusetts Governor’s Committee for the Curriculum on Substance Abuse assessment for dentistry. Fellowship training responsibilities include supervision of Anesthesia/Pain Medicine and Orofacial Pain Medicine Fellows (Mass General Hospital), as well as contributing to the behavioral sciences curriculum for Tufts School of Dental Medicine and supervision of psychology graduate interns.
Synopsis: Dr. Kulich will review assessment and management strategies for the complex patient who presents marked somatic overconcern, often sees multiple healthcare providers, and commonly experiences only transient improvement with treatment. Recent research on assessment and management is reviewed, including data to suggest that clinicians may unwittingly contribute to the worsening of the patient’s distress and disability. Several cases are discussed in historical context, with patient examples extracted from the archives of early 19th Century reports presented to the Harvard Medical School.
CE Hours: 0.75, Excessive Daytime Sleepiness: Considerations In Pain and Sleep Disordered Breathing - Jonathan Lown, MD
Bio: § Clinical Director – Delta Sleep Center of Long Island § Certified in the areas of Sleep, Internal Medicine and Lipidology § Assistant Professor of Medicine, Stony Brook University
Medical School 1995-present
§ Diplomate:
§ Sleep Medicine, American Board of Internal Medicine 2009-present
§ Internal Medicine, American Board of Internal Medicine 1998-present
§ Diagnosed with OSA in 2000; Compliant CPAP user for 20 years
Synopsis:
CE Hours: 1.25, Bruxism Workshop: Assessment and Management Guidelines - Daniele Manfredini, DDS, MSc, Phd
Bio: Daniele Manfredini received his DDS from the University of Pisa, Italy in 1999, a MSc in Occlusion and Craniomandibular Disorders in 2001 from the same University, a PhD in Dentistry from the ACTA Amsterdam, The Netherlands, in 2011, and a Post-Graduation Specialty in Orthodontics from the University of Ferrara, Italy, in 2017. He was a clinical fellow at the Section of Prosthetic Dentistry, Department of Neuroscience, University of Pisa, Italy until 2005. Since 2006, Daniele Manfredini has been Assistant Professor and coordinator of the research projects at the TMD Clinic, Department of Maxillofacial Surgery, University of Padova, Italy, and he held teachings in Prosthodontics and TMJ Physiopathology, and in Bruxism and Parafunctions at the School of Dentistry, University of Padova until 2016.
Currently, Daniele Manfredini holds teaching in Oral Physiology and in Clinical Gnathology at the School of Dentistry, University of Siena, Italy. On January 2017, the Italian Ministry of University and Research (MIUR) appointed him as a Full Professor by scientific merit at the age of 41. Daniele Manfredini authored more than 190 papers in the field of bruxism and temporomandibular disorders in journals indexed in the Medline database (Scopus H-index=34). He also edited, among the others, the book “Current concepts on temporomandibular disorders” (Quintessence Publishing, 2010), including contributions from 45 world-renowned experts, and co-authored several textbooks on the same topics.
Synopsis:
CE Hours: 0.75, Pragmatic Approach to Pain Pharmacology - Michelle Mathews, PharmD, BCACP, CPE, FASHP
Bio: Dr. Michele Matthews is Vice Chair and Professor in the Department of Pharmacy Practice at MCPHS University in Boston and serves as co-chair of the University’s Opioid Task Force. She is an advanced practice pharmacist specializing in pain management and addiction medicine at Brigham and Women’s Hospital. She participates in team-based care of patients with chronic non-cancer pain at Brigham and Women’s Pain Management Center and has also implemented a pharmacist-run chronic pain management clinic embedded within the hospital’s largest primary care center where she has prescriptive authority under collaborative drug therapy management. She has also developed an innovative collaborative care model for the management of opioid use disorder within the primary care setting and serves as the care manager for this program.
Dr. Matthews has published several articles and book chapters on topics related to pain management and substance use disorders. She has also been involved with numerous research projects that have focused on interprofessional education and training for pain management and the pharmacist’s role in improving medication management in patients on high-risk medications. She currently serves as a co-investigator for an NIH Center of Excellence in Pain Education grant that was awarded to improve pain management education in medical, nursing, pharmacy, and dental schools.
Dr. Matthews is actively involved with several professional organizations and is a founding member and trustee of the Society of Pain and Palliative Care Pharmacists.
Synopsis: The landscape for the management of pain has changed significantly over the past several years, resulting in challenges for patients, health care providers, and society as a whole. The U.S. Department of Health and Human Services Pain Management Best Practices Inter-Agency Task Force report emphasizes the importance of individualized, patient-centered care in the diagnosis and treatment of acute and chronic pain with integration of a multimodal and multidisciplinary approach. Medications are an important tool for acute and chronic pain management, along with restorative therapies, interventional procedures, behavioral health approaches, and complementary and intergrative therapies. This session will review the role of medications used in the management of various types of pain with emphasis on pharmacology and place in therapy. Principles of medication therapy in the setting of orofacial pain will be emphasized through discussion of a patient case.
Learning Objectives:
• Discuss the role of medications in the general landscape of pain management
• Compare and contrast medications used in the management of various types of pain based on pharmacology and place in therapy
• Given patient-specific information, develop a pain management plan for a patient with orofacial pain
In 2013, consensus was obtained on a definition of bruxism as a repetitive masticatory muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible, and specified as either sleep bruxism or awake bruxi
CE Hours: 1, Medical Billing: Pearls and Pitfalls - Rose Nierman,
Bio: Rose Nierman is a trailblazer in cross coding in dentistry and leading expert in her field. She is an entrepreneur, educator and author. Ms. Nierman created the first manual, seminar and software programs dedicated to helping dentists implement medical billing into their practice. Her life's work for 31 years has enabled dental practices to procure medical insurance reimbursement for their patients. Ms. Nierman is a frequent presenter at major dental CE conferences, teaching dentists and their teams how to get paid by medical insurance for Dental Sleep Medicine, TMD, Oral Surgeries / Implants, Laser Dentistry, and more. In addition, she is the speaker of Nierman Practice Management's renowned course - CrossCoding: Unlocking the Code to Medical Billing in Dentistry, held 15+ times a year nationwide. Rose has more experience training dental practices in cross-coding than any other person or group. Her journey began as a hygienist in a busy dental practice treating TMJ disorders. Rose recognized a way to successfully bill patients' medical insurance, allowing patients to receive treatments they otherwise would not have been able to obtain. Realizing the potential to help others, she refined and documented her protocols, and in 1988 wrote her first manual “Successful Medical Insurance in Dentistry.”
During the same year, she founded Nierman Practice Management and began teaching other dental practices how to implement medical billing in their own practice. Her secret revolves around proper communication and documentation - knowing how to communicate with insurance companies and showing medical necessity through thorough narrative reports.Rose developed the first version of DentalWriter™ and CrossCode™ Software, which has since become the leading dental software for implementing dental sleep medicine, TMD, and medical billing.
To date, she has authored 5 dental practice management manuals, over 100 articles, educated over 10,000 dental professionals, and continues to lead the cross-coding industry through her advancements in education, technology, and experience.
Synopsis: This presentation will highlight the history of events that led to the present specialty status of orofacial pain. The early concepts introduced by Costen suggested dentistry as the answer to facial pain. Dentists began to focus on occlusion, condylar position and jaw relationship. A variety of study clubs and philosophies emerged resulting in much debate, and at times, intense arguments. Many of the past facts and fantasies will be presented. In an attempt to resolve the many controversies came the enlightening time of evidence-based dentistry. Demanding scientific evidence drove the profession to look outside of traditional dentistry to neurology and neurophysiology of pain. Along with this came the need to understand the vast field of headaches. As the field expanded, TMD became only a relatively small part of all orofacial pains. It became obvious that dentists could play a significant role in the management of many non TMD pains. Today we find dentists diagnosing and managing many pain conditions not directly associated with the masticatory structures. With this came the need to recognize a greatly expanded field and a new dental specialty was created.
Objectives:
• Explain the first concepts that brought TMD to the dental profession.
• Describe the difference between antidotal statements and evidence-based science.
• Discuss the importance of establishing a specific pain diagnosis.
CE Hours: 0.75, New Insights Into Migraine and the Migraine-Preventative Medication, Propranolol, for Management of Painful TMD - Inna Tchivileva, MD, MS
Bio: Dr. Inna Tchivileva earned MD and MS in Biochemistry from the Russian State Medical University, Moscow, Russia. She completed her post-doctoral training in pain neurobiology, molecular biology, and genetics at the Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, where she is currently appointed as Assistant Professor. Her research interests comprise such topics as associations between TMD, headache and other functional pain syndromes; the role of genetic variations in nociception; and translation of laboratory findings to clinical applications for personalized pain management. She was a recipient of several NIH awards, including K12 “Biomedical Researcher Development Program in TMJD and Orofacial Pain,” R34, and U01 grants. The results of her research have been published in top scientific journals such as Science, Pain, and Human Molecular Genetics.
Synopsis: Many headache patients are interested in complementary and integrative medicine treatment options, with prevalence of use ranging from 29-74%. The evidence, potential benefits, and risks for the use of mind-body therapies, acupuncture, massage, supplements, and chiropractic manipulation will be discussed. This presentation will empower providers to feel confident asking and counseling patients about their use of these treatment options. An integrative approach may increase patient self-efficacy and overall care, as adherence to all treatments may improve when patients feel they are actively involved in determining their plan of care.
Learning objectives:
• Define Complementary and Integrative Medicine
• Examine the evidence base for complementary and integrative medicine for headache, including a discussion on mind-body therapies, acupuncture, massage, supplements, and chiropractic manipulation
• Discuss how to apply this knowledge into the clinical practice of headache medicine