Every prospective dental student has their reasons for why they want to become a dentist. I came to the field like many others, taken by the opportunity to help patients day-to-day by relieving their dental pain and addressing their aesthetic concerns through clinical and artistic skills. Now as a dental student, approaching the halfway point of my dental education, I appreciate dentistry for these things and a considerable amount more.
Perhaps one of the most influential reasons for my widened view was working as an assistant at an oral surgery practice during my gap year prior to dental school. My applications were already submitted, my personal statement documenting “why dentistry?” was finally set in stone, and interview season had begun. And still as I went on each interview, I felt my perspective on the field and on my future profession expanding in ways I had not expected.
As an assistant in a practice taking emergencies every day, I saw more intense dental pain and fear than I ever had shadowing in general dentistry practices. In these times where patients were experiencing intense pain, I saw I had the ability to be a part of their relief.
My role as an assistant was a smaller one. After all, I was not extracting the offending tooth or directly resolving the source of pain. However, I was standing there with each patient through their often uncomfortable and painful procedure, offering support for the dentist and our patient however I could. For the patient, that support was giving encouraging words, other times a reassuring look, offering a hand or just being present, but each time I could feel its importance.
Orofacial pain (OFP) is a specialty built on being present for one’s pain. According to the American Academy of Orofacial Pain (AAOP), OFP pain is differentiated by the lack of a clear source or sign of pathology, which not only challenges our traditional perception of pain but also can lead to its misdiagnosis and unnecessary — and sometimes irreversible — procedures. I have witnessed relatives who have been searching for years for answers and hope of relief from their facial pain. Yet, after countless doctors’ visits and attempted treatments and treatment plans across specialties, their chronic pain has persisted. Unfortunately, cases like these are not unusual in the realm of orofacial pain.
In 2020, the ADA officially recognized orofacial pain as the 12th dental specialty. According to the AAOP, OFP disorders include temporomandibular muscle and joint (TMJ), jaw movement, neuropathic and neurovascular pain disorders, as well as headache and sleep disorders. Oftentimes to successfully manage these disorders, a multidisciplinary approach is required that addresses pain through a “bio psycho social model,” the AAOP says. This approach acknowledges that there are the biological, psychological and sociological effects and consequences of diseases and disorders that have a reciprocal relationship with one another. The most effective therapy must treat all three aspects of pain. It is important to use this integrated approach from the beginning of treatment because when the main focus is on biological factors until treatments fail, later attempts to bring in the psychosocial aspects could be thought of by patients as reducing their pain to something imagined or in their head. The process of pain reduction can be far from linear, but as the specialty grows and research continues, it is hoped that patient access and quality of care will improve.
In pursuing a specialty like orofacial pain, I hope to be able to offer my patients a light at the end of the tunnel, and to start, I hope to be a witness to their pain — a pain that is seldom understood.
~Colleen Proietto, Columbia ’23