Fall 2006 - College of Dental Medicine - Columbia University

More documents

Recommendations

Info

“I don’t want you to have pain...”Lori Kraus is a kindergarten teacher. Ms. Kraus had never suffered from headaches or jaw pain until the dayin March, 2004, when she woke up with a terrible toothache. She went to her family dentist and then to aperiodontist, but neither found anything wrong and could suggest nothing to help, except for the usualpainkillers.A few days later, in spite of being “miserable,” she and her husband left on a Caribbean vacation. Ms. Kraus,however, was unable to bear the pain and “couldn’t get home fast enough!” By that time, she had a burningsensation in her lips and her teeth felt “swollen.”After seeing an eye, ear, nose, and throat doctor, who diagnosed sinus trouble and gave her a CAT scan thatrevealed nothing wrong, Ms. Kraus could find relief only when she slept. Next, she made an appointment witha neurologist who ordered an MRI of her head; he was looking for lupus, Lyme disease, or a possible tumor –none of which showed up. She was then started on an antiseizure medicine, which didn’t help until the dosewas raised to a very high level. By the time an antidepressant was added,“to get her mind off the pain,” Ms.Kraus’s nose, eyebrows, and scalp all hurt. Still, she went on teaching everyday, finding it was the only way shecould function.When a neurologist suggested she could have surgery, she was so upset she says,“I yelled at my husband thathe had to find me help!” And he did, calling hospitals all over New York, without really knowing what to askfor, until someone told him about Columbia’s Oral, Facial, and Head Pain Center at the College of DentalMedicine.Lori Kraus answers questionsfrom students in a class onorofacial pain at CDM, led byJames Uyanik, DDS.Lori Kraus was treated by Dr. James Uyanik, “a wonderful man [who told me] I don’t want you to have pain.”Best of all, he really listened to her – very carefully. Concluding that, in spite of her atypical symptoms, Ms.Kraus’s trigeminal nerve was involved, Dr. Uyanik prescribed medication that began to reduce her pain. Shewas soon reporting a 90% improvement, was able to stop taking one medication, and will shortly give up theother. But her doctor’s “gentle, wonderful manner” may have been the most important part of Lori Kraus’streatment at CDM.12primus2006
Many CDM Experts Share Careat Oral, Facial, and Head Pain Center“THE WORD ‘PAIN’ COMES FROM THELATIN POENA, MEANING PUNISHMENT, AFINE, A PENALTY” MERRIAM-WEBSTERFor the 10 to 15 percent of adults in the UnitedStates afflicted, chronic orofacial pain must certainlyfeel like a punishment. Their unremitting, sometimesincurable, misery is responsible for many thousandsof visits to both dentists and physicians, and its costto the nation can run into billions of dollars annually.In response to a growing awareness of this widespreadproblem, the College of Dental Medicine atColumbia University established its Center for Oral,Facial, and Head Pain. Because orofacial pain can betraced to a number of clinical problems, CDM initiateda multidisciplinary team approach, drawing painmanagement and other specialists from acrossColumbia University Medical Center’s dental andmedical spectrum to the new Center’s faculty. Inaddition to the dental subspecialties of endodontics,adult dentistry, and oral and maxillofacial surgery,the faculty includes specialists in acupuncture, anesthesiology,behavioral psychology, complementaryand alternative medicine, endocrinology, headache(neurology), integrative medicine, medical psychology,neurology, neurological surgery, neuroradiology,and ophthalmology.The craniofacial region is filled with a multitude ofnerve endings sensitive to numerous triggers.Considering this complexity of anatomical densityand mechanisms of referred pain, it is not surprisingthat the causes of orofacial pain, especially thoseinvolved in chronic suffering, have been considereddifficult to differentiate and diagnose. At ColumbiaUniversity’s Center for Oral, Facial, and Head Pain,patients are evaluated for a range of conditions,including: musculoskeletal disorders of the head,face, and neck, temporomandibular disorders(TMD), trigeminal neuralgia, cranial neuralgia,headache, and burning mouth and tongue syndromes,among others. Following the evaluation ofindividual patients, staff members meet to discuss adiagnosis and set up a treatment plan. Rather thanapplying piecemeal treatment to one facet of theproblem at a time, the Center designs care toencompass the entire scope of probable causes forthe individual patient’s pain, including the possibilityof comorbid influences and psychological pathology.For ease and convenience, Center patients haveaccess to all specialists and technology necessary formanaging their comprehensive course of therapy atthe single location provided by the Center.Ninety percent of Center patients are dentist- orphysician-referred. The complaint, such as earache,dizziness, accompanying muscle pain, sinus pain, andheadache, would naturally prompt the patient tomake a medical appointment initially. Conversely,apparent dental problems – pain in and around theteeth, jaw, and mouth – may actually arise from acondition which originates outside the maxillofacialarea. Cardiac ischemia, for instance, can refer pain tothe oral cavity, and a diagnosis of Lyme disease maybe missed because one of its side effects,TMD, mayovershadow the underlying cause. In addition, manyorofacial pain complaints – tension headaches,trigeminal neuralgia, temporal arthritis, and dystonia,for instance – may be mistakenly called TMD – orvice versa. If any of these diagnoses are incorrect,improper treatment planning may follow.Fortunately, ongoing research in orofacial and painmanagement, has allowed clinicians at CDM’sCenter to use specific diagnostic methods and standardizedclassification systems to discover the rootcause of such symptoms, so that their patients canbe treated more accurately and with higher successrates.Although temporomandibular disorders are onlyone group of conditions in the category of chronicorofacial pain disorders and dysfunctions, it is nowonder they are often suspect. Trouble can comefrom an unstable bite, or because of missing orpoorly aligned teeth. In such cases, the muscles mustprimus2006 11
Page 6: p. 05 •Tissue Engineeringp. 10
Page 9 and 10: The method of seeding cells on reso
Page 11: whether this or some other proporti
Page 15 and 16: New Insights Into TMD’sPathology
Page 17 and 18: primus2006 13
Page 19 and 20: BP/ONJPotential risk factors for th
Page 21 and 22: Jeanette Grauer ’88Amazonian Dent
Page 23 and 24: Barnett Gillman ’24Ortho, Law, an
Page 25 and 26: VINNIE MASCIA ’80, ORTHO ’81 is
Page 27 and 28: ObituariesCHESTER KUPPERMAN ’40AL
Page 29 and 30: DEAN OF DENTAL SCHOOL 1968-1973prim
Page 31 and 32: (ASDA) chapter for its involvement
Page 33 and 34: School Eventscloser to freezing, Ka
Page 35 and 36: Faculty NewsDEAN IRA B. LAMSTER was
Page 37 and 38: CDMDevelopmentReport2005-2006p. 36
Page 39 and 40: IRA DONORS OVER 70 1 ⁄2 FIND PHIL
Page 41 and 42: Island Dental Supply Company, IncLo
Page 43 and 44: and Friends of CDMJulie A. Connolly
Page 45 and 46: Mrs. Irma K. Kronman BS’50Chester
Page 47 and 48: Dean’s Advisory CouncilLeslie Sel

Fall 2006 - College of Dental Medicine - Columbia University

Create successful ePaper yourself

Delete template?

Save as template?