Pain Management
-
Includes Credits
CE Hours: 1.0
Description: This session will focus on the key aspects of painful TMDs and other orofacial pain conditions, including neuropathic, neurovascular, and nociplastic types, which can mimic or overlap with endodontic pain. The multifactorial etiology and contributing factors—such as occlusion, trauma, and psychosocial influences—of common non-odontogenic orofacial pain conditions will be outlined. We will explore important symptoms, medical history, and personal factors that may affect the pain experience and indicate a non-endodontic origin of pain in endodontic patients. Additionally, a brief TMD pain screening questionnaire tailored for a busy endodontic practice will be reviewed. A validated TMD examination protocol, alongside internationally recognized diagnostic criteria and differential diagnostic measures for neurovascular, neuropathic, and nociplastic pain, will also be presented.
Learning Objectives:
- Identify nonodontogenic orofacial pain diagnoses with a potential to masquerade as endodontic pain. Categorize toothaches originating from nondental sources into one of four main groups of nonodontogenic pain conditions.
- Demonstrate understanding of multifactorial etiology and contributing factors to the most common nonodontogenic orofacial pain conditions.
- Reference and utilize relevant screening tools, diagnositc criteria, and differential diagnostic measures for various orofacial pain conditions mimicking endodontic pain.
-
Includes Credits
CE Hours: 0.75
Description: Endodontists necessarily focus on the procedural aspects of root canal treatment, from diagnosis to technique and recall. However, we must also understand the patient’s perspective, and we must know ourselves. Endodontic outcomes, from the presenter’s published systematic reviews, amongst other studies, will be discussed from patients’ and doctors’ points of view. This presentation will explore data on patient’s perceptions. What do patients know about root canal treatment, and why does this matter? What level of anxiety can be expected, and how can it be reduced? Pain, what should be expected, the intensity, the duration, and management? How does root canal treatment impact quality of life? How much does tooth retention and a smile matter? Differences between institutional outcome studies and real-world community endodontics will be explained. The positive economic impact of root canal treatment on the patient will be enumerated. Data on the critical impact of root canal treatment to the elderly and the vulnerable will be summarized. Ways to identify and understand vulnerable young adults will be explained. We dentists may assume that we are completely objective dispassionate scientific professionals implementing evidence-based practice, but the reality is that we also carry all the complex attributes of humanity. Just like patients, our cognitions, knowledge, attitudes, and behaviors are shaped by all of our interactions with the wider world. These will be elucidated, and key differences between endodontists and generalists will be documented. This presentation is both a looking glass, and a celebration, of the conduct and impact root canal treatment.
Learning Objectives:
- Describe endodontic outcomes as measured by data from clinical success and survival instruments, patient-centered instruments, and dentists’ perceptions.
- List the outcome metrics that have the highest impact on patients, and comprehensively evaluate a variety of outcome metrics.
- Discuss the impact of dentists’ cognitions, attitudes and behaviors on treatment outcomes.
-
Includes Credits
CE Hours: 0.75
Description: Studies have shown that neuropathic pain occurs in 1 to 12% of the patients after root canal treatment. Due to the difficulties of diagnosis, this kind of pain is undertreated, and the patients have a history of repeated unsuccessful therapies. This presentation aims to discuss the mechanisms of its occurrence, how this pain differs from odontogenic pain, the recommended management, and how to prevent this kind of pain during root canal therapy. Among the theories of neuropathic pain, deafferentation is one of the most studied. Afferent neurons from the pulp, after their excision, can lead to chronic pain due to deafferentation. This occurrence involves central sensitization, leading to hyperexcitability of nociceptor neurons in the trigeminal system and persistent pain. In addition, this phenomenon includes glial cell activation. The clinician needs to identify this pain in their practice. The treatment is multidisciplinary and focused on the neurochemistry of this addicted neural circuit. Usually, the prevention of it can be done during endodontic therapy.
Learning Objectives:
- Distinguish neuropathic pain from odontogenic pain.
- Discuss effective treatment options.
- Prevent neuropathic pain during endodontic therapy.
-
Includes Credits
CE Hours: 1.0
Description: Fear of dentistry, often due to past painful experiences, is a significant barrier preventing patients from visiting dentists. Achieving effective pain control, especially during root canal treatments, is crucial. However, inferior alveolar nerve blocks (IANBs) have a low success rate, influenced by factors such as anxiety, anatomical variations, and technique limitations, leading to anesthesia failure. Although numerous studies have examined the cold test and electric pulp test (EPT) in assessing the success of local anesthesia, no standardized method has been established. This study evaluated the effectiveness of EPT and cold tests in assessing the depth of anesthesia in patients with symptomatic irreversible pulpitis in the mandibular first molar teeth.
At the conclusion of this article, the reader will be able to:
- Describe the effectiveness of cold and electric pulp tests (EPT) in assessing the success of inferior alveolar nerve blocks (IANB) in patients with symptomatic irreversible pulpitis.
- Evaluate the sensitivity, specificity, and predictive values of the cold test and EPT in diagnosing pulpal anesthesia failure.
- Discuss the clinical implications of combining cold and electric pulp tests for improving diagnostic accuracy in determining pulpal anesthesia success.
Farzaneh Afkhami, DDS, MSc
Dr. Farzaneh Afkhami is a board-certified endodontist and an associate professor at the Department of Endodontics, Tehran University of Medical Sciences, Iran, and holds an academic affiliation with the School of Dentistry, The University of Queensland, Australia. She has authored over 50 research papers related to endodontics in prestigious peer-reviewed journals. Her work has garnered over 1.3 K citations and an h-index of 19 on Google Scholar. Dr. Afkhami has shared her findings at international scientific conferences and has supervised both
undergraduate and postgraduate students. Additionally, she holds a patent on a nanomaterial product as a root canal medicament, further advancing the field of endodontics.
Sholeh Ghabraei, DDS, MSc
Dr Sholeh Ghabraei is board-certified specialist in endodontics. She currently serves as associate professor in endodontics department, Dental school, Tehran university of medical sciences. Her research focuses on various aspects of endodontics including randomized controlled trials of anesthesia and pain control. She published 44 peer reviewed manuscripts.
Nasim Hashemi, DDS, MSc
Dr. Nasim Hashemi is a board-certified specialist in Endodontics. She achieved 2nd rank in the Iranian Endodontic Board Examination in 2025. Her research focuses on various aspects of endodontics including randomized controlled trials of anesthesia and pain control and broken instrument removal.
She has published nine peer-reviewed manuscripts, contributing to advancements in endodontic science.
Ove A. Peters, D.M.D., Ph.D., M.Sc.
Dr. Ove A. Peters joined the University of Queensland, Brisbane, Australia, in 2020 after faculty positions in Heidelberg, Germany and Zurich, Switzerland, as well as at the University of California, San Francisco. He currently serves as the Professor of Endodontics and Head of Clinical Dentistry at UQ. Before moving to Australia, Dr. Peters was the founding director of the postgraduate endodontic program at the Arthur A. Dugoni School of Dentistry in San Francisco, a professor with tenure and the Chair of the Department of Endodontics at that school.
Dr. Peters has wide-ranging clinical and research expertise and has published more than 230 manuscripts related to endodontic technology and biology. He has authored two books and contributed to several leading textbooks in dentistry; he also is an associate editor for the International Endodontic Journal as well as the Australian Endodontic Journal, an academic editor for PLOS One and serves on the review panel of multiple other journals. Among others awards, Dr Peters has received the Hans Genet Award of the European Society of Endodontology and more recently the Louis I. Grossman Award of the American Association of Endodontists. He is a Diplomate of the ABE, a member of OKU and a Fellow of the International and American Colleges of Dentistry.Disclosure(s): Dentsply Sirona: Grant/Research Support (Ongoing), Honorarium (Ongoing), Speaker/Honoraria (includes speakers bureau, symposia, and expert witness) (Ongoing)
-
Includes Credits
CE Hours: 1.25
Description: Pain is fraught in the dental world. It is often the driver of emergency dental visits, yet it also keeps many fearful patients out of the dental chair. Thankfully, we live in a world with effective pharmaceuticals to manage pain of endodontic origin pre-operatively, effective anesthesia to eliminate painful delivery of care, and strategies to minimize postoperative discomfort. In this lecture, we’ll present an organized and evidence-based algorithm for both diagnosing and managing pain of endodontic origin, including before, during and following the delivery of definitive care.
Learning Objectives:
- Explain the origins of orofacial pain
- Discuss appropriate management strategies for pain of endodontic origin
- Review management strategies for postoperative and persistent pain conditions
Brooke Blicher, DMD, Certificate in Endodontics
Dr. Brooke Blicher received her BA in Chemistry from Colgate University, where she graduated Magna Cum Laude and Phi Beta Kappa, her DMD from the Harvard School of Dental Medicine where she graduated with honors in research, and her certificate in Endodontics from Tufts University School of Dental Medicine.
Dr. Blicher is a Diplomate of the American Board of Endodontics, and a Fellow in both the American College of Dentistry and the International College of Dentistry. She continues to be involved with teaching, research and mentorship, holding faculty appointments at both Harvard and Tufts Schools of Dental Medicine. Dr. Blicher has been involved in organized dentistry as a member of several committees for the American Association of Endodontists, and her local and state dental societies.
While providing state of the art specialty care in her private practice in White River Junction, Vermont, Dr. Blicher continues to pursue her academic interests. She authored the chapter “Diagnosis and Treatment Planning” in the 6th edition of Endodontics: Principles and Practice, as well as the textbooks Endodontics: A Review, now in its second edition, and the newly published Clinical Endodontics, available in March. She has published extensively, including in the Journal of Dental Research, General Dentistry, Inside Dentistry, and Compendium. Dr. Blicher has lectured both locally and internationally on endodontic diagnosis, non-odontogenic pain, fractures, trauma, resorption, treatment of immature teeth, and CBCTs in endodontics as well as on ideal restorative care following endodontic treatment.
Speaker Disclosure
In accordance with this policy, I declare I have a past or present proprietary or relevant financial relationship or receive gifts in kind (including soft intangible remuneration), consulting position or affiliation, or other personal interest of any nature or kind in any product, service, course and/or company, or in any firm beneficially associated therewith, as indicated: Quintessence Publishing (Individual(s) Involved: Self): other financial or materials support.
-
Includes Credits
CE Hours: 1.25
Description: The diagnosis and treatment of dental pain is fundamental to the practice of Endodontics. However, recent advances in neuroscience have illuminated how complex pain actually is, and that there can often be a disconnect between the experience of dental pain in a patient, and the presence of endodontic disease. Teeth are uniquely innervated, and cause severe pain and sensitization of the nervous system, even in the absence of pathology in the pulp. Sensitization can lead to a confusing presentation of symptoms and complicate determining the diagnosis. Furthermore, persistent pain can occur even after successful endodontic treatment, due to changes in the nervous system that have been triggered by the original injury to the pulp. Endodontic materials, including sealers can also cause inflammation and injury to nervous tissues, further complicating the clinical picture. Understanding the mechanisms by which these materials interact with the nervous system is crucial for successful treatment outcomes. In this presentation, we will discuss recent the effects of different classes of Endodontic sealers on sensory neurons, diagnostic dilemmas related to pain, and bring a biologically based approach into your Endodontic practice.
Learning Objectives:
- Recognize the process of sensitization in the nervous system and its impact on diagnosis and treatment of dental pain.
- Describe how changes in the nervous system produce persistent pain and this could contribute to ongoing symptoms after endodontic treatment.
- Explain how endodontic materials can cause injury to nervous tissues.
Jennifer L. Gibbs, MS, DDS, PhD
Dr. Jennifer L. Gibbs received her dental degree (DDS) and her Ph.D. in Pharmacology from the University of Texas Health Science Center San Antonio. She completed her Endodontic training, post-doctoral research, and a Master’s degree (MAS) in Clinical Research from the University of California San Francisco.
Dr. Gibbs is currently an Assistant Professor at Harvard School of Dental Medicine, serving as the Division Head of Endodontics, and the program director of the Advanced Graduate Program in Endodontics. She is also a practicing endodontist at HSDM and a diplomate of the American Board of Endodontics.
Dr. Gibbs heads a translational research group focused on understanding the neurobiological mechanisms of orofacial pain with a focus on the nociceptors of the dental pulp. She is a past Educator Fellow of the American Association of Endodontics Foundation and her research has been funded by the NIH/NIDCR, the AAE foundation, and other foundations.
Disclosure
In accordance with this policy, I declare that I have NO past or present proprietary or relevant financial relationship or receive gifts in kind (including soft intangible remuneration), consulting position or affiliation, or other personal interest of any nature or kind in any product, service, course and/or company, or in any firm beneficially associated therewith.
-
Includes Credits
CE Hours: 0.75
Description: CBCT has superior sensitivity in detecting periapical pathosis compared with conventional periapical radiographs. However, CBCT may not always be able to discern vertical root fractures and cracks due to the overlapping structures and fracture’s variability. Nevertheless, there are some pathological CBCT manifestations as secondary changes that aid us detecting these fractures/cracks. Several factors influence the diagnosis of cracks using CBCT such as those related to the device used, patient-related -and operator-related factors. The diagnostic accuracy detecting fractures / cracked teeth can be improved using certain strategies in clinical practice.
Learning Objectives:
- Discuss different types of cracked teeth.
- Discuss the secondary pathological changes using CBCT by correlating the clinical signs and symptoms with their CBCT manifestations.
- Discuss how to improve the diagnostic accuracy of CBCT in finding fractures / cracked teeth.
Homan Zandi, D.D.S, Ph.D
Dr Zandi graduated from University of Oslo with DDS and Endo specialty certificate. He also earned a PhD on Antibacterial and clinical outcome of retreatment of teeth with infection at University of Oslo, Dental school. He is part-time assistant professor at the same faculty and maintains a referral practice in endodontics in Oslo, Norway.
Speaker Disclosure
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.
-
Includes Credits
CE Hours: 1.0
Description: Dental pain can be incapacitating, and non-opioid alternatives to current regimens are warranted. This session will discuss Cannabidiol (CBD), a primary cannabinoid, as a dental analgesic. We will present data from the first randomized clinical trial on the effectiveness and safety of CBD for patients presenting with emergency dental pain. We will further elaborate on potential mechanisms of action based on our preclinical models.
Learning Objectives:
- Recognize the opioid crisis and the need for more non-opioid analgesics for dental pain.
- Discuss the advantages of using CBD as a drug for dental pain and utilize it in a clinical setting.
- Identify possible mechanisms of action for the CBD analgesic effect.
Vanessa Chrepa, DDS, MS, PhD
Dr. Vanessa Chrepa was born and raised in Athens, Greece. She received her DDS from the University of Athens School of Dentistry. She completed her residency and Master’s in Endodontics at UT Health San Antonio with a full scholarship from the Onassis Foundation. Later, she received a PhD in Translational Science from UTSA. She is currently an Associate Professor and Director of Clinical and Translational Research in the Endodontics and Oral Biology departments at Rutgers School of Dental Medicine. Dr. Chrepa is a Diplomate of the American Board of Endodontics and a full-time educator for 10 years. In 2017, she received the AAE Educator Fellowship Award for her academic accomplishments. Her research interests include regenerative endodontics, stem cell biology, endodontic outcomes, and cannabinoids for dental pain. She is a member and past chair of the AAE Regenerative Endodontics Committee. She is an Editorial Review member for the Journal of Endodontics and International Endodontic Journal, among others. Alongside her teaching and research, Dr. Chrepa maintains a private practice limited to Endodontics.
Disclosure(s): No financial relationships to disclose
-
Includes Credits
CE Hours: 0.75
Description: Goal: provide the audience with a better understanding of what private equity is and how it works within healthcare. We will cover ways to improve equity-holder returns. We will also discuss the implications of a buyout for patient care, your staff, the probability of bankruptcy, and key considerations in deciding to sell your practice.
Learning Objectives:
- Describe how private equity buyouts work.
- Identify who is most likely to win and who is most likely to lose in a buyout.
- Value your practice and focus on a few key points when considering a buyout offer.
Kevin Kneafsey, PhD
• Joined Wells Fargo in July 2017 as a Senior Investment Strategist in the Multi-Asset Client Solutions team.
• Previously, he was a Senior Adviser with the Multi-Asset Investments team at Schroders and before that he was Head of Research for Blackrock’s Multi-Asset Client Solutions (BMACS) team.
• Kevin joined Wells Fargo Nikko (later Barclays Global Investors BGI) in 1994 and held several senior positions including Chief Strategist, Global Market Strategies Group responsible for Global Ascent, a global macro hedge fund, and active currency mandates. In 2006 Kevin formed a Client Solutions group at BGI which was responsible for liability hedging, optimal beta/risk parity (built and managed the Market Advantage funds) and optimal alpha (managed MuSt, an internal Multi-Strategy hedge fund of funds). While in this role Kevin also became the Head of Research, Client Solutions BlackRock.
• Kevin has a degree in Accounting & Finance from the University of New Mexico and holds a Doctorate in Finance from the University of Arizona. He has taught classes at the University of Arizona and at the University of California Berkeley in the Masters in Financial Engineering Program in the Haas School of Business.
Disclosure(s): No financial relationships to disclose
-
Includes Credits
CE Hours: 2.0
Description: Narcotics can provide substantial pain relief, and when used judiciously on a case-by-case basis, can be a valuable tool. You will first learn about the inflammatory, neurological and psychological processes that contribute to the great range of pain responses you encounter. This foundational knowledge will feed a discussion of preoperative, perioperative and postoperative approaches for more effective pain management, which when used together can prevent a need for narcotics in most cases. But there are times when you will use narcotics. Dr. Young will explain how narcotics work and how they compare to each other and to other forms of pain control, in addition to dosing, how dependence and addiction occur and how that differs by age and by psychological make-up. He will also cover the controlled-substances prescribing laws, and how to recognize and address addiction and drug-seeking behavior.
Learning Objectives:
- Develop practices for pain management in dentistry.
- Describe the regulatory requirements for prescribers and dispensers.
- Develop dental office procedures for managing vulnerable or substance use disorder patients.
Andrew Young, D.D.S., M.S.D.
Andrew Young earned his DDS from UCSF, his GPR certificate from the VA Northern California Healthcare System, and his MSD in Orofacial Pain from UMDNJ (now Rutgers School of Dental Medicine). He is Board-Certified with the American Board of Orofacial Pain, and a Fellow of the American Academy of Orofacial Pain.
He is an Associate Professor with Tenure in the Department of Diagnostic Sciences at the Arthur A. Dugoni School of Dentistry, University of the Pacific. There he is in charge of the teaching, research, and patient-care of patients with temporomandibular disorders, neuropathic pain, and headaches. Before joining UOP full-time, he worked part-time at a community clinic for 9 years. His other role at UOP is heading the evidence-based dentistry curriculum, which teaches students to acquire, appraise, and apply research when making clinical decisions.Disclosure(s): No financial relationships to disclose