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Pain Management
Pain Management
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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.
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Product not yet rated 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.
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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.
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Product not yet rated 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
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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
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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
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Product not yet rated Includes Credits
CE Hours: 1.0
Description: This study assessed the accuracy of a TMD Pain Screener questionnaire in identifying patients with temporomandibular disorder (TMD) pain among those seeking endodontic treatment for tooth pain. It also investigated whether the screener accuracy could be improved by adding questions regarding putative predictors of TMD status.
At the conclusion of this article, the reader will be able to:
- Utilize the brief temporomandibular disorder (TMD) pain screening tool in endodontic patients with history of tooth pain to identify those who may need a more thorough TMD examination.
- List the components of the TMD pain screening questionnaire and describe scoring and interpretation of the screening results using a proposed interpretation grid.
- Discuss the diagnostic accuracy of the TMD Pain Screener alone and in combination with the endodontic patient’s rating of the current pain intensity of the chief complaint.
Iryna H. Daline, D.M.D., M.S.
Dr. Iryna Daline is a board-certified Orofacial Pain specialist and a board-eligible Endodontist. She completed her orofacial pain residency at the University of Minnesota and endodontic residency at the University of North Carolina at Chapel Hill. Her clinical and research interests include differential diagnosis, comorbidity, and treatment of endodontic pain and other orofacial pain conditions. She has received grants from the American Association of Endodontists, American Board of Orofacial Pain, International Association for Dental Research, and Dental Foundation of North Carolina to support her research bridging endodontics and orofacial pain. She has published articles in the Journal of Endodontics, Journal of Oral Rehabilitation, and Cephalalgia. Dr. Daline is a co-author of chapters on non-odontogenic pain in the 3rd edition of Seltzer and Bender's Dental Pulp and the 7th edition of Principles and Practice of Endodontics. She has been repeatedly invited to speak and share her expertise with both dental and endodontic professionals.
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.Gary D. Slade, BDSc, DDPH, PhD
Dr. Slade undertook dental training at the University of Melbourne, Australia (BDSc, 1982) and completed the Diploma in Dental Public Health at the University of Toronto, Canada (DDPH, 1988). He obtained his PhD in dentistry at the University of Adelaide (1994). Dr. Slade is currently the John W. Stamm Distinguished Professor of Dentistry at the University of North Carolina at Chapel Hill. His principal research interests are in population assessment of oral health related quality of life, epidemiological studies of oral disease and orofacial pain, public health interventions to prevent oral disease, and clinical interventions to treat orofacial pain. Dr. Slade published over 288 articles and 8 book chapters. In 2004, he was awarded the distinguished scientist award for Geriatric Oral Research from the International Association for Dental Research (IADR), and in 2008 he was awarded the IADR’s H. Trendley Dean Award for research in epidemiology and public health.
Ashraf F. Fouad, D.D.S., M.S.
Dr. Fouad obtained his DDS, Certificate of Endodontics and MS at the University of Iowa.
He served on the faculty and in various administrative roles at University of Connecticut Health Center, the University of Maryland, and the University of North Carolina at Chapel Hill. He is currently Professor and Chair, Department of Endodontics, and Director, Advanced Endodontics Program, at the University of Alabama at Birmingham.
Dr. Fouad has published over 100 peer-reviewed manuscripts, 24 textbook chapters, and 140 abstracts. He edited and co-authored the textbooks: Endodontic Microbiology, as well as the fifth and sixth editions of Endodontics: Principles and Practice. He is a Diplomate and Past President of the American Board of Endodontics, and an Associate Editor of the Journal of Endodontics and Dental Traumatology. He received the Distinguished Scientist Award from the Pulp Biology and Regeneration Group of the International Association of Dental Research.
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
Donald R. Nixdorf, DDS, MS
After graduating from the University of Alberta Faculty of Dentistry, Dr. Nixdorf completed hospital dentistry residency at The Ohio State University, Anesthesia fellowship at Johns Hopkins University, Orofacial Pain fellowship at the University of Alberta, and a Master of Science in Clinical Research at the University of Minnesota. As a Diplomate of the National Dental Board of Anesthesiology (NDBA) and the American Board of Orofacial Pain (ABOP), he maintains a specialty Orofacial Pain practice on the diagnoses and management of chronic TMD pain, headaches, and neuropathic pain within multi-disciplinary settings. Dr. Nixdorf’s research has focused on the topics of non-odontogenic “tooth” pain from a classification, diagnosis, epidemiology, and treatment perspectives, as well as TMD and, most recently, dental MRI, with over 85 published articles. Dr. Nixdorf is Professor, Division Director, and past Graduate Program Director at the University of Minnesota in the Division of TMD & Orofacial Pain.
Inna E. Tchivileva, MD, MS
Dr. Tchivileva is Assistant Professor in the Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill. She obtained her MD and MS in Biochemistry from the Russian State Medical University, Moscow, Russia. She then 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. Dr. Tchivileva’s research interests comprise such topics as association between TMD and headache, molecular biomarkers for TMD and migraine, the role of genetic variations in nociception, and personalized pain management. She has been a recipient of several NIH awards including the K12 award for the Biomedical Researcher Development in TMD and Orofacial Pain and served as a co-Principal Investigator for a large multisite clinical trial in TMD. Dr. Tchivileva has published 21 peer-reviewed manuscripts, 2 textbook chapters, and 22 refereed abstracts.
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Includes Credits
CE Hours: 1.75
Description: When a patient has persistent pain after root canal treatment it can be disruptive to a practitioner’s schedule and psyche. The first part of this two-part session will give practitioners a review of practice-based research outcomes on persistent pain, differential diagnosis for persistent pain following root canal treatment, pharmacologic management of persistent pain on the neurobiology of pain. The second part of the session will present cases of patients with persistent post-treatment pain, diagnostic and treatment considerations, and pharmacologic management, with opportunities for audience questions.
Learning Objectives:
- Discuss treatment options for managing persistent pain following endodontic treatment.
- Discuss pharmacologic management of persistent pain.
- Discuss how endodontists can work with facial pain practitioners to manage patients with persistent pain.
Alan S. Law, DDS, PhD
Dr. Alan Law received his Doctor of Dental Surgery and Certificate in Endodontics from the University of Iowa College of Dentistry, Iowa City, Iowa. He also completed his PhD, “Mechanisms and Modulation of Orofacial Pain”, with the Department of Pharmacology at the University of Iowa. Dr. Law has published over 40 articles in scientific and clinical journals, and has co-authored chapters on The Non-Odontogenic Toothache and Regenerative Endodontics in Pathways of the Pulp, and has lectured at over 300 local, national and international meetings. Dr. Law is a member the American Dental Association, American Association of Endodontics, and Omicron Kappa Upsilon Dental Honor Society, and a Fellow of the American College of Dentists and the International College of Dentists. He is a Past President of the American Association of Endodontists, Past President of the Minnesota Association of Endodontists, and Past President of the American Board of Endodontics. He is in full –time practice in the Twin Cities, and President of The Dental Specialists, a multi-specialty dental practice with over 35 specialists. He is also a Research Professor in the Division of Endodontics at the University of Minnesota.
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: National Dental Practice-Based Research Network and the American Dental Association.
Karen Baker, BSRPh, MS
Professor Karen Baker has been on the Dental College faculty at the University of Iowa for over 40 years and occupies a unique role in dental practice and education. She is a clinical pharmacist with a Master’s degree in clinical pharmacology and therapeutics and is focused on patient-specific dental drug therapy. She has given well over 1000 invited programs nationally and internationally and holds memberships in many dental and clinical pharmacology and therapeutics organizations. Her dental education-based pharmacy and drug therapy consultation center is the only one in the United States. She has authored many articles and abstracts and lectures extensively in pre-doctoral and graduate courses at the University of Iowa.
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.
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Includes Credits
CE Hours: 1.25
Description: When a patient has persistent pain after root canal treatment it can be disruptive to a practitioner’s schedule and psyche. The first part of this two-part session will give practitioners a review of practice-based research outcomes on persistent pain, differential diagnosis for persistent pain following root canal treatment, pharmacologic management of persistent pain on the neurobiology of pain. The second part of the session will present cases of patients with persistent post-treatment pain, diagnostic and treatment considerations, and pharmacologic management, with opportunities for audience questions.
Learning Objectives:
- Discuss the frequency of persistent pain following root canal treatment based upon results of recent practice-based research.
- Discuss potential predictors of persistent pain following root canal treatment based upon results of recent practice-based research.
- Discuss a differential diagnosis for persistent pain following root canal treatment
Alan S. Law, DDS, PhD
Dr. Alan Law received his Doctor of Dental Surgery and Certificate in Endodontics from the University of Iowa College of Dentistry, Iowa City, Iowa. He also completed his PhD, “Mechanisms and Modulation of Orofacial Pain”, with the Department of Pharmacology at the University of Iowa. Dr. Law has published over 40 articles in scientific and clinical journals, and has co-authored chapters on The Non-Odontogenic Toothache and Regenerative Endodontics in Pathways of the Pulp, and has lectured at over 300 local, national and international meetings. Dr. Law is a member the American Dental Association, American Association of Endodontics, and Omicron Kappa Upsilon Dental Honor Society, and a Fellow of the American College of Dentists and the International College of Dentists. He is a Past President of the American Association of Endodontists, Past President of the Minnesota Association of Endodontists, and Past President of the American Board of Endodontics. He is in full –time practice in the Twin Cities, and President of The Dental Specialists, a multi-specialty dental practice with over 35 specialists. He is also a Research Professor in the Division of Endodontics at the University of Minnesota.
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: National Dental Practice-Based Research Network and the American Dental Association.
Karen Baker, BSRPh, MS
Professor Karen Baker has been on the Dental College faculty at the University of Iowa for over 40 years and occupies a unique role in dental practice and education. She is a clinical pharmacist with a Master’s degree in clinical pharmacology and therapeutics and is focused on patient-specific dental drug therapy. She has given well over 1000 invited programs nationally and internationally and holds memberships in many dental and clinical pharmacology and therapeutics organizations. Her dental education-based pharmacy and drug therapy consultation center is the only one in the United States. She has authored many articles and abstracts and lectures extensively in pre-doctoral and graduate courses at the University of Iowa.
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.
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Includes Credits
CE Hours: 0.75
Description: This session will provide participants with an understanding of how chair yoga can benefit dental health care providers physically and mentally, and how it can ultimately affect the quality of care they deliver to their patients. Participants will experience yoga in their chairs and learn how the health benefits of yoga can be accessed simply in any chair, anywhere.
Learning Objectives:
- Explore chair yoga as an accessible and beneficial self-care tool
- Interpret ways to incorporate chair yoga into your day
- Utilize simple practices to relieve stress and restore the mind and body
Christina Pastan, D.M.D.
Dr. Christina Pastan is an Assistant Processor of Clinical Endodontics and the Director of Mind-Body Wellness at Tufts University School of Dental Medicine. A 300-hour certified Kripalu yoga and meditation instructor as well as a Lakshmi Volker chair yoga instructor, Dr. Pastan teaches self-regulation skills through mind-body practices in a mandatory curriculum she developed for dental students that is threaded through the four years of their training. Her work also involves lecturing and guiding experiences in the mind-body practices of yoga and meditation, and how they assist in the development of the dental professional as well as support individual personal growth and stress relief. Dr. Pastan also maintains a private practiced limited to endodontics in Boston, MA.
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.
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