Pain Management

Pain Management

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  • Includes Credits

    CE Hours: 1.0

    Description: Up until recently the only drugs available to manage acute dental l pain were acetaminophen, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids. NSAIDs cannot be taken by a variety of patients due to poor renal function, a history of GI ulcers, drug allergy or sensitivity and for the possibility of adverse drug interactions with anticoagulants and lithium. Opioids are wrought with acute side effects including dizziness, drowsiness, nausea, vomiting and constipation. Their potential to cause substance misuse, physical dependence and addiction are also well described.  On January 30, 2025 suzetrigine, a novel voltage gated sodium channel 1.8 (Nav 1.8) blocking agent was granted FDA approval for the management of moderate to severe pain.  By selectively blocking the Nav 1.8 it is hoped that side effects will be less numerous and severe compared to drugs that indiscriminately block other Nav subtypes such as anticonvulsants and local anesthetics.. Unlike opioids, suzetrigine also appears to be devoid of addiction potential. In two Phase 3 post-surgical pain trials on research patients who underwent bunionectomy or abdominoplasty, suzetrigine was significantly more effective than placebo, but its analgesic effects were only equivalent to acetaminophen 325 mg plus hydrocodone 5 mg (APAP 325 mg/HYDRO 5 mg) respectively. These results are somewhat disappointing with regards to postsurgical dental pain where 440 mg naproxen sodium or APAP 500 mg plus ibuprofen 400 mg (APAP 500 mg/IBU 400 mg) have been demonstrated to provide superior analgesic effects when compared to APAP 650 mg/HYDRO 10 mg or APAP 300 mg/HYDRO 5 mg respectively.  This presentation will discuss the genesis of dental postsurgical pain, the nomenclature and anatomical  locations  of various  Nav channel subtypes and suzetrigine's possible utility and limitations in treating orofacial pain.   Suzetrigine represents only the first step to optimize the selective blockade of Nav channels to treat various patient maladies.

    Learning Objectives:  

    • Discuss the mechanism of action of suzetrigine
    • Discuss the advantages and limitations of employing suzetrigine in the treatment of acute dental pain
    • Identify which patients should not receive analgesic regimens that contain ibuprofen or naproxen sodium
    Elliot V. Hersh, D.MD, M.S., Ph.D

    Elliot V. Hersh, D.MD, M.S., Ph.D

    Dr. Elliot V. Hersh is currently a professor of pharmacology/oral surgery at the University of Pennsylvania School of Dental Medicine. He received his D.M.D. degree from New Jersey Dental School UMDNJ in 1981 and his M.S. and Ph.D. degrees from UMDNJ Graduate School of Biomedical Sciences in 1983 and 1988 respectively. Since arriving at the University of Pennsylvania in 1988, Dr. Hersh has won the Dental School's Excellence in the Teaching of Basic Science Award 24 different times and was also presented with a University Lindback Award in 1993, the highest teaching honor in the entire university. He has published more than 200 scientific articles, abstracts and book chapters in the areas of dental pharmacology, drug interactions, analgesics and local anesthetics. His scholarly and research contributions in the areas of local anesthesia and pain control were recognized by the International Association of Dental Research in 2007 when he was presented with the Distinguished Scientist Award in Pharmacology, Therapeutics and Toxicology. He is currently collaborating with Dr Katherine Theken at PENN in trying to identify presurgical biomarkers that may predict the analgesic response to NSAIDs. "While the research accolades are nice, the most important thing I do is sharing this knowledge with my students and other dental professionals."

    Disclosure(s): NIH/NIDCR: Grant/Research Support (Ongoing)

  • Includes Credits

    CE Hours: 0.75

    Description: Endodontics has achieved significant progress in both diagnostic procedures and therapeutic approaches. However, the pharmacological management of acute endodontic pain still relies heavily on conventional strategies, predominantly based on systemic monotherapy. Although many of these approaches are clinically effective, their inappropriate or excessive use has contributed to relevant public health issues, particularly due to the misuse and overprescription of certain drugs. In this context, an important question arises: where should the future of acute endodontic pain management be directed? While the development of new analgesic drugs remains a long and expensive process, more accessible short-term alternatives may be considered. These include the combination of existing pharmacological agents to achieve synergistic effects, as well as the design of advanced drug delivery systems aimed at modulating peripheral mechanisms of pain transmission.Multimodal analgesia, through the use of synergistic combinations, allows for a shift in prescription habits-offering enhanced analgesic efficacy, reduced side effects, and shorter treatment durations. Furthermore, the incorporation of hydrogels, nanomaterials, and polymeric scaffolds as carriers for localized, controlled drug release presents a promising alternative that may significantly reduce the need for systemic drug exposure. This lecture explores currently available multimodal analgesic strategies in endodontics and discusses emerging peripheral alternatives that target pain control directly at its source. Such innovations may represent a paradigm shift in how dental professionals approach pharmacological pain management, promoting more precise, efficient, and safer therapeutic protocols.

    Learning Objectives:  

    • Recognize the peripheral and central mechanisms involved in the development of endodontic dental pain.
    • Identify the principles to propose effective pharmacological combinations by analyzing multimodal strategies based on analgesic synergism.
    • Identify emerging drug delivery systems as a strategy for the peripheral control of endodontic pain.
    Daniel Chavarria-Bolanos

    Daniel Chavarria-Bolanos

    Director

    Endodontics Master Degree Program, University of Costa Rica

    Dr. Daniel Chavarría-Bolaños, MSc, PhD, earned his Dentistry degree from the University of Costa Rica and completed his Master’s in Endodontics at San Luis Potosí University in Mexico. He later obtained a PhD in Engineering and Materials Science from San Luis Potosí University through a dual-degree program with the University of Liège in Belgium, where he also received a PhD in Biomedical and Pharmaceutical Sciences.

    He is currently a Full Professor and Researcher at the Faculty of Dentistry, University of Costa Rica, where he serves as Director of the Graduate Program in Dentistry and is the Founder and Head of the Master’s Program in Endodontics. Dr. Chavarría-Bolaños also teaches at the Orofacial Pain Clinic and is an Assistant Researcher at the National Laboratory of Nanotechnology, where he leads specific projects in biomaterials and pharmacological innovation.

    A former President of the IADR Costa Rica Division and the current Vice President of the Costa Rica Academy of Endodontics, he has been actively involved in advancing the profession nationally and internationally. His research focuses on biomaterials, drug delivery systems, dental anesthesia, and pain management, and he has published extensively in peer-reviewed journals as well as contributed to several book chapters.

    Disclosure(s): Zeyco: Speaker/Honoraria (includes speakers bureau, symposia, and expert witness) (Ongoing)

  • Includes Credits

    CE Hours: 1.5

    Description: Post-treatment pain remains one of the most significant concerns for both patients and providers following root canal treatment. This session will explore the latest evidence and clinical strategies for recognizing, preventing, and managing pain after endodontic therapy. Experts will review the differential diagnosis and management of acute posttreatment pain, highlight advances in understanding the mechanisms and risk factors for persistent pain, and discuss findings from practice-based research that reflect real-world outcomes across diverse practice settings.

    Learning Objectives:  

    • Diagnose and manage acute posttreatment pain using evidence-based strategies for pharmacologic and non-pharmacologic interventions.
    • Recognize the risk factors, mechanisms, and clinical presentation of persistent pain following root canal treatment and apply current management approaches.
    • Interpret findings from practice-based research on posttreatment pain and integrate these insights into everyday clinical practice.
    Alan S. Law, DDS, PhD

    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 orofacial pain and regenerative Endodontics in Pathways of the Pulp and The Dental Pulp, is an editor of Endodontics: Principles and Practice, and has lectured at over 300 local, national and international meetings. He 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, Chief Clinical Officer-specialrty Practices for Park Dental Partners, Inc., and President of The Dental Specialists, a multi-specialty dental practice with over 45 specialists. He is also a Research Professor in the Division of Endodontics at the University of Minnesota.

    Disclosure(s): Kenvue: I serve as a medical consultant for Kenvue, providing expert clinical guidance on analgesic treatment strategies and medical affairs programs. (Ongoing)

    Donald R. Nixdorf, DDS, MS

    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 Clinic 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 95 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.

    Disclosure(s): No financial relationships to disclose

  • Product not yet rated Includes Credits

    CE Hours: 1.25

    Description: This lecture will provide an overview of common orofacial pain  clinical presentations and diagnoses to help the endodontist differentiate between odontogenic and non-odontogenic etiology and provide a roadmap of evidence-based treatment strategies. The lecture will include relevant head and neck anatomy, neurologic pathways, treatments and a practical approach to clinical diagnosis and management of patients who present with atypical clinical symptoms.

    Learning Objectives:  

    • Describe the pathophysiology of common non-odontogenic causes of orofacial pain mimicking dental symptoms
    • Identify clinical exam and diagnostic testing strategies to identify the true source of pain
    • Describe evidence-based management of non-odontogenic symtpoms
    Sherwin Arman, DMD, MPH

    Sherwin Arman, DMD, MPH

    Dr. Sherwin Arman is the program director for the Orofacial Pain residency program and director of the continuing education department at the UCLA school of dentistry. He completed his dental education at Boston University and AEGD at University of Southern California and his specialty training in orofacial pain at UCLA. He established a practice in orofacial pain in Orange County prior to his tenure at UCLA. His research interests include advances in injectables for the management of temporomandibular joint pain, the impact of steroids on intra-articular tissues and uses of acupuncture in orofacial pain management of neuropathic pain and the management of anxiety. He has recently completed a textbook chapter for neurology board review on the topic of neuropathic pain and several articles on the management of orofacial pain and obstructive sleep apnea.

    Disclosure(s): No financial relationships to disclose

  • Product not yet rated Includes Credits

    CE Hours: 1.0

    Description: Central sensitization is a critical mechanism underlying persistent pain following root canal therapy. It occurs when the central nervous system enters a prolonged state of hyperexcitability, leading to the amplification of pain. This phenomenon contributes to the development of neuropathic pain, which may affect approximately 1-12% of patients after endodontic procedures. One proposed mechanism is deafferentation, where the removal or injury of pulp afferent neurons disrupts normal sensory input. This disruption can trigger maladaptive neuroplastic changes, including activation of glial cells, which perpetuate a hyperexcitable state and reinforce chronic pain pathways. Preventing neuropathic pain begins during endodontic therapy. Minimizing neural trauma, recognizing early signs of sensitization, and applying evidence-based pain management strategies are essential to improving patient outcomes. This lecture aims to clarify central sensitization in endodontic therapy, its relationship with neuropathic pain, and the implications of these occurrences in endodontic treatment.

    Learning Objectives:  

    • Identify signs of central sensitization in endodontic patients
    • Define the neurobiological mechanisms linking endodontic procedures to neuropathic pain
    • Implement preventive  strategies to reduce the risk of persistent post-treatment pain
    Helena F. Filippini, D.D.S., M.S, Ph.D

    Helena F. Filippini, D.D.S., M.S, Ph.D

    Dr. Filippini is an assistant professor of Endodontics at Virginia Commonwealth University. She received a D.D.S. from the Lutheran University of Brazil in 1998. In 2002, she got her Master of Science degree in Endodontics from the same university. Dr. Filippini completed her residencies in Endodontics (2001) and TMJ and orofacial pain (2010) at the Brazilian Association of Dentistry in Brazil. After that, she got a grant from the Brazilian Government that allowed her to do part of her Ph.D studies in Canada at Dr. Barry Sessle's Lab at the University of Toronto. During her Ph.D., her research was focused on the mechanisms of dental pain and central sensitization, specifically exploring the roles of glial cells and toll-like receptors. She continued to expand her expertise through postdoctoral fellowships in Neuroscience at Dr. Avivi-Arber's lab at the School of Dentistry and at Dr. Bonin's Lab at the School of Pharmacy, both at the University of Toronto. Her studies aimed to understand nociceptive behaviors in mice, particularly the neuropharmacology of hanging behavior that is decreased under inflammatory and neuropathic pain. In addition, Dr. Filippini worked as an adjunct professor at the Lutheran University of Brazil for over 16 years. Her teaching experience focused on Endodontics, Comprehensive care clinics, Physiology, and Microbiology. She also had her private practice in Brazil for over 20 years, focusing on Endodontics and Orofacial pain therapies. Her research interests are dental pain, glial cells, rodent behavior, and pain modulation.

    Disclosure(s): No financial relationships to disclose

  • Includes Credits

    CE Hours: 1.5

    Description: Orofacial pain presents a complex diagnostic landscape that often overlaps with endodontic pathology, making accurate diagnosis and effective treatment a significant clinical challenge. The collaboration between orofacial pain specialists and endodontists is emerging as a pivotal strategy in improving patient outcomes, especially in cases where conventional endodontic diagnosis fails to fully explain a patient's symptoms. This interdisciplinary approach enables a more comprehensive evaluation of pain mechanisms, distinguishing odontogenic from non-odontogenic sources, neuropathic conditions, and referred pain patterns.Recent therapeutic advances have enhanced the ability to identify and manage atypical presentations of endodontic pain, such as persistent idiopathic facial pain and neuropathic components of post-root canal treatment.   

    Learning Objectives:  

    • Differentiate among odontogenic, musculoskeletal, neuropathic, and referred pain mechanisms.
    • Use structured approaches to evaluate cases that do not follow conventional endodontic patterns.
    • Integrate recent evidence and therapeutic advances in the management of acute non-odontogenic pain in their practice.
    Mark A. Kerr, D.D.S.

    Mark A. Kerr, D.D.S.

    Dr. Mark Kerr is a board-certified endodontist, educator at the Arizona School of Dentistry and Oral Health and owner and operator of Kerr Endodontics. He earned his Doctor of Dental Surgery degree from the Virginia Commonwealth University School of Dentistry, where he also completed an Advanced Education in General Dentistry residency. After practicing general dentistry, Dr. Kerr returned to Virginia Commonwealth Univeristy to pursue advanced specialty training in endodontics. In 2010, he achieved diplomate status with the American Board of Endodontics. Dr. Kerr serves as adjunct faculty and oversees the endodontic curriculum and endodontic care for the NYU AEGD program at the Arizona School of Dentistry and Oral Health. Dedication to helping patients find relief from pain led Dr. Kerr to expand his practice by incorporating an Oral Facial Pain Specialist, ensuring comprehensive care of patients with complex dental and facial pain conditions. Dr. Kerr is active in organized dentistry as a member of the American Dental Association, Arizona Dental Association, American Association of Endodontists and Arizona Endodontic Association of which he is past president. Outside of dentistry, he enjoys time with his wife, children and grandchildren. He loves traveling and is an avid sports enthusiast, embracing nearly every sport with enthusiasm.

    Disclosure(s): No financial relationships to disclose

    Joseph R. Cohen, DDS

    Joseph R. Cohen, DDS

    Dr Cohen is Board Certified in Orofacial Pain and Past President Of the American Academy of Orofacial Pain (AAOP) and the American Board of Orofacial Pain (ABOP). He was the Orofacial Pain Commissioner for the Commission on Dental Accreditation (CODA) October 2021- October 2025 and has Over 50 Years of Dental Clinical practice with over 35 years of full time practice of Orofacial Pain. He is Part time faculty at UCLA OFP residency and is the Director of the OFP clinic at AT Still University in Mesa Az Dr Cohen was Elected as fellow in the American College of Dentists, International College of Dentists, American Headache Society, AAOP. and the Peiere Fuchard Academy He has been a Section Editor for the journal "Cranio" the official journal for the AAOP for over 15 years. Dr Cohen has given many lectures both nationally and internationally on subjects related to Temporomandibular Disorders and Orofacial Pain and recently with a special emphacis on Non Dental Tooth Pain. He has also been author or co author of many published scientific papers, He currently lives in Phoenix, Arizona with his wife Sue and has a son in the LA ares and a dughter with two grand children in Phoenix. He enjoys golf, skiing, hiking, and is active in many social and volunteer activities.

    Disclosure(s): No financial relationships to disclose

  • Product not yet rated Includes Credits

    CE Hours: 1.25

    Description: This course is an unbiased and evidence-based presentation of marijuana and its role in dentistry. I will present an introduction to the history of marijuana and trends pertaining to its use. Next, I will provide a basic science review regarding the Cannabis plant, the drug marijuana, and the Endocannabinoid System. I will review how marijuana use affects oral and general health. Finally, I will address areas of possible dental research related to cannabinoids.

    Learning Objectives:  

    • Describe the Endocannabinoid System, what cannabinoids are, and how marijuana is connected. 
    • Define how marijuana affects oral and general health - specifically detailing oral pathology, dental caries, and periodontal disease 
    • Describe how to communicate with patients regularly using marijuana 
    Barry Taylor, D.MD

    Barry Taylor, D.MD

    Dr. Barry Taylor is the Executive Director of the Oregon Dental Association and is a volunteer Clinical Assistant Professor at the Oregon Health & Science University School of Dentistry. Prior to attending the OHSU School of Dentistry, he worked as a research assistant for two year in the field of Neuropsychopharmacology at the U.S. Veteran's Hospital in Portland, Oregon. Dr. Taylor served as ODA's Editor for nine years and served as the President. He was a member of the ADA's Council on Communications. Dr. Taylor has been awarded the “Dentist of the Year” from the Oregon AGD as well as Alumni of the Year from the OHSU School of Dentistry.

    Disclosure(s): No financial relationships to disclose

  • Product not yet rated Includes Credits

    CE Hours: 1.0

    Description: Cannabidiol (CBD) is a primary cannabinoid that has shown great promise as an analgesic alternative. This talk will present the most up-to-date data on the use of cannabidiol (CBD) for managing dental pain.

    Learning Objectives:  

    • Evaluate the current preclinical and clinical evidence on CBD for dental and orofacial pain, including efficacy, dosing considerations, safety profile, and limitations of existing studies.
    • Describe biological mechanisms by which cannabidiol (CBD) modulates dental pain, with emphasis on peripheral and central nociceptive pathways.
    • Discuss the potential clinical implications of CBD as a non-opioid adjunct for dental pain management, highlighting opportunities, challenges, regulatory considerations, and future directions for endodontic and dental practice.
    Vanessa Chrepa, D.D.S., M.S.

    Vanessa Chrepa, D.D.S., M.S.

    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: 1.0

    Description: This presentation will explore current evidence-based strategies for pain management before, during, and after endodontic procedures. We will review the neurobiological mechanisms underlying acute and persistent pain, providing a foundation for understanding the core principles of effective pain control. Emphasis will be placed on integrating these principles into clinical decision-making to optimize patient outcomes. Additionally, the session will include case-based scenarios that highlight pain management challenges, such as performing endodontic treatments on patients with pre-existing chronic pain conditions. These cases will illustrate practical evidence-based strategies that tailor pain management strategies to individual patient needs. The knowledge gained will enhance attendees clinical practice by optimizing patient comfort during and after surgical and non-surgical procedures.

    Learning Objectives:  

    • Describe the neuro-biological mechanisms that drive acute and persistent pain after endodontic treatments.
    • Identify risk factors for worse or non-resolving pain after endodontic procedures in your patients.
    • Identify the current evidence for newer pharmacologic and non-pharmacologic approaches to pain control.
    Jennifer L. Gibbs, MS, DDS, PhD

    Jennifer L. Gibbs, MS, DDS, PhD

    Dr. Jennifer Gibbs is the program director for endodontics at Harvard School of Dental Medicine. Her body of research mainly comprises investigating the neurobiology of peripheral sensory afference, focusing on pain as an endpoint.

    Disclosure(s): Odne: Grant/Research Support (Terminated, July 1, 2024)

  • Product not yet rated Includes Credits

    CE Hours: 1.0

    Description: Acute apical abscesses are known for rapid-onset pain and swelling from pulp necrosis. While typically associated with polymicrobial infections, recent research suggests that active herpesvirus infections may also contribute. This randomized, doubleblind, placebo-controlled trial aimed to evaluate if valacyclovir, when combined with amoxicillin, can consistently manage pain and how individual patients respond within a larger population.

    At the conclusion of this article, the reader will be able to: 

    • Explain the proposed role of herpesviruses, particularly HCMV and EBV, in the pathogenesis and severity of acute apical abscesses. 
    • Describe the rationale for using adjunctive valacyclovir with systemic antibiotics in patients with acute apical abscesses and moderate-to-severe persistent pain. 
    • Evaluate the study design, eligibility criteria, and primary clinical outcomes used to assess whether adjunctive valacyclovir accelerates pain reduction and decreases analgesic use.
    Mike Sabeti, DDS, MA

    Mike Sabeti, DDS, MA

    Dr. Sabeti's impressive dental career began with a DDS degree from the University of Texas Dental Branch at Houston in 1993. He then pursued further specialization, completing programs in Periodontics at Tufts School of Dental Medicine and Endodontics at the Herman Ostrow School of Dentistry of USC .
    Following his postgraduate training, Dr. Sabeti served at the University of Texas Dental Branch from 1995 to 2000 in postgraduate periodontology. He has since distinguished himself through leadership roles at the University of California, San Francisco (UCSF). Currently, he directs their postgraduate endodontics program and chairs the PECC. He also holds the prestigious position of president for the Northern California Academy of Endodontics. He is also a site visitor for The Commission on Dental Accreditation and a delegate with the American Dental Education Association.
    Dr. Sabeti is a board-certified endodontist renowned for his contributions to the field. He has actively shared his expertise through numerous invited presentations, publications in textbooks and chapters, and his dedication has been recognized with several awards. These include the Certificate in Recognition of Outstanding Services at USC, a Certificate of Appreciation from the University of Texas, and the Excellence in Teaching Award from UCSF's Haile T. Debas Academy of Medical Educators.

    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.

    Kyle Kitasoe, DDS

    Kyle Kitasoe, DDS