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URMC / Eastman Institute for Oral Health / Word of Mouth / June 2014 / EIOH Resident Eliminates Patient's Prolonged Pain

EIOH Resident Eliminates Patient's Prolonged Pain

Some people believe in coincidence, while others believe that a certain chain of events is orchestrated by the hand of a higher being.

Whatever the source, Theresa Nelson of Elmira, NY, is incredibly happy that her particular series of events led her to Eastman Dental, where she finally received relief from pain she had been experiencing for years.

Teresa with Dr. LiuMany years ago, Nelson had a bridge placed involving the back three right upper teeth. More recently, her dentist told her she had a small cavity on the tongue side of that last tooth at the gum line. He filled it, but it fell out—twice. The third time he used a different material, and explained it was challenging because of the cavity’s location.

What followed was continuous pain in the same area, and several visits back to the dentist, to no avail. After checking the need for a possible root canal, she said her dentist fixed a couple malocclusions, but insisted nothing else was wrong.

“The pain increased in intensity,” Nelson remembered, “I would frequently have to stop eating because the pain was so severe and radiated across every tooth on the right. Also, I had been chewing mostly on my left side because the right side was so sensitive. I reached the point where I felt I just wanted the whole bridge removed.”

Then a new situation occurred. Nelson’s jaw began to go out of joint and then get stuck. Yawning, laughing or eating an ice cream cone would trigger it, but she figured out how to push it back in place when it happened. “In addition to the tooth pain, I was now having a lot of pain and headaches associated with my jaw,” she explained. “I searched online and found the TMJ Clinic at Eastman Dental.”

TMJ expert Ross Tallents, DDS, examined her and agreed that clearly something was going on with the tooth in back, and would not treat the TMJD until the tooth issue was resolved.

At that point, Nelson sought the advice of another dentist, who filed down part of the ridge, and provided minimal relief.

To add insult to injury, Nelson was diagnosed with chronic fatigue syndrome. “It seemed as though every system in my body was turned upside down…I was having multiple symptoms, on top of terrible head, jaw and neck pain,” she said.

“The pain would come out of nowhere and intensify greatly,” she explained. “I was at a dinner to celebrate my daughter’s college graduation, but the pain was so incredible I had to stop eating. It was then and there that I decided to call Eastman Dental.

“When I called for the appointment, the person I spoke with said she would do all she could to get me in quickly,” Nelson said. “She ended up getting me in that Saturday…I was thrilled!!!”

And it was that Saturday morning, whether by coincidence or fate, she met Xiuxin Liu, DDS, PhD, a resident at the time in Eastman’s Advanced Education in General Dentistry program who has a special interest in the diagnosis and management of dental orofacial pain.

He recently completed research about ATP signaling, which provides energy for living cells in dental orofacial pain, and its implication in dentin hypersensitivity. That study, which proposed to explain why different stimuli induce similar pain in the teeth, was published in the Journal of Dental Research. Because of his novel approach in this area, Liu recently landed a coveted two-year National Institutes of Health clinical translation science institute grant– the KL2 Scholar Award– to continue his work in this area of dental orofacial pain. After listening to Nelson’s story and performing a thorough exam, Liu explained that he thought the filling was jagged, irritating the gum and causing pain.

“He talked about understanding pain and that I had dealt with the pain for so long that my nerves likely became hyper-sensitized,” Nelson remembered. “Dr. Liu gently cleaned up the affected teeth, took x-rays and had me schedule another visit with him to give him time to check the x-rays and review my case with his supervisor.

“When I came back for the second visit, the pain was the same in intensity,” she said. “Based on the x-rays and my response to the tests from the first visit, Dr. Liu was certain the filling was the cause of my agonizing tooth pain.”

“Pain is not just a harmful sensation, but pain itself can induce inflammation and injury to the tissues.” Liu explained. “For Mrs. Nelson’s case, palliative care and avoidance of secondary injury are necessary for tuning down her sensitized nerves. Stress relief and nutritional instruction would also be helpful for her comprehensive rehabilitation.”

After cleaning and reshaping it, Liu removed a significant amount of filling material. At the end of the following day, Nelson noted that she had not experienced awful pain at all that day, or the next and the next. “At my third visit with Dr. Liu, I was so excited to report that the intense, incredible pain was gone!” Nelson said. “I explained to him, however, that while I could chew soft foods on my right side, I still had an issue with chewing harder foods. Dr. Liu felt it could be an occlusal issue and made an adjustment. “I am happy to report that I now can chew all foods on my right side, something I hadn’t been able to do for quite a long time.”

“I feel so grateful to Dr. Liu for diagnosing the source of my severe tooth pain,” she explained. “While it is a two hour drive for me to get to Eastman Dental, I feel it is well worth it to have Dr. Liu address the health of my teeth.

Karen Black | 6/3/2014

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