May 2022 Society Spotlight

Orofacial pain is a specialized field of dentistry that involves the diagnosis and management of pain disorders of the face, mouth, jaw, head and neck.

Imagine that you cannot enjoy a delicious meal because chewing or opening your mouth hurts you, or daily activities such as brushing your teeth, washing your face, and even laughing or smiling are causing excruciating pain. Imagine that you go to the dentist because you feel pain in your teeth, but the examination reveals that nothing is wrong with them, or dental procedures have not been able to relieve it. Unfortunately, very often people experiencing these symptoms have visited multiple care providers with the hope for answers and relief, but unsuccessfully.

These orofacial pains greatly affect the quality of life of the sufferer and require specialty training to be properly diagnosed and managed. Orofacial pain is a specialized field of dentistry that involves the diagnosis and management of pain disorders of the face, mouth, jaw, head and neck. Orofacial pain disorders include temporomandibular disorders (TMD), craniofacial neuropathies, such as trigeminal neuralgia and other trigeminal neuropathic pains, and also neurovascular disorders.

My name is Marcela Romero Reyes DDS, PhD, FAHS, FAAOP. I am a researcher and a dentist specialized and board certified in orofacial pain. I have had the honor to serve as the chair of the AHS Special Interest Section of TMD, Cervical Spine and Orofacial Pain, and I have the privilege to be the liaison between the AAOP and the AHS.

My journey into the orofacial and head pain world started at the National Autonomous University of Mexico (UNAM), School of Dentistry, studying temporomandibular reflexes under the great mentorship of Dr. Fernando Angeles Medina. This included wonderful summer visits at the UCSF Center for Orofacial Pain where I learned so much from Drs. Charles McNeill, Patricia Rudd and Robert Gear, and decided to formally pursue orofacial pain as a career path. During my PhD and Orofacial Pain residency program at UCLA School of Dentistry, I was under the clinical mentorship of Drs. Robert Merrill, Steven Graff-Radford and Alan Rapoport. Here, I developed a great interest in headache disorders because of patients with orofacial pain that resembled characteristics of primary headaches, and for the exacerbated symptoms observed with comorbidities between TMD and migraine as well as cervical myofascial pain with migraine and tension type headache. At this time, I also understood that not only knowledge and skill are necessary for the care of the orofacial pain and headache patients, but also a compassionate and listening heart to hold space for them.

My official welcome to the headache field was through the wonderful opportunity to pursue postdoctoral training under the mentorship of Dr. Andrew Charles at the UCLA Headache Research and Treatment Program, now known as the Goldberg Migraine Program, in the department of Neurology, UCLA School of Medicine. Since that moment, the AHS has been an integral part of my career and academic home. Headache research became one of my main interests.

One of the ways to give hope to our patient population is through research and the translational effort to bring exciting new and safer targets for management from the bench to the clinical setting. Together, with multi-PIs, Dr. Simon Akerman and Dr. Daniela Salvemini, we are exploring the sphingosine-1-phosphate receptor 1 (S1PR1) and adenosine A3 receptor (A3AR) in migraine management. These efforts are funded by the DoD and the NINDS. We have also explored the role of reactive nitroxidative species, particularly peroxynitrite production, along the trigeminovascular pathway and our data supports peroxynitrite as a potentially effective target for migraine.

Current work with Dr. Simon Akerman integrating the fields of headache and orofacial pain, has explored further the role of CGRP in TMD pathophysiology, as well as CGRP as a key link in the comorbidity of migraine and TMD. These data explain how the presence of TMD may exacerbate migraine and provided further evidence-based support for CGRP as a potential target for orofacial pain. These data also demonstrate the anatomical and neurophysiological relation of the disorders we diagnose and manage, emphasizing the importance of the multidisciplinary care for our patients. In addition, there is an interplay of other orofacial pain disorders with headache that is an exciting avenue to further explore together as disciplines.

During my time as the chair of the AHS Special Interest Section of TMD, Cervical Spine and Orofacial Pain, we highlighted the importance of this multidisciplinary dialogue between the fields of orofacial pain, physical therapy, and neurology, to assist in the diagnosis and management of headache, orofacial and cervical pains, to improve patient outcomes as well as to propose together new research questions and to provide answers validating evidence-based management approaches. The significance of working together as fields was represented in the great series of pre-courses developed with a dynamic duo partnership with Dr. Paul Mathew, chair of the AHS Procedural Headache Special Interest Section.

The AHS is very committed to headache education and to support the new generations of clinicians and scientists to become headache leaders, as well as through wonderful outreach programs, to ignite curiosity to learn more about the headache field. As a member of the Resident Education for Assessment and Care for Headache (REACH) Program Committee and Orofacial Pain task force, this wonderful AHS initiative is now being offered to all the academic orofacial pain residency programs in the nation. In addition, together with Drs. Antonia Teruel Castellon, Maria F. Hernandez Nuno de la Rosa and Ali Ladak we have developed orofacial pain modules to be integrated into the REACH program curriculum.

I am very thankful to the AHS for their continuous support since the beginning of my academic and professional career as a scientist and as a clinician. I am committed to contributing in moving forward the AHS mission and to building its legacy for the care of our patients and as a mentor for the clinicians and researchers of the future.

If you or your patient have orofacial pain, look for us, we are here to help you! Please join the AHS Special Interest Section of TMD, Cervical Spine and Orofacial Pain for more information and I hope to see you in Colorado at the upcoming 64th Annual Scientific Meeting!

Warm regards,
Marcela

Marcela Romero Reyes, D.D.S., Ph.D., FAHS.,FAAOP
Clinical Associate Professor, Director, Brotman Facial Pain Clinic
Department of Neural and Pain Sciences
University of Maryland, Baltimore
School of Dentistry
Diplomate, American Board of Orofacial Pain