Forty years ago, after witnessing how some patients’ pain conditions did not improve after treatment, Dr. Jeffrey Okeson at the University of Kentucky College of Dentistry abandoned the idea that adjusting a patient’s occlusion, the relationship between upper and lower teeth, should be the go-to method to resolve a patient’s facial pain. That decision, which led to the creation of the UK Orofacial Pain Clinic, will be celebrated at the annual UK Orofacial Pain Symposium later this week.  

In 1974, Okeson began teaching the art of occlusion at UKCD. At that time, the dental community’s predominant thought was that most facial pain comes from when a patient’s bite is misaligned or off. After finding that only some patients’ pain was relieved after bite adjustments, Okeson started the Orofacial Pain Clinic in 1977 with two other faculty to see patients whose bite did not seem to be part of their facial pain problem. 

Abandoning the belief that a patient’s bite could be the sole cause of pain was revolutionary at the time, but UKCD leadership was supportive of establishing the first university-based orofacial pain clinic in the country. Following the creation of the clinic, a graduate-level program was created—becoming one of the first orofacial pain programs in the nation to be accredited by the Commission on Dental Accreditation and the first nationally-accredited program by the Post-Graduate Education Committee of the American Academy of Orofacial Pain. 

“Pain crosses all the boundaries. Every specialty of dentistry deals with some type of pain. Every specialty in medicine deals with some type of pain,” shares Okeson. “Now, each spring, we have 15 clinicians from different medical and dental specialties come to the clinic and speak with our residents about pain, from oral surgery to neurology to interventional pain management.”

As one of 12 accredited programs in the country teaching evidenced-based information on pain, UKCD remains a driving force furthering the study and treatment of orofacial pain. “Residents aside, just what we teach our student dentists in this area is far beyond what others receive—some get no exposure to this information at all. Hopefully we’re helping to develop a culture where graduating dentists understand the importance of this type of care and know what to do when they encounter a patient in pain,” shares Okeson. 

The following UK Orofacial Pain Program graduates will address symposium attendees: Romulo Albuquerque, DDS, MD, PhD; Peter Bertrand, DDS; John F. Johnson, DDS, MS; Gary Klasser, DMD; Pei Feng Lim, BDS, MS; and Matthew E. B. Russell, MS.

After completing the program, Bertrand went on to establish an orofacial pain program at the Naval Postgraduate Dental School. When Bertrand retired, John Johnson went on to serve as program director. This program largely supports orofacial pain patients suffering from concurrent "polytrauma," pain from combined traumatic brain injury, post-traumatic stress disorder, and multiple other hard/soft tissue injuries.

“Dr. Okeson and Dr. Charley Carlson were both instrumental in providing the training and collegial support that helped us to establish the orofacial pain center at the Naval Postgraduate Dental School in 2001. The "ripple effects" of their efforts have directly contributed to our ability to care for this country's wounded warriors over the past 16 years,” said Johnson.

“The program gave me a solid foundation on evidence-based pain medicine and nurtured my passion on the subject. It gave me not just the tools, but the confidence to manage patients with complex persistent pain and mentor the next generation of pain clinicians and researchers…,” shares Lim, director of the Oral and Maxillofacial Pain Program at the University of North Carolina at Chapel Hill.

Albuquerque, assistant professor, UK Department of Ophthalmology, recounts how he feel in love with the area of orofacial pain after learning about the diagnosis and treatment of temporomandibular disorders (TMDs) from one of Okeson’s textbooks. 

“Jeff and his training program whet my appetite for pursing lots of training. After I finished my 
Orofacial Pain Master’s degree, I obtained a medical degree and a PhD. Although I am now a retina surgeon, my scientific interest still revolves in understanding the complex mechanisms of trigeminal pain…,” shares Albuquerque.

Russell, a UK clinical psychology doctoral student, believes the program offers an “incredible opportunity” for young psychologists to work as part of a multidisciplinary treatment team in a healthcare setting. 

“I feel, and research indicates, that there are a large number of advantages to including a behavioral treatment approach for pain management…A major challenge for me is to provide each patient with a convincing rational for why breathing works and how it could help them manage their pain better,” said Russell. 

After working in private practice for a number of years, Klasser completed the program in order to expand his knowledge around TMDs. He now serves as president of the American Academy of Orofacial Pain and Associate Professor in the Department of Diagnostic Sciences at Louisiana State University School of Dentistry.

“Because I provided comprehensive care to all of my patients, I began managing their TMD as best as I could...I decided that if I wanted to manage these patients somewhat competently that I needed to seek out additional education and training,” said Klasser.

When asked what lays ahead for the clinic, Okeson shares, “For some patients, we still can’t stop the pain. We don’t know why some neurons just continue to produce pain. Similar to migraine conditions, which can only sometimes be controlled, there is still a lot to learn.”