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ESE pre-congress symposium: New Orofacial Pain Classification ICOP-1 beta – What’s in it for the endodontists?

A new international all-inclusive classification for orofacial and head pain was developed in 2017-18 by a special interest group within the International Association for the Study of Pain (IASP). The International Classification for Orofacial Pain Disorders (ICOP) is the first classification that includes both acute and chronic pain in the orofacial area. Its purpose is to provide definitions and diagnostic criteria for dental and dentoalveolar pain conditions, such as pulpal, periodontal and mucosal pain, along with regional muscle pain, TMJ pain, orofacial neuropathic and idiopathic pain conditions, and trigeminal pain associated with migraine and autonomic disorders. In orofacial pain research, the proposed new classification is important because it has the potential to improve the basis for research in diagnostics and treatment. For endodontists and general dentists, orofacial pain research is highly relevant since we frequently encounter acute as well as chronic tooth pain in our patients and are frequently required to differential diagnose between pain conditions.

This workshop aims to:

• Improve the participants’ understanding about common systems for classification and their relevance in dentistry and medicine

• Present and explain the new orofacial pain classification and its rationale

• Contribute to participants’ awareness about the present level of scientific evidence for diagnostic methods used in endodontics today, and needs for development in this field

• Invite active participation and feedback from clinicians and researchers within endodontics on this new classification towards its future development and improvement

COST: 130 + VAT Euros (ESE Registered Postgraduate students 90 + VAT Euros)

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14:00
rightWhy do we need an orofacial pain classification?
Gain understanding about common systems for classification and their relevance in dentistry and medicine

Objectives

The process of diagnosis is the determination of whether disorder is present or not, as well as separate different disorders. Given the subjective nature inherent with pain, the close proximity of a number of tissues that may produce pain, and the overlapping symptomology occurring with various pain-producing disorders, this presentation will cover the background and rationale behind pain classification, as well as outline common problems that such classification systems try to avoid to reduce communication errors.

rightDr Donald Nixdorf
Dr Donald Nixdorf

Dr. Donald Nixdorf graduated from the University of Alberta, Faculty of Dentistry in 1996. He then completed a residency in hospital dentistry with a Masters 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 part of an NIH-funded training program. He is a Diplomate of the National Dental Board of Anesthesiology (NDBA) and the American Board of Orofacial Pain (ABOP). Dr. Nixdorf is an Associate Professor, Division Director, and past Graduate Program Director at the University of Minnesota in the Division of TMD & Orofacial Pain. Dr. Nixdorf maintains a clinical practice restricted to the diagnoses and management of chronic TMD pain, headaches and neuropathic pain within a multi-disciplinary settings. Dr. Nixdorf’s research has focused on the topics of persistent non-odontogenic “tooth” pain, investigating classification, diagnosis, epidemiology, exploration of mechanisms, and treatment options. In 2018, Dr. Nixdorf was awarded AAE honorary membership for his service to the field of endodontistics.

15:00
rightWhat is the ICOP and how does it fit it in with our endodontic diagnoses?

Abstract

See overall session abstract.

Aims

Become knowledgeable about the new orofacial pain classification and its rationale

Objectives

ile not all endodontic pathosis is painful, relief of and prevention of pain are among the most important objectives of endodontics. Pain is a common symptom reported to endodontist, with many patients presenting to their endodontist because of pain. Diagnostic terminology for orofacial pain, and endodontic pain in particular, has been debated for decades. The lack of consistency in pain diagnoses terminology leads to confusion in research and clinical practice. This presentation will address how the ICOP has classified pulpal and apical pain and how this should aid in research, academics and clinical practice. Specifically, the structure of the classification will be explained, as well as the relationship between the proposed classification and the diagnostic terminology developed by the AAE in 2009. Attendees will be asked for feedback on the proposed terminology.

rightAlan Law
 Alan Law

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 several of articles in scientific and clinical journals, and has co-authored chapters on The Non-Odontogenic Toothache and Regenerative Endodontics in Pathways of the Pulp. Dr. Law is a member the American Dental Association, American Association of Endodontics, and Omicron Kappa Upsilon Dental Honor Society. He teaches continuing education courses at the University of Minnesota, is a Past President of the Minnesota Association of Endodontists, and a former Director of the American Association of Endodontics, and Past President of the American Board of Endodontics. He started in full –time practice in the Twin Cities in 1996. For the past 15 years he has been the president of The Dental Specialists, a multi-specialty dental practice. He is also an Adjunct Associate Professor in the Division of Endodontics at the University of Minnesota. He is married to an orthodontist and has 18 year old twins.

16:00
COFFEE BREAK
16:30
rightDifferential diagnostics in painful tooth conditions – what we know today and what we do not

Abstract

(Please note that this is the overall abstract for the pre-congress course, we do not think separate abstracts for each presentations are needed given that the overall purpose is to invite discussion and feedback. I discussed this with Paul Dummer who agreed that this would be reasonable)

--- A new international classification for orofacial and head pain was developed in 2017-18 by a collaboration between the International Association for the Study of Pain (IASP), the International Headache Society (IHS), and the International Network for Orofacial Pain and Related Disorders Methodology (INfORM). The International Classification for Orofacial and head Pain (ICOP) is the first classification that includes both acute and chronic pain in the orofacial area, as well as being integrated with headache diagnoses and other pain classifications. The purpose is to provide healthcare providers and researchers with a tool for diagnosis and categorization of cases. Definitions and diagnostic criteria are provided for dental and dentoalveolar pain conditions, such as pulpal, periodontal and mucosal pain, along with regional muscle pain, TMJ pain, orofacial neuropathic and idiopathic pain conditions, as well as trigeminal pain associated with migraine and autonomic disorders.

In orofacial pain research, the proposed new classification is important because it has the potential to improve the basis for research in diagnostics and treatment. For endodontists, orofacial pain research is highly relevant since we frequently encounter acute as well as chronic tooth pain in our patients, and are frequently required to differential diagnose between pain conditions.

The overall aim with this pre-congress course is to invite active participation and feedback from the endodontic community to ensure this perspective is incorporated in the final edition of the classification.

Aims

Contribute to participants’ awareness about the present level of scientific evidence for diagnostic methods used in endodontics today, and needs for development in this field

Objectives

Pain is a well-known feature of endodontic disease, and when we dentists assess patients with pain complaints, we routinely take into consideration a number of aspects, such as how the pain presents, e.g. the pain intensity, frequency, duration and modifying factors. We also interpret clinical signs such as periodontal probing depth or tenderness on percussion, and the results of various diagnostic tests, including response to pulp vitality tests, into a diagnosis. But how strong is the scientific support for the validity of endodontic diagnostic methods, and is there a need for more knowledge? Where should research in dental pain diagnostics be going? After presentation of the current state and suggested future direction, discussion will be invited.

rightDr Maria Pigg
Dr Maria Pigg

Maria Pigg, D.D.S., Odont.Dr. (Ph.D.) is an associate professor in the Department of Endodontics, Faculty of Odontology, Malmö University. Dr. Pigg graduated with a degree in dentistry from the University of Gothenburg 1993, and obtained postgraduate clinical training in endodontics at Malmö University, where she also completed her research training. Her doctoral thesis on diagnostics in chronic intraoral pain led to a doctoral degree obtained in 2011 and she has also held a docenture since 2017.

Dr. Pigg’s current research focuses on the development and validation of clinical diagnostic methods in acute and chronic orofacial pain. She frequently lectures on acute and chronic dental pain including differential diagnostics and has co-authored review articles and book chapters on persistent dentoalveolar pain, neuropathic orofacial pain and endodontic emergencies.

Dr. Pigg is a member of the Swedish Endodontic Society, the European Society of Endodontology, the American Association of Endodontists, and the International Association for the Study of Pain. She is program director of International Postgraduate Studies in Dental Science at Malmö University, an associate editor of the Journal of Oral & Facial Pain and Headache, and currently president-elect of the neuroscience group of the International Association for Dental Research (IADR).

17:30
Discussion
18:00
SESSION ENDS
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