UB's six new dental clinics treat special disorders

Romance is the main reason people come to UB's Breath Disorders Clinic, one of six clinics established last fall by the UB School of Dental Medicine to treat special dental problems. The others are devoted to diagnosing and treating facial pain, dental phobias, salivary-gland dysfunction and medical conditions of the oral cavity. A sixth offers specialty diagnostic imaging.

"We hope to make this the Dental Mayo Clinic of Western New York," Norman D. Mohl said of the clinics, which were his brainchild and are housed in the Department of Oral Diagnostic Sciences, which he chairs. "We have all this talent here," he said. "Our senior faculty members are leaders in their specialties. I felt there was a real need they could fill."

Not surprisingly, the Breath Disorders Clinic is one of the busiest clinics. "We live in a very smell-oriented society," said clinic director Mirdza E. Neiders. "One-third of the U.S. population uses mouthwash because of fear of having bad breath."

Many of Neiders' patients are young people trying to pick their way through the minefields of social life and relationships. "They come here very concerned," she said. "Many definitely have problems because they don't take the time to follow good oral habits."

Although bad breath can be caused by abnormal conditions in the nose, stomach, or lungs, or by systemic diseases such as diabetes, Neiders said most cases can be attributed to lax oral hygiene. "It's bacteria," she said. "Bad breath isn't a very complicated thing. Bacteria hiding in places patients don't think of cleaning produce volatile sulfur-containing compounds."

More often than not, she recommends flossing, brushing the teeth and the tongue, and seeing a dentist regularly.

For an estimated 5-25 percent of the U.S. population, however, the mere thought of going to the dentist can cause incapacitating anxiety.

"There are people who will have all their teeth pulled rather than go to a dentist," said Elliot N. Gale, professor of oral diagnostic sciences and director of UB's Dental Fears and Phobia Clinic. He has been treating patients with dental phobias since 1969.

Irrational fear of the dentist can be caused by bad personal experiences, frightening stories, a popular culture that frequently equates dentists with pain, even by misguided parents who use going to the dentist as a threat to induce good behavior, Gale explained. He tries to help patients overcome their fears by defining the specific scenarios they find most frightening, and working through them one at a time, using relaxation and visualization techniques, a process called systematic desensitization. Eighty percent of his patients-nearly all of them adults-gain the ability to go to the dentist without extreme anxiety. "They may not be comfortable," Gale said, "but they can go."

Three of the new clinics were establishedto help diagnose relatively new dental conditions. Some of these conditions are the natural consequence of an aging population, others have come to light through dental research and new knowledge about the relationship of oral health to other medical conditions, such as heart disease and osteoporosis.

Ahmed A. Uthman, an oral medicine specialist, directs the UB Temporomandibular Joint Disorders (TMD) and Oralfacial Pain Clinic, which diagnoses and treats many types of facial pain. Along with Alfredo Aguirre, D.D.S., an oral pathologist, he co-directs the Salivary Gland Dysfunction Clinic. In both clinics, most of the patients are women. "The ratio of women to men with TMD is 5 to 1," Uthman said. "We don't know why. Maybe they have more stress, more to worry about. (Grinding the teeth, often a sign of stress, is one cause of TMD.) Pregnancy also may intensify the symptoms."

Facial pain attributed by patients to TMD often originates from other causes, Uthman said. "If you can eat properly and can open your jaw without pain, you don't have a joint problem," he stated. When the facial pain is caused by a joint disorder, treatment may involve physical therapy to correct the movement of the jaw, heat treatments to increase blood supply to the jaw muscles, pain medication, or a mouthpiece that patients wear at night to keep themselves from clenching their jaws or grinding their teeth.

His treatment also involves simple re-assurance. "Yes, there is TMD," Uthman tells his patients. "But there is also life after TMD."

While TMD patients are mostly women between the ages of 18 and 40, patients with salivary gland dysfunction, or dry mouth, are 90 percent postmenopausal. The condition is quite common, and can be caused by medications, radiation, chemotherapy, autoimmune disorders or hormonal changes. Salivary dysfunction is a major dental concern because the lack of saliva can cause teeth to rot. The clinic was set up to determine the cause of the loss of saliva and recommend treatment.

Alan J. Drinnan, along with Aguirre, links the fields of medicine and dentistry in UB's Oral Medicine Clinic. Drinnan specializes in diagnosing unusual oral symptoms, and is an expert in bite-mark analysis, a skill he has been called upon to use in more than one criminal trial. In the Oral Medicine Clinic, he helps determine the cause of conditions such as painful tongue, loss of sense of taste, oral lesions and ulcers, fungal and yeast infections, and numbness in the lips and jaw, often the first sign of an oral tumor.

"Physicians pay limited attention to the oral cavity," Drinnan said. "The range of things that can occur there is very wide." Patients are referred to the UB Oral Medicine Clinic from across the state.

Laurie Carter, director of UB's Oral and Maxillofacial Diagnostic Imaging Clinic, provides critical support to all of the clinics. An accomplished researcher with a degree in experimental pathology, she reported the results of her study showing that a standard type of dental X-ray can reveal blockages of the carotid arteries, one of the main causes of stroke, at the 1997 International Association for Dental Research meeting.

"A dentist is responsible for anything on the dental film, not just the teeth," Carter said. "We really are physicians of the head and neck area. Many systemic diseases manifest themselves first in the oral cavity." Her clinic provides a wide variety of imaging services to help diagnose developmental, inflammatory, metabolic, traumatic and other diseases and conditions of the head and neck.

Mohl hopes to add a sleep apnea clinic and other specialty clinics as the need arises. "Dentistry involves much more today than caries, gum disease and replacing missing teeth," he noted. "It is now a very broad field that is integrating increasingly with medicine. We think these clinics reinforce the dental expertise of the entire community."