CHALLENGING DENTAL MYTHS: DR BARRY GLASSMAN’S CAREER JOURNEY

Dr Barry Glassman, a renowned expert in chronic pain management and dental sleep medicine, has spent his career exploring the intricacies of bruxism, temporomandibular disorders (TMD), and orofacial pain.

His journey from practicing dentistry to becoming a sought-after educator and lecturer has been shaped by his personal experiences and his determination to demystify common misconceptions in dentistry.

In this article, Dr Glassman shares his career journey, his thoughts on the state of dental education, and his mission to improve the quality of care within the profession.

What initially sparked your interest in the areas of chronic pain management and dental sleep medicine?

I graduated from the University of Pittsburgh in 1973, and a few years later, I was in private practice with my brother. I was treating a woman in her mid-thirties who was complaining of pain in an upper bicuspid. My clinical exam and dental radiographs revealed no dental pathology. A root canal, crown, and eventual extraction did NOT resolve the pain. In fact, it made the pain worse.

A brochure from Dr Niles Guichet crossed my desk. The trifold brochure described a course that would explain how dental malocclusions can cause hyperactive anterior temporalis muscle activity and referred pain to the dentition. My tortuous path through all the "TMD camps" led by "TMJ gurus" had begun.

What inspired you to move from practising dentistry to also becoming an educator and lecturer?

Teaching was never in my plans. I was asked by BioRESEARCH, a biotech company whose instrumentation I learned to use early in my career, to lecture for them. When I told my wife Sharon, who is an excellent, well-trained educator in her own right, that I was asked to teach, she questioned how someone totally unfamiliar the principals of teaching could be possibly even consider attempting to teach.

Sharon would not come to hear me lecture at first, fearing the worst. But eventually she did listen to me lecture at a course in Las Vegas. I saw her enter the room during the presentation, and then shortly after looked again to see that she was gone.

We went to dinner that night, and she said not a word about the teaching experience. Finally, over coffee and desert, I blurted, “I saw you there. Well, how did I do?”

Sharon’s response was most interesting. She said she was surprised how much material on the subject of orofacial pain and joint dysfunction I had obviously mastered. “Wow,” I thought to myself, “how great is that?”

She continued, "If your purpose was to let everyone in the room know how much you knew, you were fabulous. If your purpose was to teach them… you failed."

My lessons in how to teach were about to begin. Sharon taught me how to use my acting skills (we’ve participated in amateur and professional theatre for years) and how to identify visual, auditory, and kinaesthetic learners at teach them all at the same time. She taught me how to make my lectures about the attendees, and not about me. My role models, the ones that I had seen teaching, clearly knew none of what I was about to learn.

With such a demanding schedule of teaching, speaking, and practising, how do you stay motivated and continue learning new aspects of your field?

For me, staying motivated hasn’t been an issue. The motivation comes from the fact that I truly believe what we teach can help so many people in so many ways. There is so much in dentistry that has been learned through anecdotal empirical evidence solidified by confirmation bias. My goal has been to make the tortuous path I took to good medicine and intelligent risk-benefit decision-making less cumbersome for fellow dentists, allowing them to help our fellow man.  

The issue, then is not how to stay motivated, but how to continue to unlearn and learn, and how to incorporate that unlearning and learning into a message that in a short day or two-day course has the potential to be meaningful.

My hope was that when I retired from clinical practice in 2015 my schedule would be less demanding. That hasn’t happened. There is more to read and learn and more to teach than ever before.

Having taught internationally, have you noticed any differences in how bruxism and TMD is approached or understood in various countries?

This is a great question, and sadly, the answer is no. The myths of occlusion and bruxism are clearly universal, and the struggles of a knee jerk response with heavy emphasis on “evidence-based dentistry” leads to a battle between two extremes.

The use of the myths confirmed by confirmation bias in practice is often practicing using logic in the absence of science. With no real evidence, the practice is honestly close to voodoo. At the same time, if we only practice based on the flawed high-level science of double-blinded random controlled studies, the practitioner is handcuffed and prevented from valid risk-benefit decision-making.

The key is learning how to use science to guide one’s art while making well-considered risk-benefit decisions for quality care.

You’re currently co-authoring a book that addresses the challenges within the dental profession. What inspired you to take on this project?

I hoped that the message in my teaching, which can be so critical to a dentist’s practice, would be much more universally spread. I was asked by several gurus to teach with them, but it could never work out because their own legacies became more important than the science itself. In each case, they tried to make the science fit their flawed theories.

In his recent book The War on Ivermectin, Pierre Kory writes: “Medicine is one of the slowest-evolving systems in the world. It is replete with massive egos that are incapable of embracing an idea that is not their own. And in my experience, the more earth-shattering and brilliant a new intervention, technology, or technique is the more likely they are to cause the inventor’s license to be revoked.”

Our book is geared to help dentists, who are bright, intelligent people, who have all experienced “dental school,” where we are taught by non-evidence guided practitioners who continue to pass down myths as fact. They teach people very capable of critical thinking to think in a linear fashion. Without realising it, the perfection they teach as a goal becomes frustrating to the student and eventually the practitioner. The combination of poor science and an unreachable goal often leads to less-than-ideal treatment and in many cases early burnout in our amazing profession.

The goal of the book is to expose the truth and encourage the end of logic in the absence of science. The goal is to rekindle the intellectual capacity of our bright professionals and put them in a position to do exactly what our profession was meant to do: improve the quality of lives of our fellow man.

How do you manage to balance your professional commitments with your personal life?

Balancing everything was more difficult when I was younger, with a growing child, teaching, practicing, and staying active in theatre.

My child has just turned 50, is a United States Naval Academy graduate, with a master’s degree in business. He experienced a tour in Iraq and is now a public defence attorney in Florida where we now live. I’ve given up theatre, but I continue reading, learning, and teaching, with Sharon supporting me by editing my writing and participating in courses. I am so proud of who Sharon is, and what an amazing teacher she was.

There is no question that I was among her most difficult challenges.

Looking back at your career, what achievements are you most proud of, particularly in the context of helping patients manage conditions like bruxism?

While I am truly disappointed that our teachings didn’t have a greater influence on the massive dental profession, I am acutely aware of the number of dentists whom I have been able to work with in such a positive way that has improved their lives and put them in a position to improve others.

In my lectures I often talk about what an amazing profession dentistry is. We have chosen a profession that, with the right approach, has the ultimate goal to provide quality care to those who entrust us with their health. Rather than judge our success by the amount of dollars or pounds we can extract from our patients, we have much more altruistic goals.

I often say that both Sharon and I will be able to lie on our death beds knowing that we truly did spend our lives doing our best to improve the lives of our fellow man.