Psychologists off the beaten career track

By Bridget Murray
Monitor staff

Psychologist Alan Glaros, PhD, is still haunted by the image of a woman who came to his office nearly 30 years ago. She was a hand model with long, tapering fingers. But when she opened her mouth to speak, she revealed a set of ghastly teeth. At night, while she slept, the woman had ground them down to nubs.

Five years of psychotherapy hadn?t stopped the grinding, so she?d come to Glaros at New York City?s Institute for Behavior Therapy , hoping he could help. Much to his frustration, the behavioral side of dentistry wasn?t yet advanced enough that he could adequately treat her.

'At the time, in the early 70s, behavioral treatment techniques were new,' says Glaros. 'We had promising literature suggesting some possible treatment venues, but there was nothing literal I could use to treat her.' He was certain, though, that behavioral therapy was the missing dental instrument his patient needed. So, with the juxtaposition of her flawless hands and eroding teeth fixed in his memory, he set out to unravel the muscle tension that triggers tooth friction, and to help investigate mouth guards and nocturnal alarms?the electric monitors that jangle patients awake when they grind or clench their jaws.

Several years later, in 1976, Glaros got his break. A grant from the National Institute of Dental Research (NIDR) gave him the chance to investigate the needed treatment for tooth-grinding?or Bruxism as it?s also known?thus launching his fruitful career in orofacial pain.

Since then, Glaros and his colleagues have raised psychology?s profile in dentistry with their findings that behavior is key to treating jaw disorders. Granted, there?s still much to be learned, but psychologists have found that an interplay of stress and muscle tension underlies most jaw problems, and they?ve developed ways to ease that tension. If Glaros? original Bruxism patient were to seek treatment from him now, he could help still the gnashing jaw muscles that wore her teeth away.

Beginnings

Though firmly ensconced in dentistry these days, Glaros? first love has always been psychology. After graduating from high school in Ashtabula, Ohio, in the 1960s, he was temporarily waylaid by warnings that the psychology field is highly competitive. But neither of the majors Glaros tried at Stanford University?pre-medicine and pipe organ?stoked his interest like psychology.

'I finally said, ?to heck with it, I want a field I find personally fulfilling,?' says Glaros. 'I decided I wanted to look forward to coming to work every day.'

So he majored in psychology and pursued clinical psychology doctoral work at the State University of New York at Stony Brook. That led first to an internship at the Institute for Behavior Therapy, then to a faculty position at Wayne State University?s psychology department, where he first started studying dentistry and pain issues in addition to smoking cessation and biofeedback. From there he moved to a post in the department of clinical and health psychology at the University of Florida, which was housed in the dentistry building. While there, he directed the psychology internship program and the Pain and Stress Management Clinic. During his time there he met Dudley McGlynn, PhD, a psychologist studying ways to encourage good oral hygiene and teaching dental students about oral pain.

It was McGlynn who brought Glaros to the University of Missouri?Kansas City in 1988 to help him establish a behavioral science department in the university?s dentistry school. Among his other tasks there, Glaros trains dentists in behavioral aspects of dental care, helps phobic dental patients conquer their fear of dental treatment, counsels patients on managing dental pain and continues researching dental pain.

McGlynn considers Glaros 'perfect for the position because he?s got strong skills in research, teaching and clinical practice, a rare combination.'

'When Glaros came to help me build the department, I slept better at night,' says McGlynn, who has since moved from Missouri to a new post at Auburn University.

During his tenure at Missouri, Glaros? research interests have evolved from primarily Bruxism to broader issues of facial pain. Fueling his work is the growing attention to psychology in dentistry, he says.

'There?s now marked recognition that emotions and behavior play a critical role in the onset and treatment of oral disorders and pain,' says Glaros. 'I?m no longer the lone voice for these issues.'

For a long time, however, Glaros, felt he was a lone voice for the psychological side of dental problems because people didn?t realize how much they stem from behavior. Glaros was often the butt of jokes. If he was headed for the research lab he?d hear, 'Going back to the old grind?' or if he mentioned his work to colleagues, they?d say, 'Bruxism? That?s a topic you can really sink your teeth into.'

But his colleagues began taking his research more seriously when it demonstrated just how much stress affects people?s jaw muscles. A recent study he conducted (Journal of Orofacial Pain, in press) shows that jaw-clenching leads to chronic jaw muscle and joint problems called temporomandibular disorders (TMDs). That strong relationship between stress, anxiety and muscle pain makes psychologists like Glaros uniquely qualified to treat TMDs, says dentist Ernest Glass, DDS, who works with Glaros at Missouri.

'Dentists get next to no training in human behavior, yet a good 60 percent to 80 percent of orofacial pain is behaviorally related,' says Glass. 'If I?ve got a patient who?s clenching her jaw because of anxiety or depression, I would overlook that if Glaros didn?t come in and take care of it. He sees patients about the effects of everyday behavior on pain.' According to Glaros, 'a whole host of everyday activities set people?s teeth on edge.'

They clench and tap as they drive to work, sit at their desks typing or even read a magazine. This doesn?t 'just happen when the boss yells or the kids act up,'says Glaros. People often tense their facial muscles without knowing it. Many of his patients say the pain from muscle tension makes them irritable and short-tempered, which only spurs more muscle tension.

Armed with this understanding, Glaros alerts patients to the feel of their tensed muscles and the activities that trigger clenching and tapping. He teaches patients to interrupt the tension by relaxing their jaws and breathing deeply. And if his original Bruxism patient were to seek treatment today, Glaros could aid her by recommending a mouth guard and helping her use a nocturnal alarm that interrupts sleep-related grinding.

What next?

As much as grinding and clenching problems fascinate Glaros, they haven?t always been his main focus?he?s taken some 'slight detours' into such areas as lower back pain treatment, chemotherapy and smoking cessation. But his main interests lie in facial pain, and his present position allows him to channel his energies there. For that reason, he?s reached the high point of his career, and he?s got big plans for the future.

First on his agenda is an investigation into the causes of TMDs?to what degree does stress trigger them, for example, and what underlies different jaw movement patterns? Why, for instance, do some patients grind their teeth at night and clench them during the day?

Glaros also hopes to divulge the muscular and biochemical underpinnings of TMDs, unearthing the physical changes that lead to jaw pain. Finally, he plans to bolster the training he provides to dental students, possibly working with Glass to start an honors program in behavioral dental treatment and helping dentists design curricula that emphasizes the role of patients? behavior in their dental health.

'What patients do after they leave the dental chair is critical to their dental health whether that?s what they eat, how much they brush or how they control their jaw muscles,' says Glaros.

This is one in a series of Monitor articles that profile psychologists with unconventional careers.