Dr Andrew Greenland: 0:00

Welcome to Voices in Health and Wellness. This is the podcast where we sit down with leaders across the clinical and wellness landscape to uncover how care is evolving, what's changing in the industry, and what it really takes to build a sustainable career in health today. I'm your host, Dr. Andrew Greenland, and this in this episode I'm joined by someone who brings both clinical expertise and deep personal insight into the conversation, Dr. Suzie Bergman. Susie is a dentist by training, but her work and passion reach far beyond teeth. She's the founder of Dentistry on Officers Row in Vancouver, Washington, where she specialises in um orofacial pain, TMJ dysfunction, and sleep disordered breathing and chronic overlapping pain conditions. Suzie, welcome to the show. Thank you so much for joining us this afternoon.

Dr Suzie Bergman: 0:42

Thank you so much for the invitation. I'm delighted to be here.

Dr Andrew Greenland: 0:46

So maybe you can start at the top. Could you perhaps tell us a little bit about your path into orofacial pain and TMJ disorders? Because I know that was part of a deeply personal journey.

Dr Suzie Bergman: 0:56

Sure. Yes. So I um became a dentist in the early 90s. And a few years before I went to dental school, I was a young college student in my teens, and I was involved in a crazy accident where I uh ended up being thrown over a hill by a car, my friend's car actually, and that accident resulted in some severe damage to my temper mandibular joints. So even before I realized that I would want to treat people with this type of chronic pain condition, I became a patient myself. And that really sort of changed the trajectory of my future work and my career in the dental and healthcare space. And my passion is to bring medical, dental, and behavioral health providers together to look at a whole person rather than just a mouth in one operatory and other parts of the body in different exam rooms.

Dr Andrew Greenland: 2:10

Thank you. And you shared you had jaw joint replacement surgery. I mean, how did that shape your lens as a clinician, having such a major thing?

Dr Suzie Bergman: 2:18

Yeah, that's a great question. So it was actually quite a long journey until I became an end stage patient and had to have total joint replacement. So along the way, I really was um introduced to many different treatment philosophies, treatment modalities. I had a couple open joint surgery procedures prior to the time when I developed ankylosis and was no longer able to use my jaw the way we are intended to use it. So I learned a lot because I had to really kind of research everything that I was going to agree to for myself as a patient, and I came to realize that this is an area that no one really wants, well, I shouldn't say no one, but very few people want to get involved in because it really kind of bridges dentistry and medicine, and the training that we receive in our curriculum doesn't really prepare us for this unless someone attends an orofacial pain residency program, which is a relatively new specialty in dentistry. And so I kind of learned as I went along the years, and when I got to the point where I had to have the surgeries, I realized that I needed to help people navigate this area of um orofacial pain and uh associated coexisting um conditions and comorbid conditions to make their journey a little bit less circuitous.

Dr Andrew Greenland: 4:09

Got it. And that journey itself, I mean what what were the major gaps in terms of how pain and complex conditions are treated in your experience through that journey yourself?

Dr Suzie Bergman: 4:20

So um, you know, dentists, we dentists tend to be very mechanical. So when we see a problem, we want to fix it, we want to um remove caries and and place a restoration inside, or we want to get rid of a necrotic pulp with a root canal. And uh chronic orofacial pain is very different, temporomandibular joint disorders in particular, these are not things that we just um do a procedure and and the pain completely goes away. So we have to think much more as a diagnostician, we have to think orthopedically, and because the TMJ is the only joint in the body that's not treated by orthopedists, there is a really deep divide between the communication that we have with the medical, our medical counterparts. We have to end up doing a lot of explaining, and often patients feel like they're the ones who research their condition and bring that information to their health care providers, which isn't always ideal because there are some who are willing to listen, and there are others who just say this isn't really within my scope of expertise, and they just end up uh referring patients. So there's a lot of time spent in chasing a diagnosis only to end up with maybe, you know, orthotic devices in a drawer in the nightstand or a medicine cabinet full of prescriptions that haven't been helpful. And I think that what I've learned is it is absolutely imperative to communicate with every member of a person's health care team and to actually develop a team as opposed to having you know different providers who don't know one another and who haven't collaborated about a person's chronic pain condition.

Dr Andrew Greenland: 6:31

And you you're obviously a big advocate of integrated models based on your personal journey. So, what does your care team look like now and who do you collaborate with to ensure the best possible care for these patients?

Dr Suzie Bergman: 6:43

That's a great question. So I actually um I really like the idea of interdisciplinary clinics, which are few and far between, but when we have all of the providers under the same roof, they're able to speak with each other in real time. We eliminate some barriers to care for the patients. And I believe that people with chronic overlapping pain conditions need to have more than just dental providers taking care of them. So there's definitely a need for a behavioral health specialist to deal with the anxiety and depression and those types of conditions that result from being in pain. I like to see a nurse practitioner or primary care physician as part of the team, a dentist or a facial pain specialist, a physical therapist, sometimes a speech and language therapist, a rheumatologist can often be helpful, a sleep uh sleep dentist or sleep medicine provider. And um this team needs to be kind of uh it needs to be uh specific to each patient's condition. So it may not always involve all of these providers, but they should at least be on board in case they need to be consulted.

Dr Andrew Greenland: 8:17

Thank you. And with that, I mean, how are you seeing these other specialities responding? You know, things like neurology and behavioral health or airway focused care. How are they reacting to the sort of intersection with dentistry?

Dr Suzie Bergman: 8:30

Um, it is varied, definitely. There are some who are um are very grateful for the communication and willing to collaborate, and there are others who will say, Um, what office are you from? Why are you calling me? You know, they don't really make the connection, but those who do, um, they want to help their patients. And I think the majority of us who go into healthcare really do want to help our patients. So when the opportunity is there for continuing education and for learning what was not taught to them in the past, most people respond favorably to that. And if the model is one that they can easily integrate into their practices, then they're willing to make adjustments. But our system is a little bit, it works against us sometimes. And so there are times when patients will have to say, I think I need to kind of start over with my core team. And once they have a really good core team, and those are um, you know, providers who are communicating with each other, that's when we start to see improvements in patient health.

Dr Andrew Greenland: 9:51

Thank you. And with that, I mean, what what and from a patient perspective? Um, what's the patient's awareness of these different connections? Is that changed? Is that getting better? Are patients more aware of these um the necessity for these different people to become involved in their care?

Dr Suzie Bergman: 10:06

Yeah, so sometimes patients will say, Well, I, you know, why are you asking me about my sleep? That doesn't have anything to do with why I came in to see you. So it is really an opportunity to educate the patient. I like to ask them, you know, questions that they may not realize are relevant. Um, are you having any trouble with your stomach? You know, because um digestion starts with chewing, and so if you're having difficulty chewing, that can cause gastrointestinal upset. And so once we discuss it and the connections are made, they say, yeah, you know, this makes a lot of sense, or I've been thinking this and I've been trying to talk to my primary care physician about, you know, the changes that I've seen since I've started having this type of pain. Um, maybe it started with them in puberty or it started during you know, childbearing years. It's very common for women with temporomandibular disorders. So the hormonal um uh link is something that they're very interested in. And I think that patients realize very quickly that um their you know their body is not um separated into compartments the way that the healthcare system separates it. So they're usually very grateful for making those connections.

Dr Andrew Greenland: 11:45

That's really interesting. And outside of your work, do you think we're generally doing better at connecting the dots between systems or is care mostly still siloed? Like I said, outside of your work, because I know you have a passion in this area. I'm just wondering whether the wider field of dentistry is that are they getting are they getting this?

Dr Suzie Bergman: 12:00

It's start, it's starting to improve. I definitely think there is a great deal of work to be done. Um, but there are some um institutions that are taking a more um whole person approach and training uh dental students alongside medical students or physical therapy students. Um, when they do this, the outcomes are really significantly improved for patients, and it is going to take a lot of work on the part of the health care education systems to say, you know, just because this is the way that we've always done this doesn't necessarily mean it's right. And um, in the US, the first dental school was created in the mid-1800s because there was a need for uh physicians to be more specialized in treating oral health problems, but the intent was never to separate the mouth from the body, and that was a really unfortunate um uh byproduct of making dentistry uh a different um entity than um medicine. So my hope is that we can break down those silos and bring the disciplines closer to one another again.

Dr Andrew Greenland: 13:28

Bring it on, bring it on. Um so tell us a little bit about your practice at um Officers Row. I know you have a strong um focus on education, prevention, and systems-based thinking, but just tell us a little about your practice, what's going on there? Yeah.

Dr Suzie Bergman: 13:40

Well, so I've been in practice with my husband since um 1999, actually, and we have a family-based practice. However, it really has evolved over the years since um my focus has changed quite a bit. So right now um we do offer almost all the um dental-related procedures. We refer a few out, but my husband does the majority of that type of practice, and I'm really limited these days to treating uh temporomandibular disorders and orofacial pain. I also do some orthodontics. I'm uh limiting my orthodontic treatments now because I'm spending more time working on interdisciplinary approaches, and so I have invited other healthcare specialties into my practice from time to time, or I've gone to their practices so that we can treat patients in the same day, the same appointment, and try to reduce some of the inconvenience for patients. So dentistry on officers row is um it's my home base, but I spend a lot of time here actually working on continuing education and um advocacy work and things that are unrelated or I shouldn't say unrelated, but uh separate from clinical care.

Dr Andrew Greenland: 15:18

Thank you. And you do have a lot of roles, I know. How do you structure your time? I mean, how do you balance it all out?

Dr Suzie Bergman: 15:25

Not very well. I I'm working on that actually. I have um I have a young uh gentleman who is a college student that is an assistant to me in the um different roles that I have, such as my role as the president-elect at the American Association of Women Dentists, and uh some work that I do for Immersify Education, which is a digital learning platform, and a few other um um endeavors. And so he kind of helps keep me organized. And I have learned that um my time in the clinic has had to be decreased in order to do some of the work that I feel will hopefully uh make a difference on a larger scale than I'm able to accomplish one patient at a time.

Dr Andrew Greenland: 16:23

I mean, and do you think the traditional idea of balance is flawed for the clinicians?

Dr Suzie Bergman: 16:28

Balance, yes. I I don't like the word balance at all because I I think that especially for women dentists, I think that we put a lot of pressure on ourselves when we use words like that because there is always it, it I don't know if it's a balance, but it's kind of more like a um a juggling of responsibilities. And sometimes we have to put something down because we just can't um give it the focus that it needs at the time, because it in reality we just have to prioritize. So when family needs us, then family needs to be our focus. Um, in in our careers, we have times where maybe we can we can contribute more, and there are times when we have to pull back a little bit, but um health and wellness is important for for the dental provider as much as it is for the patients that we treat.

Dr Andrew Greenland: 17:27

I hear you. And when we had our um pre-podcast chat, I think you mentioned about the when your work is tied to your personal health story or sense of purpose, it could be harder to switch off. How do you navigate that?

Dr Suzie Bergman: 17:40

Yes, that's very true. I think what I what I've learned, and you know, I still have some learning to do, but um, there are things that are not within our control. And so, you know, as much as empathy is important, there are times when we have to realize um I need to also take care of myself. I've had some um challenges this past year and a loss of a parent and some health issues unrelated to my jaw. And so um during this time, I I've realized that you know, when we talk about um what people refer to as balance, what we're really trying to do is make sure that we are just um respecting ourselves in the same way that we respect um our patients and our colleagues and family members. So it's it's definitely a day-to-day exercise.

Dr Andrew Greenland: 18:42

And there are any particular sort of signs of burnout or overwhelm that you watch out for in yourself just to make sure that you know you're keeping in the best possible space. What will your triggers or watch signs?

Dr Suzie Bergman: 18:55

Yes, definitely. So there are times when I get to my desk and um I s realize that I'm kind of sitting looking at my schedule or my calendar or looking at my screen and feeling a little bit stuck, like you know, wondering what is my priority. And those are the times when I realize that I need to step back a little bit and evaluate. And um, I've learned that it's really good to kind of make goals that are reasonable instead of you know goals that are so lofty that there's no way of accomplishing them. So I like to use the old-fashioned um pen and paper to write down, you know, things that I want to get through in a day. And then I like to cross those off my list because at the end of the day I can take a look and say, oh, I actually really did um accomplish more than it felt like, you know, in the moment. And then when I go home, I have to kind of just turn it off, spend some time with my family, take my dog for a walk, do some exercise. It's very important to me to um to not bring work home. And sometimes that's necessary if there's traveling, you know, coming up or something, but separating uh work from time that isn't meant for work has been a lesson that I've learned gradually over the years, and it's been it's been beneficial because I see that my kids are also learning that from me.

Dr Andrew Greenland: 20:42

And do you think female clinicians face a different kind of pressure in this area?

Dr Suzie Bergman: 20:46

Absolutely. I mean, that's um that's a topic that I've spoken about, and um I'm actually really passionate about that because uh we tend to be very hard on ourselves. And you know, the stage of life that I'm in, I have um one aging parent, I have um adult children whose needs are different from what they were when they were younger, and you know, my husband and I practice together, we have to think about the direction that we want our practice to go. And I know other women face similar challenges. We want to be caregivers and we want to excel in our careers, we want to take care of our patients, but um we put a lot of pressure on ourselves, and then that affects our health in negative ways. And so when we don't feel well, we can't bring our best to anyone. And it takes a lot of intention and um and focus to really, you know, take a step back sometimes and say, I am feeling too much pressure, I I need to give myself a break and be as kind to myself as I would be to someone else.

Dr Andrew Greenland: 22:09

I hear you. Um so what's working well in your practice at the moment? What are you particularly proud of? What are your sorts of success stories?

Dr Suzie Bergman: 22:16

Well, I will have to say that actually today is a great day to tell you about this because um yesterday I was notified that the research I have been involved in at OHSU for the past four years or so was recognized by the Journal of Neurosurgery as an editor's choice article, and that work is something that I've been doing both on campus and here in my clinic, where a neurosurgeon and I are looking at patients together because they're often misdiagnosed, and so many patients will get a diagnosis of trigeminal neuralgia, which is extremely rare, but can present like TMD and other orofacial pain problems, and those patients can sometimes receive even a surgical intervention that was not necessary because of misdiagnosis. So, since we've started this work, we've developed an AI tool to help with diagnosis, and the fact that that our work has been recognized is both humbling and very gratifying.

Dr Andrew Greenland: 23:32

Congratulations, that's an amazing achievement. Well done.

Dr Suzie Bergman: 23:35

Thank you.

Dr Andrew Greenland: 23:36

And similarly, what are the are there any particular challenges that you've recently had to overcome or any bottlenecks or things that you find difficult in your practice?

Dr Suzie Bergman: 23:45

Yeah, so I um as I became more and more involved in um in education and advocacy work and infrastructure, um planning some things for uh larger scale kind of rollouts, I realized that I had to cut back on some of the things that I really enjoyed. And so I actually was an orthodontic instructor for about 10 years, and my orthodontic practice was very rewarding for me, but I just realized that that's something that I have to scale back because I'm just not as available to my patients, and it creates um challenges for my staff when I'm traveling and and not able to um to give as much focus as I used to to that department in our practice. So it was um a little bittersweet, but I I realized that it's what's best for for everyone. And so, you know, that's part of the learning process and hopefully becoming a little wiser with age.

Dr Andrew Greenland: 24:59

Sure. And operationally, are there any sort of challenges or difficulties with doing what you do from a business perspective?

Dr Suzie Bergman: 25:07

Um, yes, from a business perspective, it is definitely a challenge, but it's something that we've worked on quite a bit. So um I I do have um a separate assistant who just helps me with things that are not related to dentistry on officer's row. And having that dedicated um uh support is really helpful because it's difficult to switch gears. And so if you're asking an assistant to be um involved in something clinical and then turn around and do something that's more administrative, it can just get really exhausting. So having having additional support has really been um a game changer for us.

Dr Andrew Greenland: 25:57

Thank you. If you um had a sudden influx or like a tidal wave of new patients or referrals, um, you might think it's a nice problem to have, or maybe not, but what will be the first thing to break? And please don't say you.

Dr Suzie Bergman: 26:11

Um, what would be the first thing to break? Well, I think um that would be very difficult from a scheduling um uh point of view, because we really can't um, even though, like you said, uh that can be a nice problem to have, it is a problem because there are only so many hours in the day, and I don't like to rush with my patients, especially patients who are experiencing pain. So I would not really know if I would have room for everyone if we had such a big influx because I wouldn't be comfortable shortening appointments, and I have you know certain days that I'm not available. So I think having patients wait a long time to get in would really that would not be ideal either.

Dr Andrew Greenland: 27:11

Fair comments. And if you had a magic wand and you could fix one thing in how the profession supports um complex or chronic pain patients, what would that be?

Dr Suzie Bergman: 27:19

Oh, I love that question. If I had a magic wand, I think I think I would make it a requirement that everyone um everyone who treats patients, whether they be dentists, um, dental assistants, dental hygienists, and um other healthcare professionals as well, that they would get more training and that they would um they would have to have an understanding of the temporomandibular joint and how it relates to health and well-being, and that they would understand that this is actually the only joint in the body that we need to sustain life. We um use it to eat and to speak and to express emotion, so it's a vital structure and it's part of other systems in our body, and I would just love for everyone to understand that on a deep level.

Dr Andrew Greenland: 28:24

Amazing. And finally, looking back, if you were starting your clinical journey again with the wisdom you've gained, would you do anything differently?

Dr Suzie Bergman: 28:33

Oh. I'm sure I would do things differently. Uh, but I will have to say, I think that sometimes it's a blessing not to know the things that we don't know in the moment, because um I think that where I am now has been uh it's been a process of becoming the provider that I am today. I I spent a lot of time doing other things in dentistry. I I did a lot of pediatric dentistry at the beginning of my career, and then that kind of evolved into the orthodontic um treatment, which later allowed me to reach more people because of the people that I met through continuing education. And so I think that all of it builds, and and you can't really know how that's gonna happen unless you go through the process.

Dr Andrew Greenland: 29:31

Susie, on that note, thank you so much for your time this afternoon. It's been a really enlightening conversation hearing about your personal journey and how it's sort of shaped what you do and the interests that you have, and this whole necessity for an integrated model for this very complex problem that patients have. So, thank you so much for sharing your experience, your journey with us this afternoon. It's been very much appreciated.

Dr Suzie Bergman: 29:51

Uh, thank you too. I really enjoyed it. Have a wonderful afternoon.