The Dental Pioneer
One morning last summer, Athena Papas welcomed her first patient of the day at the Rubenstein Oral Medicine Clinic. The patient was a 20-year-old college junior who, after coming home from school her freshman year with 13 cavities, had been diagnosed with Sjögren’s syndrome.
Papas, J66, is head of Tufts School of Dental Medicine’s oral medicine division and an expert in Sjögren’s, an autoimmune disease that damages the salivary glands, among other parts of the body, and can lead to severe tooth decay and oral infections. The disease is painful and can make it difficult to speak or to eat, leading to unhealthful weight loss in some patients.
Like many patients with Sjögren’s, the young woman had been struggling with both her physical and emotional well-being. There were times, she told Papas, when contracting the disease felt like the end of fun, and even of life itself. The patient said that her muscle and joint pain had gotten worse lately.
Fortunately, she said, she’d been attending 10-day silent meditation retreats that had helped her develop skills to cope with the dry mouth and dry eyes that characterize Sjögren’s. “I visualize saliva,” she told Papas. “And it’s worked! Now I’m like, what do I do with all this saliva?”
“Well, the mind-body connection is real,” Papas assured her. Of course, there are medical remedies for Sjögren’s, too. As the appointment continued, Papas performed a manual stimulation to clear her patient’s blocked glands, a treatment that can help increase the natural production of saliva, and applied a topical fluoride to help prevent further tooth decay.
In the roomy exam room, six floors above busy Kneeland Street, Papas was casually leaning against a wall. Though she remained very much in command—she rarely minces words if she thinks her patients aren’t doing what they can for their own health—the appointment with Papas was, as usual, more a conversation. A follow-up appointment was scheduled for three months later, by which time, Papas hoped, the patient would be able to gain enough weight to qualify for one of her drug trials, which require subjects to be at least 110 pounds.
Seeing patients—bringing them relief, and no small degree of hope—is just part of Papas’ work at the Tufts School of Dental Medicine. In addition to leading the oral medicine department, she is the Dr. Erling Johansen, D49, Professor of Dental Research. She also runs one of the country’s top clinics aimed at treating xerostomia, or dry mouth (Sjögren’s—pronounced “show-grins”—is just one of the conditions that falls under the category), as well as one of the only practices dedicated to treating the effects that Sjögren’s syndrome has on the teeth and mouth. And she’s been instrumental in launching life-changing medications, like Salagen, which is used to treat xerostomia.
Papas is 70, but she has shown no signs of slowing down. Last December, she was named a Distinguished Professor, a title reserved for a very small number of senior professors throughout the university who are recognized as preeminent in their fields and outstanding teachers and mentors. She has seven active research grants and a considerable patient load, and she continues to teach. Most days she eats lunch on the go, if she eats lunch at all.
Athena Papas, who goes by Tina, is one of the most well-funded specialists in her field. She’s received more than $24 million in grant money since 1978, and led more than 65 clinical trials, including 15 funded by the National Institutes of Health and the U.S. Department of Agriculture.
Through these studies, she has made groundbreaking progress in dental health care for the elderly and other medically compromised populations. She has worked on research and development with almost every major oral care brand, helping to launch such products as Caphosol (a rinse for dry mouth), Enamelon toothpaste and gel fluoride varnish, and Biotene’s Dry Mouth Oral Rinse. Her recent favorites, she said with a matter-of-fact flash of her gums, are Crest Pro-Health two-step whitening toothpaste and Crest Sensi-Stop Strips.
She has also earned the International Association of Dental Research’s most prestigious honor, the Distinguished Scientist Award. Her career reached a milestone in 2014, when the Commission on Dental Accreditation approved Tufts’ oral medicine residency program, one of only seven such accredited oral medicine programs in the nation.
Papas’s achievements would be noteworthy for any dental professional, but to truly appreciate them, they must be understood within the context of gender. Today, women make up nearly half of all dental students in the United States, and 25 percent of practicing dentists. But when Papas earned her D.M.D., in 1974, just 3 percent or so of American dentists were women.
That makes Papas something of a pioneer. Yet growing up, she said, it never occurred to her that women couldn’t be dentists. Her father ran a busy clinic on Marlborough Street in Boston’s Back Bay, where he worked until he died at age 89. Her mother earned her dental degree in Greece, and although she didn’t practice after she and her husband emigrated to the States, all of her best female friends were dentists.
“My parents never treated me any differently from my brother,” Papas told me, referencing George Stevens, D81, who runs a successful cosmetic dental practice out of their father’s old office. “They raised me to expect and to want to work.”
Papas studied biology as an undergraduate at Tufts, finishing in three years. “Seven courses a semester,” she said. It wasn’t until she was ready to apply to dental school in 1966 that she understood the challenges that lay ahead.
“There is something of a glass ceiling for women in dentistry,” she said, “though it’s far subtler now than when I was coming up.” As she considered various dental programs, she was told on at least one occasion that she was “too pretty” for a career in dental medicine, and it wasn’t uncommon for her to get catcalled during campus tours.
“Back then, dental schools would simply tell you they didn’t want to admit you,” she said. A man, after all, would be more likely to continue on in the workforce, unencumbered by such inconveniences as pregnancy, child rearing and having to be home at 5 to make dinner.
Papas was accepted to Tufts dental school, her first choice, but declined to enroll when she realized she’d be the only woman in her class. Instead, she changed her career focus to research, joining the doctoral program at MIT, where she had two cousins in the oral biology department. It wasn’t an easier route—the field of research is certainly not immune to gender bias, she said, as evidenced by the professor on the thesis committee who said she was taking the place of a man—but the family connection was comforting and her passion for research genuine.
She excelled at MIT, earning predoctoral fellowships with the National Institute of Dental Research and at Massachusetts General Hospital, and eventually became the first woman to receive a Ph.D. in oral biology from the school. After that, Harvard invited her to apply to its dental program. “They had one other woman, an African-American woman,” she said, “and they wanted one more.” Upon graduating from Harvard with her D.M.D. in 1974, she at last joined the Tufts dental school, taking a position as an assistant clinical professor.
Spearheading Sjögren’s Research
What’s always been most notable about Tina, to me, is the tremendous amount of empathy she has in relating to patients, almost like a caretaker-mother relationship,” said Kathleen O’Loughlin, D81, the executive director and chief operating officer of the American Dental Association and Papas’ former research associate and mentee.
“Our first study together was looking at patients who had been diagnosed with HIV and were suffering symptoms of the disease in their mouths, including a cancer known as Kaposi’s sarcoma. This was the ’80s, and HIV patients were treated in a very discriminatory way. But Tina treated them like human beings. She showed me that you can and should keep your empathy even while being engaged in very rigorous and very serious work.”
Papas first began studying Sjögren’s syndrome in the early 1990s. It was a natural extension of her work in geriatric dentistry and xerostomia, both of which involve, to one degree or another, how the salivary glands work, how they can be restored when they’re damaged, and how they affect a patient’s overall health.
But there was another reason that Papas was drawn to Sjögren’s: 90 percent of the people who have it are female. “No one was studying it, or looking for a cure or treatment,” she said. “No one was doing anything—maybe because it was a woman’s problem, which, of course, was right up my alley.”
What she soon noticed about Sjögren’s diagnoses was that they were often made very late—the average patient might suffer for seven years before anyone figured out what was wrong. The tennis star Venus Williams, for instance, was diagnosed with Sjögren’s in 2011 after having gone through years of misdiagnoses.
That’s largely because the disease’s symptoms can be attributed to any number of things. Though its hallmark symptoms are dry eyes and dry mouth—which can cause an increased risk of not just cavities but also periodontal disease, bad breath, and systemic and fungal infections in the mouth—many patients also report fatigue, depression, anxiety, and trouble with concentration and memory.
Papas started by treating the symptoms of the disease in an effort to minimize patient discomfort. As time went on, though, she began to focus on ways to treat the underlying cause and determine the disease’s larger impact on health. For instance, she helped lead one landmark study, conducted jointly with Tufts School of Medicine, that investigated the severity of Sjögren’s cognitive and fatigue symptoms, and another that looked at the economic impact of dry eyes on women with Sjögren’s.
While Sjögren’s is not curable, Papas said that her ultimate goal is to develop therapeutic interventions that block the process that causes the inflammation and other symptoms. To that end, she is currently overseeing three FDA trials, with dozens of patient participants. Once there’s an effective, and approved, therapy for Sjögren’s, she said, she’ll be ready to retire. Until then, though, it’s hard for her to turn down any research opportunity that might present a way to help the country’s 4 million Sjögren’s patients.
Papas has been spectacularly productive in her career—but hasn’t always been embraced for it. “There was, at the time—and in many ways there still is—a lot of jealousy and bias in the field of research and dentistry,” said O’Loughlin. “Questions like ‘How come she thinks she’s worth that much money?’ Or ‘Why should she get that position when a man has been working for it, too?’ But Tina quietly and humbly kept doing her own thing.”
Some of Papas’ reaction may have been strategic, but some of it was simply a reflection of a gentle and caring personality that O’Loughlin said was evident in everything from the way Papas treated her patients to her insistence that she could have a fulfilling family life as well as a high-powered career.
“She cooked and she cleaned and she was a typical Greek mom who also happened to be a brilliant and committed researcher who put Tufts on the map,” said O’Loughlin. “Her two children are remarkable, which to me says that you can do it all. It’s just really hard work. She was a tremendous source of inspiration.”
Papas told me that the work-life balance was never easy—or ever truly balanced—and that she had plenty of help raising her two sons, who are six years apart (and, regrettably, she said, not dentists, though “very successful”). Her husband, a psychiatrist in private practice for much of their marriage, worked from home half the time. “I was very lucky in that he didn’t want me to have to give up my career,” she said. “And in that I had a good nanny who could start the dinner.”
Mentor to All
It is not a stretch to say that there is an element of parenting in Papas’ approach to patient care. “She was always a dentist who really cared,” said Lonnie Norris, DG80, dean of the dental school from 1996 to 2011, who first met Papas when he joined the faculty in 1980. “She had a natural rapport, and new patients would more often than not become permanent patients.”
When the Johansen professorship became available at the dental school, he said, the nominating committee had a number of highly qualified candidates, but selected Papas because of her longevity, productivity, national recognition and, not least of all, generosity of spirit. An endowed faculty position like the Johansen professorship—named for the dental dean who preceded Norris—provides perpetual funding to enable the work of passionate researchers like Papas.
“She came in at a time when there were very few women nationally and established herself in this world of men that we were at Tufts,” Norris said. “She’s always had multiple studies and a lot of work to do, but she’s accessible and approachable. I don’t think Dr. Papas ever says no to anything, probably to the detriment of her own self.” Plus, he couldn’t help but add, she’s an excellent cook.
Though at an age when many of her colleagues have already retired, Papas continues to maintain a full schedule of patient care and research and to mentor students and younger faculty. O’Loughlin recalled the time that she came back to the school to give a graduation speech. “During commencement, I was onstage with the dean and one of the young men that Tina had mentored received his Tufts dental degree,” she said. “He had literally trekked across the Himalayas to come to the U.S. to be a dentist.”
That young man was Mabi Singh, DI07, now an associate professor in the Department of Diagnostic Sciences and Oral Pathology. Singh told me that when he first came to the United States from Nepal, in 1997, he didn’t know anyone, though he had been connected to Papas through a mutual friend.
He’d been accepted at the dental school but didn’t have the resources to attend. Papas hired him to work on her research team until he had enough money saved up to enroll in the dental program. “It’s not an exaggeration to say she’s how I got into Tufts and why I have the job I have now,” he said. “And it’s just one example of her nature. Everything I know is because of her.” And yet he insisted that he wasn’t special. “I think,” he said, “she would have done the same for anyone.”
Back at the Rubenstein Oral Medicine Clinic, after Papas had said goodbye to the college junior suffering from Sjögren’s syndrome, she welcomed her next patient—a 46-year-old woman who’d been diagnosed 20 years ago with non-Hodgkin’s lymphoma and treated with mantle radiation, a focused neck-up treatment that had destroyed much of her salivary function.
After that, Papas saw an 80-year-old patient with Sjögren’s that was so advanced her tongue sometimes swelled to the size of her mouth. She suggested that the patient take daily walks outside to boost her mood. The woman looked doubtful. Her husband wouldn’t go for that, she said. He wasn’t that outdoorsy. And besides, she asked, was a woman of her age and in her condition really up to such walks? Papas said she was, indeed. So she offered to accompany her on one.