29 minute read
Shelter in a Patient’s Storm
EIOH
Lucky7 Pays Off for this Patient
Asuccess. “The rinse helped, but it never Sharon Elad, DMD – the seventh specialist went away and started getting much worse a Kathy saw – recently joined Eastman to fter appointments with six year later.” chair its new Oral Medicine Division. different specialists hoping for relief from Along with the worsening burning Oral Medicine, which began gaining the increasing pain in her mouth, it was the sensation, other symptoms started to appear. U.S. recognition in the 1940’s, focuses on seventh specialist who finally gave Kathy the “It looked like a big chunk on the left side the oral health care of medically complex help she longed for. of my tongue was gone, and there was white patients and with the diagnosis and non–“It was an ongoing, stabbing pain, and stuff on the inside of my cheeks,” Kathy surgical management of medically-related was worse when I ate foods with seasonings described. “And the inside of my upper and disorders or conditions affecting the oral or spices,” explained Kathy (who prefers bottom lips had the white stuff, plus red and maxillofacial region. not to use her last name). “Certain textures, blisters.” For example, oral medicine specialists like the crust on a slice of bread, were too It was at an appointment with a diagnose and treat conditions like oral painful to eat.” periodontist, Jack Caton, DDS, where ulcers, dry mouth, color changes of the oral Throughout her many visits to different Kathy found new hope. lining, recurrent blisters, lumps or swelling, specialists, she would either leave their office “Dr. Caton looked in my mouth and oral pain, burning mouth, taste disorders, with a special rinse to provide temporary said, ‘I want you to go see this doctor who oral infections, and benign growths, relief, or with an “I’m sorry, but I don’t we hired for her knowledge about mouth among others. know how to help you.” diseases,’” she said. “He told me, ‘If anyone “I was so impressed with her,” Kathy One specialist diagnosed her as having can help you, it’s going to be her.’ said. “She wouldn’t even look in my mouth burning mouth sensation, and told her it “At that point, I was struggling to eat until we went over my medicines.” At that affects about 1 in 500 people. Kathy, 65, scrambled eggs, cottage cheese and milk,” time, Kathy, who became paralyzed from used a rinse for about a year with some Kathy recalled. “Even drinking water hurt.” the waist down during a medical procedure
7colors of the rainbow • 7 Wonders of the ancient world 7 days of the week • the 7-day story of creation the 7 branches on a Menorah • 7 Chakras of meditation 7 heavens in Islamic traditions • THE 7 deadly sins • 7 planets 7 continents • 7 Periods in the Table of Elements 7 seas • the 7-year itch
seemed to know or care what I had, but she took the time.” —Kathy, a grateful patient
Kathy’s tongue before treatment (left) and following treatment from Dr. Sharon Elad (right).
16 years ago, was taking 28 different medications a day.
“In addition to the white patches, Kathy’s oral presentation included redness (erythema) and ulcerations,” Elad explained. “The white patches were the result of two conditions occurring at the same time.”
One of those conditions, Elad explained, involved removable white plaques that were diagnosed as oral candidiasis, or basically a yeast infection. The many medications she was taking induced dry mouth, which created favorable conditions for an oral fungal infection to emerge. Secondly, she had non-removable white color changes that were diagnosed as Lichen Planus/ lichenoid reaction, described as a chronic inflammatory reaction in the inner lining of the oral cavity.
“For the naked eye, the mix of white patches, redness and ulcerations could easily look like missing chunks,” Elad continued. “The chronic nature of this condition along with secondary infection and local trauma due to teeth imprints on the swollen soft tissue, probably enhanced the effects of the inflammation.”
Elad recommended a biopsy in order to rule out a malignant transformation.
“I was so impressed because Dr. Elad did the biopsy right in my wheelchair,” Kathy commented. “I’ve never seen anybody work on someone like that.”
“During the first few appointments, the clinical presentation was severe with some tissue areas totally losing the normal shape,” Elad described. “LP/lichenoid is defined as a potentially malignant disorder, so it was important to rule out malignant transformation. The lab report came back negative for cancer or dysplasia and conclusive for LP/lichenoid.”
The next step was to determine why this painful condition was happening to Kathy. Elad read carefully through her medical background and the medications list.
“I compared the list with literature resources about medications that are associated with lichenoid reaction,” she said. “Once these medications are identified, attempts are made, in consultation with the physician who prescribed it, to find a substitute.”
But that can be easier said than done, especially if the suspected medications are key for balance of a fragile medical condition, or if many medications are suspected as the culprit, determining which one to replace can be very challenging.
“Furthermore, since lichenoid reaction is associated with numerous medications and materials, it is difficult to prove a definitive link to a suspected drug or material as a similar reaction may develop with the second line of treatment, too,” Elad reiterated.
Dr. Elad, Oral Medicine chair, diagnoses and treats conditions like oral ulcers, dry mouth, color changes of the oral lining, recurrent blisters, lumps or swelling, oral pain, burning mouth, taste disorders, oral infections, and benign growths, among others.
After careful and thorough analysis and collaboration with her other providers, five of Kathy’s medications were stopped, and her treatment was adjusted accordingly.
“Dr. Elad saved my life,” Kathy said. “I couldn’t stand the way I was living anymore. No one else seemed to know or care what I had, but she took the time. She’s very personable and truly cares.”
During three weeks between appointments doing a rinse four times a day, Kathy was back to eating almost all normal foods again.
“I’ll never forget the first time I sat down and had a cheeseburger,” she remembered. “I was so thankful.”
Today, Kathy continues to see Elad, as part of her routine follow up.
“Her current condition is much better than when I first saw her,” Elad said. “As with any chronic condition, there are ups and downs, but we adjust treatment as needed, and we work together to give her the best possible care.”
“Because this is chronic, I recognize that there’s still a road ahead of me,” added Kathy, “but I’m so glad there is a Dr. Elad to help me along the way.” Sharon Elad, DMD, MSc Q. Oral Medicine is relatively
new in this area – do you find it challenging to explain what this specialty is and how it can benefit patients?
A. Absolutely. In many regions in the world oral medicine is a wellrecognized specialty, with long training programs, and high-impact in academic institutes. The U.S. is different, as oral medicine accredited training programs only started recently and oral medicine is largely only found in academic health centers. So it is a challenge to explain how valuable oral medicine can be for patients, the dental professionals, the university and the medical community.
Q. When did you know and why
did you choose Oral Medicine?
A. Since I was an undergraduate student I was working as a research assistant in the Department of Bone Marrow Transplantation. My BSc and DMD theses were about certain medical complications in patients undergoing bone marrow transplantation. During graduate studies, I found the topic of medically complex patients intriguing. After graduation,
Getting to Know Dr. Sharon Elad
gaining experience in hospital dentistry was attractive to me. The protean exposure I had during the four-year oral medicine program had a great impact on my professional career. During this entire time I continued developing a special interaction with the departments of Bone Marrow Transplantation, Hematology and Oncology in respect to clinical service, research and education.
Q. What is the most rewarding part of being in Oral Medicine?
A. Having the opportunity to contribute unique knowledge to patient care, often in cases in which the patient suffered from a chronic oral disease for a long time. Likewise, the familiarity with both dentistry and medicine allows me to introduce concepts arising in medicine into the dentistry world and vice versa.
Q. Right now you work out of
SMH and Wilmot Cancer Center Do you envision partnerships with other areas within URMC?
A. Yes! There is room for many more collaborations. Oral medicine interfaces with dermatology, internal medicine, solid-organ transplantation, ophthalmology, rheumatology, OB/GYN and many more medical specialties.
Q. What types of research are you
involved in?
A. Currently I’m involved in multiple research projects. Here are a few examples: • Developing a novel treatment for oral chronic graft versus host disease • Developing the Multinational
Association of Supportive Care in
Cancer / International Society of
Oral Oncology (MASCC/ISOO) guidelines for managing oral mucositis • Assessing the effect of oral chronic graft versus host disease on saliva secretion, taste and quality of life • Reviewing bleeding risk in patients treated with novel anticoagulants Q. Describe some of your other
professional affiliations/activities?
A. Co-chair of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer / International Society of Oral Oncology (MASCC/ISOO) • Organize the annual research workshop, moderate panels, write position papers • Chair section within the Oral
Care Study Group Member of the American Academy of Oral
Medicine • Immediate Past Secretary of the International Society of
Oral Oncology • Author of many book chapters, publications in professional journals • Invited speaker, oral medicine advisor to groups around the world
Dentistry Partners with URMC to Help Patients
t started one day last summer, when
60-year-old Jill Terhune had suddenly
lost her voice and the urgent care center
sent her home with antibiotics. Her voice
never came back fully and stayed raspy
in the following months. On Christmas
Eve, she had difficulty breathing and
went back to urgent care, where they
diagnosed her with viral bronchitis and
gave her an inhaler. Still suffering a
week later, she went to the emergency room, where they discovered a tumor.
A tracheotomy was performed for a
biopsy, and a few weeks later, the
cancerous tumor, along with her larynx,
also known as the voice box, were
removed.
Terhune is just one of countless people who suddenly find themselves facing a serious illness and subsequent treatments that could involve strong medications, radiation and/or chemotherapy. A dental evaluation before treatment can provide many benefits, like reducing the risk and severity of complications, such as jaw bone damage. For Terhune, she had 11 teeth extracted prior to radiation.
“We have provided pre-treatment dental care for Strong Memorial Hospital’s specialty care patients for nearly 20 years,” said Lisa Sansone, RDH, coordinator for Specialty Care in EIOH’s Oral Medicine Division. Specialty care includes those who have cancer or an infectious disease, those undergoing a transplant or other surgeries, or receiving radiation or chemotherapy. “Clearing oral infections prior to cancer treatment often includes treating cavities, fractured teeth, gum disease, or multiple extractions, performed by an EIOH General Practice Residency resident or an Oral and Maxillofacial surgeon.”
Now, thanks to a newly formed group of dedicated URMC professionals across several disciplines, a new system is in place to help patients get proper long term dental care after treatment, a longstanding gap that EIOH Social Worker Lenora Colaruotolo was determined to close.
Dental treatment before a transplant, surgery or radiation is deemed medically necessary and is covered by medical insurance or the hospital’s Charity Care program. When their hospital procedures are completed, patients are then referred to Eastman Dental for follow-up long-term dental care.
But, Colaruotolo explains, as an Article 28 institution, Eastman Dental does not have a Charity Care program or a hardship fund for meeting the needs of those patients who are uninsured or underinsured.
“Patients without adequate dental insurance who may need dentures, partial dentures or restorations are those we are not able to serve, unless they have financial means to pay for dental treatment.
“For many, this leaves very limited options for affordable, follow-up dental care,” she continued. “It was difficult to witness situations where so many patients
Patient Jill Terhune
(l to right) Cindy Micelli, Robert Ulp, Dr. Nirmala Tasgaonkar
just completing cancer treatment were forced to manage with few or no teeth. The stress of a cancer diagnosis and treatment is hard enough, yet now they’re also dealing with quality-of-life, dignity, and functionality challenges that can negatively impact their recovery.”
“Because of the long term effects of radiation and chemotherapy on the oral cavity, ongoing dental care after cancer treatment is extremely important for recovery,” added Sansone, who has been working with specialty care patients for many years.
A First Step in Closing the Gap
“Lenora put together a diverse group of professionals who were all in some way connected to the problem and wished to make a difference and find a solution,” explained Nirmala Tasgaonkar, DDS, assistant professor in EIOH’s Community Dentistry Division. “These included a head and neck nurse, social workers, a hygienist, dentists, administrators and coordinators from EIOH, Wilmot Cancer Center, Head & Neck, Bone Marrow Transplant and Infectious Disease.”
After initial brainstorming meetings, the new task force collaborated with Sharon Elad, DMD, MSc, chair, EIOH Oral Medicine Division, to help develop an organized referral system partnering with Jo Ann Snyder, RN, BSN, Head and Neck Surgery nurse coordinator at the Wilmot Cancer Center. Head and Neck patients who did not have his or her own dentist would be referred to Eastman Dental’s clinic at School #17.
“What began as an informal referral process soon became a regular stream of patients coming to our clinic for treatment and follow up,” Tasgaonkar said. After Snyder sends a comprehensive update on the patient and their medical history, Tasgaonkar’s team ensures the patient visit is comfortable, anxiety-free and pleasant. “We provide an exam, diagnosis, explain a treatment plan and schedule subsequent visits.”
“We use a multidisciplinary team approach to coordinate care of our patients,” explained Snyder. “While there was a strong pathway to pre-treatment care, we were lacking a good post treatment pathway to care for these special needs patients. Dr. Tasgaonker has stepped in and become an active member of the team. She is accessible and knowledgeable about patients’ disease and treatment consequences, and she develops timely and appropriate individualized treatment plans.”
After one radiation treatment, Terhune, a single mother of two grown boys, was unable to complete the process due to extreme claustrophobia and anxiety. Because treatment stopped, she was ready for followup dental care, but her life-long fear of dentists triggered more anxiety.
“I had my first filling when I was 3 years old,” explained Terhune, who says she has genetically bad teeth, and explained that her brittle teeth led to several cavities and root canals and procedures that didn’t go well. “One dentist didn’t believe me when I told him the Novocain wasn’t working and another yelled at me to stop crying when the gas he used hadn’t taken effect yet.” As a part-time employee for a food vending machine company, she does not have dental insurance; plus her fear and anxiety prevented her from going for preventive visits. To ease her nerves, she brought son Corey Terhune along to her first visit at Eastman Dental. “Turns out, I had nothing to be afraid of,” Jill Terhune said. “Dr. T is so laid back and easy going and funny! She made me laugh, which made me much more comfortable. She and Cindy are such a caring team.”
After Dr. Tasgaonker examined Terhune, she provided a cleaning and treated a few cavities to prepare for her new upper and lower partial dentures.
Proudly showing off those new dentures, Jill said she is very grateful for the care she received. “I feel like a new person.”
Another patient referred by Wilmot Cancer Center is Robert Ulp, a Vietnam veteran and a former patent illustrator. Diagnosed with Agent Orange related NonHodgkin’s Lymphoma in 1989, he was treated with aggressive radiation treatment in his upper chest, neck and lower jaw, which arrested the disease but severely damaged the function of his salivary glands. This, in turn, accelerated damage to his
EIOH Social Worker Lenora Colaruotolo
dentition, leading to frequent repair of small areas of decay and occasional removal of teeth too damaged to repair.
A relapse of the disease in 1996 was successfully treated with chemotherapy which further impaired recovery of his struggling salivary function.
“By 2010, the Non-Hodgkin’s had morphed into an aggressive bone marrow cancer,” Ulp explained. “What followed was 96 straight hours of chemotherapy, which arrested the disease.” He then went through six months of intermittent chemotherapy, which he said caused further damage to his salivary glands, resulting in additional tooth decay and more extracted teeth.
“I had chronic dry mouth, which not only damaged the ability of normal salivary action in my mouth to protect my teeth, but made even a simple phone conversation difficult to sustain,” Ulp remembered. As his dentist expressed increased concern over this condition and the specter of substantially higher costs arose, he asked his oncologist if he could provide a referral for treatmentrelated dental work.
He was referred to Tasgaonkar, who soon initiated a program of repair and extraction procedures preparing for upper and lower dentures.
“I found Dr. T and the staff at Eastman Dental to be very easy-going and competent in their professions, providing a friendly and relaxed atmosphere as work progressed,” Ulp said. “My new dentures are now fitted and comfortable. They are truly a well-made example of the craftsman’s art and I feel fortunate to have made the connection to Dr. T and her staff at Eastman Dental for this restoration work.”
To date, more than 30 patients have benefited from the efforts of this task force, with high patient satisfaction. But, Colaruotolo says, there are still many who need help. Often, dental insurance coverage doesn’t pay for everything, and many patients suffer financial hardship as they and their caregiver have had to stop work during treatment and recovery.
“Having good teeth or comfortable dentures are important to function for getting good nutrition, as well as appearance,” added Snyder. “It not only helps their physical well being, but also their self esteem and mental health.”
“We are looking at every option in search of supplemental funding, including benefit events, outreach, and grant opportunities,” Colaruotolo said. “Specialty care patients need our help the most as maintaining adequate nutrition and weight gain is a priority for return to optimal health.”
“This new referral system is a positive step to ensure post-treatment dental care and will prove very beneficial for many patients,” Sansone added.
Other EIOH clinics are part of the organized referral system, and include General Dentistry, Prosthodontics, Eastman Dental Downtown and the University Dental Faculty Group at Clinton Crossings. “Faculty and staff from these clinics collaborate as a multi-disciplinary team dedicated to the important goal of providing excellent oral health care to our specialty care patients,” said Elad. “Among the leads are Drs. Yunker and Ercoli who are very committed to the goal.”
Colaruotolo hopes to eventually influence legislation that will ensure comprehensive health insurance coverage for oral health care, yet in the meantime, she and the task force are working to increase awareness, partner with organizations such as the Seventh District Dental Society of New York, American Dental Association, and the American Cancer Society, as well as continue to seek funding sources.
Task Force Members
Lenora Colaruotolo, LMSW, Sr. Social Worker, Eastman Institute for Oral Health Mike Ellis, LMSW, Social Worker, Blood & Marrow Transplant Jo Ann Snyder, RN, BSN, Head and Neck Surgery Nurse Coordinator, Wilmot Cancer Center Rita Goodman, LMSW, Social Worker, Wilmot Cancer Center Sandra Sabatka, LMSW, Sr. Social Worker, Wilmot Cancer Center Frank Cannizzaro, LMSW, Social Worker, Infectious Disease Lisa Sansone, RDH, BS, Coordinator for Specialty Care Patients, Oral Medicine, Eastman Institute for Oral Health Patricia Carlson, DDS, Assistant Professor, General Practice Residency, Eastman Institute for Oral Health Sharon Elad, DMD, MSc, Chair, Oral Medicine, Eastman Institute for Oral Health Nirmala Tasgaonkar, BDS, MDS, MS, MBA, assistant professor, EIOH Community Dentistry Carol Vanini, MS, Director of EIOH Advancement Thanks also to Gina Curtiss, former School 17 Practice Manager, Cindy Miceli, Dental Assistant, Amber McGowan, Coordinator Rochester's School 17, one of Eastman Dental's community locations.
ome people believe in coincidence, while others believe that a certain chain of events is S orchestrated by the hand of a higher being.
Whatever the source, Theresa Nelson of Elmira, NY, is incredibly happy that her particular series of events led her to Eastman Dental, where she finally received relief from pain she had been experiencing for years.
Many years ago, Nelson had a bridge placed involving the back three right upper teeth. More recently, her dentist told her she had a small cavity on the tongue side of that last tooth at the gum line. He filled it, but it fell out— twice. The third time he used a different material, and explained it was challenging because of the cavity’s location.
What followed was continuous pain in the same area, and several visits back to the dentist, to no avail. After checking the need for a possible root canal, she said her dentist fixed a couple malocclusions, but insisted nothing else was wrong.
“The pain increased in intensity,” Nelson remembered, “I would frequently have to stop eating because the pain was so severe and radiated across every tooth on the right. Also, I had been chewing mostly on my left side because the right side was so sensitive. I reached the point where I felt I just wanted the whole bridge removed.”
Then a new situation occurred. Nelson’s jaw began to go out of joint and then get stuck. Yawning, laughing or eating an ice cream cone would trigger it, but she figured out how to push it back in place when it happened.
“In addition to the tooth pain, I was now having a lot of pain and headaches associated with my jaw,” she explained. “I searched online and found the TMJ Clinic at Eastman Dental.”
TMJ expert Ross Tallents, DDS, examined her and agreed that clearly something was going on with the tooth in back, and would not treat the TMJD until the tooth issue was resolved.
At that point, Nelson sought the advice of another dentist, who filed down part of the ridge, and provided minimal relief.
To add insult to injury, Nelson was diagnosed with chronic fatigue syndrome. “It seemed as though every system in my body was turned upside down…I was having multiple symptoms, on top of terrible head, jaw and neck pain,” she said.
“The pain would come out of nowhere and intensify greatly,” she explained. “I was at a dinner to celebrate my daughter’s college graduation, but the pain was so incredible I had to stop eating. It was then and there that I decided to call Eastman Dental.
“When I called for the appointment, the person I spoke with said she would do all she could to get me in quickly,” Nelson said. “She ended up getting me in that Saturday…I was thrilled!”
And it was that Saturday morning, whether by coincidence or fate, she met Xiuxin Liu, DDS, PhD, a resident at that time in Eastman’s Advanced Education in General Dentistry program who has a special interest in the diagnosis and management of dental orofacial pain.
He recently completed research about ATP signaling, which provides energy for living cells in dental orofacial pain, and its implication in dentin hypersensitivity. That study, which proposed to explain why different stimuli induce similar pain in the teeth, was published in the Journal of Dental Research.
Because of his novel approach in this area, Liu recently landed a coveted twoyear National Institutes of Health clinical translation science institute grant – the KL2 Scholar Award – to continue his work in this area of dental orofacial pain.
After listening to Nelson’s story and performing a thorough exam, Liu explained that he thought the filling was jagged, irritating the gum and causing pain.
“He talked about understanding pain and that I had dealt with the pain for so long that my nerves likely became hypersensitized,” Nelson remembered. “Dr. Liu gently cleaned up the affected teeth, took x-rays and had me schedule another visit with him to give him time to check
Theresa Nelson is pain-free, thanks to Dr. Liu (right)
EIOH Resident Eliminates Patient’s Prolonged Pain
Getting to Know Dr. Liu
the x-rays and review my case with his supervisor.
“When I came back for the second visit, the pain was the same in intensity,” she said. “Based on the x-rays and my response to the tests from the first visit, Dr. Liu was certain the filling was the cause of my agonizing tooth pain.”
“Pain is not just a harmful sensation, but pain itself can induce inflammation and injury to the tissues.” Liu explained. “For Mrs. Nelson’s case, palliative care and avoidance of secondary injury are necessary for tuning down her sensitized nerves. Stress relief and nutritional instruction would also be helpful for her comprehensive rehabilitation.”
After cleaning and reshaping it, Liu removed a significant amount of filling material.
At the end of the following day, Nelson noted that she had not experienced awful pain at all that day, or the next and the next.
“At my third visit with Dr. Liu, I was so excited to report that the intense, incredible pain was gone!” Nelson said. “I explained to him, however, that while I could chew soft foods on my right side, I still had an issue with chewing harder foods. Dr. Liu felt it could be an occlusal issue and made an adjustment. “I am happy to report that I now can chew all foods on my right side, something I hadn’t been able to do for quite a long time.
“I feel so grateful to Dr. Liu for diagnosing the source of my severe tooth pain,” she explained. “While it is a two hour drive for me to get to Eastman Dental, I feel it is well worth it to have Dr. Liu address the health of my teeth.”
As a clinician-scientist with a background in neuroscience, Liu’s research activity at Eastman has focused on the underlying mechanism of pain sensitization, a situation that usually occurs with chronic pain patients who show extreme pain to a light or even non-harmful stimulus.
With a strong interest in clinical translational research, Liu’s research activities have encompassed multiple fields since he graduated from dental school in China. “Solving clinical problems is the long-term objective for my research,” Liu said.
Liu earned his PhD in Pharmacology at Heidelberg University in Germany and then worked in electrophysiology. Before becoming an AEGD resident at Eastman, Liu worked as a postdoctoral fellow and faculty in Neurobiology at Yale University. “I chose Eastman because of its reputation and its roots in research and invention,” Liu added. “Many significant advancements in dentistry have come from Eastman dentists, like Drs. Bibby and Buonocore, whose work changed the profile of dentistry in the past century.
Liu’s ideal job would be to have a lab with sufficient resources and facilities to carry out clinical translational research. “This would enable me to not only provide service in clinics, but also to make contributions for the development of new techniques in pursuing better diagnoses and therapies.
“I am fortunate that I get support from Drs. Malmström, Ren and Eliav for my research at Eastman,” he added. “It has been the very right choice for me to select this institution.”
A self-described risk taker, Liu says the biggest risk in his life was 10 years ago, when he decided to come to the U.S.
“It was a cold, windy afternoon when my son and I landed at Kennedy International Airport,” he recalled. “For the first two weeks, we slept on the floor of an apartment in New Haven, CT, and in those moments, I had no idea what my family’s life would be like in this new world.”
It hasn’t been such a bad ride so far. His wife, Qin Amy Wang, DDS, PhD, graduated from the AEGD program in 2012, and now practices dentistry in Virginia. His son Max Liu, is a graduate of UCLA and is now a second year MD, PhD student at the University of Iowa Carver College of Medicine, and is planning a career in neurology.
I chose Eastman
and invention.
– Xiuxin Liu, DDS, PhD
Makeover Winner Smiles a Lot More Now
Greg Ras, center, celebrates his new smile with (l to r) his father Michael Ras, Dr. Elyce Link, Dr. Carlo Ercoli and his mother Colleen Ras.
wenty-five year old Gregory Ras says he is treated differently now than he used to be. Acquaintances and co-workers seem T Gregory had been diagnosed with two congenital conditions where some of his teeth were missing (oligodontia), and the when he won!” said Colleen. The specialists in Eastman Dental’s Prosthodontics, Periodontics and to be friendlier and more outgoing toward ones he did have were smaller than normal Orthodontics divisions collaborated to him. He thinks it’s because of his new size (microdontia). develop Greg’s treatment plan. He would teeth. But Gregory’s mom, Colleen Ras, Ercoli said they are both common, need a full arch implant-supported bridge thinks his overall confidence and self esteem people can get either one or the other or in the lower arch and implant-supported have grown considerably since his smile both, and with varying degrees of severity. crowns and tooth bridges in the upper arch. makeover, and as a result, people respond “It can range from affecting one tooth, “His upper premolars were extracted more favorably than before. which can be missing or misshaped, to and four implants were placed,” explained “Hundreds of people like Greg who many teeth as in Greg’s case,” Ercoli Ercoli, who oversaw Greg’s case over the two entered our Smile Makeover contest were explained. “The more teeth affected, the years and four months of treatment. “After unhappy with their teeth and shared similar more complex the case gets as the gum and the implants were placed, Gregory spent sentiments – they were too embarrassed and bone structure do not form as well as they about six months in orthodontic treatment.” self-conscious to smile or go out in public; should.” Orthodontics resident Evan Brown, or they had lost teeth and always cover their “We had been to a few specialists to DDS, who was supervised by attending mouth with their hand,” remembers Carlo get estimates on how to fix his teeth, but faculty Edward Sommers, DDS, provided
Ercoli, DDS, chair, Prosthodontics Division without insurance covering most of the treatment to move his upper left canine and at Eastman Dental. “We completely work, it was extremely expensive,” explained create more space for his upper left bridge. understand that one’s teeth can impact Colleen. “So when I saw the ad for the Next, all of his lower malformed quality of life, either positively or negatively. contest, I definitely encouraged him to baby teeth were extracted, except for his
That’s why choosing just a few winners enter.” permanent molars and six implants were from nearly 1,000 people who entered our “I wanted to get a better smile to look placed. After the orthodontic treatment smile makeover contest was a very difficult nice, so I entered the contest,” Greg said. was completed and the healing period challenge.” “We were all so surprised and ecstatic for the implant was finished, the final
I’m loving my new smile.
— Gregory Ras
prostheses were delivered. In the upper arch, four implant crowns replaced the missing premolars and two three-unity bridges supported on his central incisors and canines replacing the missing upper lateral incisors. In the lower arch, long span implant bridge supported by six implants replaced all his missing teeth except for his molars.
“It’s been exceptional care,” Colleen said. “So professional, smart and caring through every step of the process. They’ve been wonderful and patient, really thorough and great bedside manner…we couldn’t have asked for any better. Dr. Ercoli was attentive and a pleasure to meet and go through this experience with. We are so lucky to get all this care from him and all his residents.
“Gregory’s smile looks fantastic, more grown up, and just a perfect fit for him!” she added. “I believe his overall confidence about his looks will help to continue to keep growing as a person at work and in his personal life. I can tell he feels good about it.”
“I’m loving my new smile,” Gregory said, smiling. “Originally, I thought they would grind my teeth down, but they did a lot more work than I thought..the whole process was a learning experience for me. They definitely exceeded my expectations.” Greg added that they were very considerate, trying to match him with doctors that fit his personality, accommodating his work schedule, and always making sure he was comfortable.
“I definitely smile more than I used to,” Greg said. “My friends and co-workers say my teeth look awesome. My family, aunts and uncles have also complimented me and say I now have the best teeth in my family!”
In addition to Dr. Carlo Ercoli, the residents who were involved in treating Greg include Drs. Berge Wazirian, Kostas Chochlidakis, Dimitri Papadimitriou, and Elyce Link.
