Patients with Very Complex Conditions Rely on Eastman

The word is out. No matter how far they have to drive, patients are grateful for the highly specialized care and treatment they can get only at Eastman Institute for Oral Health. Throughout Eastman, faculty and residents treat patients with a wide range of complex medical issues, including people on ventilators, stretchers or confined to wheelchairs and those with cancer, diabetes, obesity, rare syndromes, and intellectual and developmental disabilities. Here are just a few examples.

Man with LVAD Heart Pump Travels Four Hours for Each Dental Visit

Loren Vinal was in pain due to a cracked tooth. But instead of booking an appointment, he got a dental ghosting. A note taped to the office door read: “Retired.”

Loren was dismayed. After he had a Left Ventricular Assist Device (LVAD) heart pump implanted in 2018 by the cardiac team at the University of Rochester Medical Center, he better understood the importance of good oral health because of the strong link between oral and heart health.

Eastman Institute for Oral Health was one of the options listed on the office door note for records transfer. It was far from his Corning, NY, home, but doable as Loren already made the four-hour roundtrip drive to URMC once every three months for a heart checkup.

His wife, Sandy Olson, called for an appointment and a few days later they met with the Specialty Care team. Loren immediately realized the disparity between his past dental care and Eastman.

“They didn’t just look at the one tooth; they took a look at everything and put together a dental plan,” he said. “I thought my old dentist was doing an okay job. My old dentist was a minor league player, and EIOH is clearly the major league.”

For the next 15 months, Loren and Sandy drove to Rochester twice a month for dental appointments. The full-mouth rehabilitation plan included two root canals, two posts and cores with crowns, four extractions, an upper partial denture, and a deep cleaning.

“It was complicated, but that’s what we do here. It’s important to come to a medical center for this type of care,” said Szilvia Arany, DDS, PhD, (GenDen ’17) who handled the fillings, crowns, and dentures.

In addition to prescribing antibiotics before each appointment, the dentists relied on specialized equipment called a Dopler to continuously measure Loren’s blood flow and monitor his bleeding because his blood does not clot easily. Sandy is a nurse, and was very helpful to the Eastman team about the Dopler.

“Not every dentist can accommodate or are comfortable treating high-risk patients,” said Nadejda Stephens, DDS, PhD, (GenDen ’10), who performed Loren’s oral surgeries. “Most don’t have the special training and equipment or know how to handle medical emergencies if they arise. We were grateful for Sandy’s recommendation and have since purchased our own Dopler for Loren and other patients who have an LVAD.”

The Specialty Care clinic treats patients with a wide range of complex medical issues, including patients on ventilators, or who have cancer, diabetes, obesity, rare syndromes, and intellectual and developmental disabilities. In addition, patients who are wheelchair bound or on a stretcher travel from around the state and neighboring states for Eastman’s expertise.

Given the volume of procedures Vinal needed and the long trek from Corning, the team of dentists, hygienists, and administrative staff coordinated efforts to limit the number of appointments by grouping his procedures when possible. They also took into consideration Loren’s heart appointments and gig schedule with his band, Loren V and the Heartbeats.

“As a musician, getting up to do anything at 7:30 a.m. is not in my comfort zone, but we always know it’s worth it,” said Loren. “It’s always impeccable service, efficient, professional, and delivered with kindness. They make me feel very important and cared for. We feel like family.”

Loren also appreciated EIOH’s efforts to advocate for him to his insurance company.

Loren and Sandy say that the level of care and willingness to help address any problem, dental or otherwise, continually exceeded their expectations.

For example, Loren says the team boosted his spirits by praising his ability to withstand discomfort, showed interest in his set list for upcoming gigs and in photos of his and Olson’s recent wedding. They offered kindness and assistance on days when his arthritis was acting up, and welcome Sandy in the room for both support and if

Loren’s LVAD battery needed changing.

“Once, when Loren was having difficulty finding an appointment before leaving for Georgia, the receptionist offered her own dental appointment slot. “It was a kind and unselfish act,” he said.

“Without truly knowing and understanding your patient, you’re not treating a person, you’re treating just a mouth and teeth,” said Dr. Arany. “For us, compassion is everything.”

Medically Frail Woman Receives Treatment in Stages

Due to her several medical conditions, 56-year-old Brenda Bidwell of Waverly, NY had to move to a nursing home in 2018 for rehabilitation.

But when Covid hit the nursing home and she contracted it, her situation became worse. Nursing homes followed mandates to keep their residents in and visitors out. Add to that the critical staff shortages nursing homes experienced then, and continue to struggle with now.

“I felt so stuck,” Brenda recalled. In addition to being a diabetic, she is a double amputee, has a tear in her retina, is prone to blood clots and has lymphedema. She suffers from chronic pain, anxiety, and obstructive sleep apnea. Previously, she had a stroke and ostomy surgery.

If that wasn’t enough to manage, she could tell her oral health was declining during that time. She had been getting much needed dental treatment but the dental office she was going to closed during Covid. Eventually, she felt pain and swelling in her mouth.

“I could feel how much more my teeth were decaying,” Brenda said, who turned to eating only soft foods because of the pain and infections. Because of staff shortages and other more urgent needs, daily oral healthcare was not a priority.

Because of the multiple medical concerns, Brenda can only be seen by a dentist affiliated with and close to a hospital. Eastman Institute for Oral Health’s Eastman Dental, part of the University of Rochester Medical Center, was the closest choice for her, even though it meant a three-hour one-way ambulance ride to transport her on a stretcher.

But Eastman Dental wasn’t new to Brenda, because Able2, a medical and dental clinic in Elmira that serves children with special needs, referred her two sons to Eastman for their braces.

“Able2 and Eastman Dental have been in my life for 20 years,” she said. “They’re both fabulous.”

“Her oral health is in need of significant treatment,” explained Dr. Nadia Stephens, assistant director, EIOH’s Specialty Care Clinic. Dr. Stephens.

“Brenda had multiple missing teeth, and the teeth on her upper jaw were extremely sensitive because of severe rampant decay,” explained Dr. Stephens. “In addition, she also had decayed teeth on the bottom and had multiple abscessed roots.”

Because of Brenda’s complex medical issues, it’s hard for her body to fight infection, which could trigger a spike in her blood sugar resulting in swelling; and the pain affects her blood pressure, all which could have potentially very serious consequences. Unable to be put under general anesthesia or IV sedation, Brenda’s treatment must be done in stages, and therefore prioritized. The teeth causing the most pain would be removed during the first visit, followed by three more visits for more extractions of the unrestorable decayed teeth and infected retained roots.

After the long ride on the second visit, Brenda arrived at Eastman and her twin sister Bonnie helps her get settled. A dental assistant comes in to take Brenda’s blood pressure and check her blood sugar level.

“It’s critical that her blood sugar and blood pressure are at levels where it is safe to proceed with treatment,” said Dr. Stephens, who works closely with patients’ medical providers to ensure quality, safe care is provided. “We see patients from throughout the region who have very challenging medical conditions. It’s an honor and privilege to help people when other dentists aren’t able to help them.”

“Dr. Stephens is very competent and has a great technique,” Brenda said. “I can’t even feel the Novocain when it goes in.”

“She is very thorough, works quickly and effectively,” added Bonnie.

“I thank God Eastman is here and I’m able to get the care I need and get the dentures my insurance covers in a facility where I’m safe,” Brenda added.

Very Rare: Baby Born with these Two Conditions

URMC Team Delivers Multi-Disciplinary Care

When the young couple found out during a routine ultrasound that their baby would be born with a cleft lip and palate, they were understandably worried about the unknowns.

“But that feeling was short lived,” Angelee said, “and we immediately started to research and learn more about it and options for treatment. During that same ultrasound, Angelee and her boyfriend John learned the baby’s gender, and agreed on a name the very next day.

Their son would be named John Freddie, after his father and his father’s best friend who passed away less than a year earlier.

“It was rough,” recalled John, “and that’s why when we heard the news about the baby’s cleft, it was just another step for us, and we were determined to walk right through it.”

Little did they know they would need to lean into that mindset again, just days after Freddie was born.

During the pregnancy, they met with Melisande Ploutz, PNP, team coordinator and nurse practitioner for the University of Rochester Medical Center’s Cleft and Craniofacial Center, known nationally for its excellent clinical outcomes and research. The couple decided the NAM was the right approach for their son.

The NAM, short for nasoalveolar molding, is a presurgical structural treatment provided to infants born with cleft lip and palate by Erin Shope, DMD (Pedo ’12, MS ’15, MS ’20), a pediatric dentist at Eastman Institute for Oral Health.

Freddie was born in late February, weighing exactly 8 pounds, with a full head of dark hair and the biggest, most beautiful brown eyes destined to melt hearts.

Dr. Shope came to the hospital and fitted Freddie for the NAM. They were discharged from the hospital and brought their 3-day old baby to meet the rest of the Craniofacial Team, led by Clinton Morrison, MD, a URMC plastic surgeon who specializes in treating children and adults with craniofacial conditions.

“When Dr. Morrison came in, he immediately noticed something,” John said. “He placed his hand on Freddie’s head and said ‘we need to get a CT scan right away’.”

Freddie was diagnosed with craniosynostosis, which occurs when a baby’s skull bones fuse together too early before the baby’s brain has fully formed.

After genetic testing didn’t show any connection, Dr. Morrison quickly reassured the new parents. Craniosynostosis is pretty common, occurring one in 2,500 births, with no known cause. However, Dr. Morrison added that it is very rare for an infant to be born with both the cleft lip and palate and craniosynostosis.

“We needed to wait until Freddie was 4 months old to do the surgery on his skull,” said Dr. Morrison, who has performed surgery on some 200 infants with craniosynostosis.

In the meantime, Angelee and John brought Freddie to Eastman Dental to see Dr. Shope once a week to adjust the NAM and measure his progress. The NAM helped bring symmetry to Freddie’s nose and mouth.

“Dr. Shope is amazing and the reason he can eat 48 ounces of milk a day and eat solid foods,” said Angelee, including Freddie’s favorite banana oatmeal.

“Using the NAM is a big commitment, and can be challenging and sometimes frustrating,” said Dr. Shope. “Angelee and John have done a tremendous job with Freddie, as demonstrated by his progress.”

Dr. Morrison performed the successful skull surgery, careful to make the incision so the scar would hide in his hairline as he grows older. He later performed the palate closure and lip repair.

Oral Cancer Surgery Takes Most of Man’s Bottom Teeth, Tissue

By the time the surgeon was done removing the cancer in the base of his mouth, Jack Reid only had three bottom teeth left. The surgeon also had to remove a significant portion of surrounding tissue. Thankfully, no radiation or chemotherapy was necessary and his upper teeth remained intact.

But recovery from the surgery was tough, and Jack, a retired psychotherapist, lost about 15 pounds because he was only able to eat soup and soft foods for several weeks.

When he was ready for the next step, he went to see Dr. Ira Kamp, his general dentist in Ithaca, where Jack and his wife moved from Colorado to be closer to their daughter and grandchild.

“Jack was understandably frustrated about his limited ability to eat, speak or function like he used to,” said Dr. Kamp, who teaches part-time at Eastman Institute for Oral Health’s Advanced Education in General Dentistry Residency Program. “Because a large part of the tissue and jaw bone had been removed, I recommended Jack receive treatment at Eastman, where a team of different specialists including oral surgery and prosthodontics are in one place and could effectively manage his complex condition to restore his function and aesthetics.”

“It was indeed a very challenging case,” agreed Alexis Ghanem, DDS (GenDen ’14), associate professor and director of the AEGD One-Year Residency Program. “Traditional dentures wouldn’t work for him, and we determined the best solution would be a bone graft to implement and support the remaining bone and then two implants to support dentures.”

“We have had such a great team, especially Dr. Shope and Dr. Morrison,” Angelee said. “They really made this process easy. They are legendary.”

“Freddie’s case is an excellent example of team work across specialties, between dentistry, neurosurgery, and plastic surgery, all working together to do the right operations for Freddie at the right times,” said Dr. Morrison.

In addition to Dr. Ghanem, Jack’s interdisciplinary dental team included Assistant Professor Dr. Alejandro Sanchez Lara (GenDen ’16, Prostho ‘17), and two AEGD residents, Dr. Oscar Ramos and Dr. Aron Lee.

After x-rays and impressions were taken and evaluated, Dr. Ghanem and Dr. Sanchez Lara discussed the options with Jack.

“They made a game plan, and explained to me how they could prepare my mouth in a way that would allow removable dentures to work well,” Jack recalled. The plan included the bone grafting and the placement of two implants.

“Unfortunately, one of the implants didn’t fuse properly for lack of enough ridge,” explained Jack, who drove two hours each way to for his appointments at Eastman.

“Then they did a bone graft again and four months later placed the second implant, which worked really well.

“The care was great and it was really assuring to see so many people working together as a team,” he added.

“I thought they were very diligent. It was obvious how very important it was to them to do everything so well.”

As the population ages, dentists will continue to see challenging cases like Jack’s. “Older adults will naturally have a wide range of medical conditions that can impact and affect their oral health,” Dr. Ghanem said.

“As educators, it’s important that our residents get the opportunity to face difficult cases and learn how to manage sensitive situations,” Dr. Sanchez Lara added. “Mr. Reid’s case was very good learning for our residents. We help many patients who are referred from private practices due to the complexity of the cases. We’re so glad we’re able to help them.”

Jack is very appreciative for the help he received at Eastman Institute. “I think I’ve got a lifetime warranty on my smile now,” he joked. “And it’s great to be able to eat what I want. The hardest thing was finding a parking spot.”

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