Pediatric Dentist Learned to Address Barriers, Advocate for Patients at EIOH

Dr. Mathew

Dr. Mathew

When Moncy Mathew, DDS, MPH, who graduated from the Eastman Dental pediatric dentistry program, encountered patients with complex psychosocial issues, he sought consultation with Eastman Dental’s social worker.

During on-call one evening, Dr. Mathew recognized that a dentist’s responsibility does not end with providing emergency dental care in the hospital’s Emergency Department.

“While patients have dental needs, we rarely understand the obstacles families experience in trying to access dental care,” he said. “One of the most difficult challenges we face when treating children is addressing those barriers. Teamwork is very important in dentistry, and collaborating with social work allows us to address barriers and to be successful in treating children who otherwise would suffer from not being part of a dental home.”

The following scenario describes how the collaboration between Pediatric Dentistry and Social Work has benefited a patient.

Suspected Dental Neglect
little girl toothache stockDr. Mathew was called to the ED late one night when a 2 year-old female presented with a dental abscess, large facial swelling, and fever. Initially, the patient was brought to a local hospital emergency room; however was transported to Strong Hospital via ambulance.

During the oral assessment, Dr. Mathew identified extensive cavitation on multiple teeth, with some teeth requiring extraction.” The child’s mother reported that she obtained sole custody since leaving the relationship eight months ago and that the child’s father is incarcerated.

Following a psychosocial risk assessment the ED Social Worker filed a Child Protective Report for suspicion of medical neglect and lack of proper guardianship. The child was discharged the next morning and instructed to follow up at Eastman Dental.

Dr. Mathew and EIOH Sr. Social Worker Lenora Colaruotolo discussed the case and strategized how to approach the family. Despite two voice mail messages, the family failed to follow through or confirm the child received follow-up dental care with another dental provider. Due to the severity of the child’s treatment needs, along with the concern that the dental neglect was soon going to cause a subsequent visit to the ED, we collaborated on how to facilitate the child’s care.

The assigned Child Protective caseworker and Colaruotolo partnered to support the mother in obtaining insurance for the child, and follow up with Eastman Dental. As a result, the child received necessary dental care in the operating room under general anesthesia.

Getting to Know Dr. Mathew

Why do you want to be a pediatric dentist?
As a Public Health Dentist, my efforts had been focused on preventing dental caries at the population level. I had been involved with water fluoridation, school-based fluoride rinse programs and dental sealant programs at the state level. While working as faculty at the dental school, I was asked if I would work locum tenens for a school-based dental program to cover for a dentist on maternity leave. I began to enjoy working with children and wanted more. Over the next 5 years, I received more locum tenens requests and every experience was better than the previous one. I realized, although late in life, my calling was to working with children and decided to pursue pediatric dentistry.

How did you become interested in dentistry?
I always wanted a profession that included working with my hands. After exploring numerous options, I decided to pursue dentistry as it had more of an emphasis on the ‘art’ of dentistry within the science of the profession. It appeared very rewarding when something that you could do with your hands could help people attain a better quality of life with improved oral health.

Describe your experience with Eastman Dental.
During the residency match process, I had ranked EIOH as my first choice. One of the factors that influenced my decision was the presence of a social worker within the dental department. No other program that I interviewed at had a social worker.

The pediatric dentistry program has a perfect balance between didactic coursework and clinical experiences. Dentistry is so much more than just teeth – the resources available through the Strong Hospital made my experience more well-rounded and enjoyable. I hope the knowledge and skills learnt at EIOH will help me be a more compassionate dentist.

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$1.3 Million Prosthodontic Clinic Renovation Complete at Eastman Dental

prostho clinic entranceDental patients have begun to enjoy the recently completed $1.3 million renovation and expansion in Eastman Dental’s Prosthodontic clinic.  Additional treatment rooms, the latest technology and new equipment have improved patient privacy and comfort, and enhanced care provision.

“This is another example at Eastman and the Medical Center of our commitment to patient care excellence,” said UR Medicine CEO Bradford C. Berk, M.D., Ph.D., at the ribbon cutting ceremony. “Similar to the new children’s hospital and the new cancer center, Eastman Institute is undergoing a transformation to meet the same state-of-the-art standard we expect in all of our clinical spaces.”

A formal ceremony was held to celebrate the new space.

A formal ceremony was held to celebrate the new space.

University of Rochester employee Mary Hines, 55, decided to give Eastman Dental a try when her teeth and gums became very sensitive to cold air, along with discomfort when chewing hot or cold foods.

After she was examined by Eastman Dental’s periodontist (a dentist who specializes in treating gum disease and placing dental implants), Hines learned that she had severe gum disease, which was not only causing her sensitivity, but also causing her teeth to become loose (view her story on video).

Mary Hines teeth before

Mary Hines’ teeth before treatment

“Gum disease becomes severe when the plaque on the teeth isn’t treated properly,” expained Tal Rapoport, D.M.D., the periodontist who treated Hines. “The bacteria basically take over and travel down to where the teeth are attached and eat away at what’s holding the tooth in place. Bone loss, inflammation, gum bleeding, sensitivity and pain are definitely present at this point.”

Dr. Rapoport provided Hines with extensive periodontal treatment, including a thorough and deep cleaning.

“Severe periodontal disease almost always requires some surgery, as well,” Dr. Rapoport explained. “When everything is clean, the gums will attach back to the tooth and bone. In some cases, bone loss can be reversed with adding new bone to the area.”

This is one of several new rooms with the latest technology.

This is one of several new rooms with the latest technology.

“After the inflammation has been taken care of, it’s important to know that it’s critical to keep the gums healthy or the disease will recur,” she added. “In addition, placing dental implants while there is active periodontal disease will likely contribute to the failure of the implant.”

Now, with her periodontal disease treated and regularly monitored, Hines was ready to move forward with getting the dental implants she’s always wanted. A childhood injury caused her front tooth to die, and her gum disease created tooth movement, resulting in a large, undesirable space.

Between Eastman Dental’s reputation for excellent work, affordable rates, a discount as a UR employee, and some insurance coverage, Hines said the choice was easy.

Mary's teeth after

Mary Hines’ teeth after treatment at Eastman Dental.

To accomplish her esthetic goals with the limitations of her bone loss, Rapoport and Chief Prosthodontist Resident Elyce Link-Bindo, D.M.D., worked together using the latest technology in 3D surgical planning before removing Hines’ top teeth and placing six implants.

Over the next several months, Drs. Link-Bindo and Rapoport made sure Hines was comfortable with her ability to chew, speak and smile during the transition.

Dr. Tal Rapoport

Dr. Tal Rapoport, Eastman Dental Periodontist

“Throughout the year-long treatment time, I had to make removable

Dr. Elyce Link-Bindo, Prosthodontist

Dr. Elyce Link-Bindo, Prosthodontist

dentures to allow for healing after the implants were placed,” explained Dr. Link-Bindo. “When the implants were healed, I made her two different sets of temporary teeth to assess her esthetics and speech throughout the process.”

These temporary teeth attached to the implants and molded her gum gum tissue to make the teeth look as they were coming out of the gums. Dr. Link-Bindo and Hines had met several times to ensure all of the Hines’ esthetic desires were addressed. Once everything had healed and she was satisfied with her new look, Dr. Link-Bindo made her final teeth prosthesis.

“If I knew then, what I know now,” Hines reflected. “But I’ve become really passionate about my cleanings; they taught me how to brush my teeth right, and the importance of flossing. Overall, it’s been a wonderful experience.

“The care I received at Eastman Dental has been awesome, and felt like they cared about what I was going through,” Hines said. “They made my life different. Before, I wouldn’t even talk or smile. I would mumble because I didn’t want anyone to notice my teeth. Now I smile a lot more!”

For more information or to schedule a free screening, call 585-275-1147 or visit Eastman Dental.

 

 

 

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Marit Aure, PhD, Shares 1st Place in World-Wide Dental Research Contest

Postdoctoral associate Marit Aure, PhD, of the Center for Oral Biology in the Eastman Institute for Oral Health, tied for first place at the highly-competitive International

Marit Aure, PhD

Marit Aure, PhD, tied for first place for her salivary gland research.

Association for Dental Research/Johnson & Johnson Hatton Awards Competition held recently in Cape Town, South Africa.

The judges determined that the science presented by Aure and Korea’s Joo-young Park, was exemplary in both projects, surpassing 36 other researchers from around the world in their category. This is the first time in IADR history that two first place winners were named, with no second place winner.

Aure had qualified for the international competition by earning second place in the American Association of Dental Research/Johnson & Johnson Hatton Awards Competition, held in Charlotte, North Carolina in March. For the international round of the competition, all participants were required to condense the research talk into a four-slide, 10-minute presentation to be given in front of three judges.

“Telling the whole story in 10 minutes and four slides was especially challenging,” said Aure, who said the poker-faced judges had some very tough questions. “My reaction to winning was a mix of surprise, excitement and joy! It feels really good to get positive feedback and exposure for the salivary research we’re doing.”

Aure, who works in the lab of Catherine Ovitt, PhD, associate professor in Biomedical Genetics in EIOH’s Center for Oral Biology, presented “Mechanisms of Acinar Cell Maintenance in the Adult Murine Salivary Gland,” which revealed that replacement of cells in the salivary gland depends primarily on the duplication of the secretory cells, rather than on stem cells. The outcome of this work is important for designing a strategy to repair damaged salivary glands, as it indicates this may be accomplished by using healthy salivary gland cells for transplant therapy. Park’s research involved the genetic basis for cervical lymph node enlargement.

Aure and Park

Aure (left) and Park shared first place at the International Association Dental Research conference in South Africa.

Aure and Park, who each won $1,600, competed in the Senior Basic Science Category, where entrants must be enrolled in a post-dental, post-graduate, or Ph.D. program or have performed the unpublished research submitted to the competition within three years of earning a PhD. All the meeting abstracts will be featured in a special edition of the Journal of Dental Research online.

Aure completed her undergraduate, master’s and PhD degrees in her native Norway. She met Ovitt a few years ago at a Gordon conference on Salivary Glands where she was presenting her PhD research.

Dr. Catherine Ovitt

Catherine Ovitt, PhD, has mentored Aure for the last couple years.

“Marit’s background training and her research interests made her a great postdoctoral candidate, and I invited her to apply for a position with us,” Ovitt said. “She came from Norway to join my laboratory after completing her PhD, and has put enormous effort into this project over the past two and a half years. We are thrilled with her accomplishments – both at the bench and in the competitions! Her results not only change the way we think about the renewal of salivary glands, but they also serve as the basis for a new R01 application just submitted to NIDCR, which proposes to follow the fate of acinar cells after radiation treatment.”

The International Association for Dental Research, headquartered in Alexandria, Va. is a nonprofit organization with more than 11,500 members worldwide. Its mission is to advance research and increase knowledge for the improvement of oral health worldwide, to support and represent the oral health research community; and to facilitate the communication and application of research findings.

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Five Recognized for Research Excellence

Five Eastman Institute for Oral Health professionals were recognized at this month’s American Association for Dental Research’s local meeting.

Dozens of visitors reviewed all the poster presentations.

Dozens of visitors reviewed all the poster presentations.

One of the coveted awards is named after Dr. William Bowen, who is seen here reviewing a research project.

Thirty researchers from the Rochester area participated in oral and poster presentations covering a wide range of basic and translational science topics, such as fluoride varnish effectiveness, use of therapy dogs in pediatric dental settings and the success of implants, among many others.

Twenty of these competed for one of the three coveted awards:

The Basil G. Bibby Award is given for outstanding scientific merit among oral and poster presentations by non-degree candidates, such as technical staff, international dental students, residents and those not currently enrolled in an MS or PhD program.

The Michael G. Buonocore Award is given for outstanding scientific merit among oral and poster presentations by degree candidates.

The Bowen Award is given for outstanding scientific merit among oral and poster presentations by candidates in postdoctoral programs.

Each award winner is selected by a panel of judges on the basis of outstanding scientific merit through relevance and originality of hypothesis, clarity of presentation, use of innovative experimental design, methods or data presentation and/or findings or results that contribute significantly to the field of interest.

Winner Leandro Carneiro, center, with Dr. Eli Eliav and Dr. Dorota Kopycka-Kedzierawski

Winner Leandro Carneiro, center, with Dr. Eli Eliav and Dr. Dorota Kopycka-Kedzierawski

Leandro Carneiro, DDS, a Periodontics resident, won the Basil G. Bibby award for his oral presentation on Biomechanical and Histological Evaluation of a New Dental Implant, An Experimental Study in Dogs.

Vanessa Munoz, Prep student, in Dr. Quivey’s lab, won the Basil G. Bibby award for her poster, “Coordinate Regulation of Acid Adaptive Genes in S. mutans. By CodY and CcpA.

Alejandro Aviles Reyes, a Microbiology and Immunology graduate student in Dr. Lemos’ lab, won the Michael G. Buonocore award for his oral presentation, “Modification of Streptococcus mutans Cnm by PgfS Contributes to adhesion, Endothelial Cell Invasin and Virulence.

(l to r) Brendaliz Santiago, Dr. Robert Quivey, Vanessa Munoz, Alejandro Aveiles Reyes, Dr. Jacqueline Abranches, Dr. Jose Lemos, and Marit Aure.

(l to r) Brendaliz Santiago, Dr. Robert Quivey, Vanessa Munoz, Alejandro Aveiles Reyes, Dr. Jacqueline Abranches, Dr. Jose Lemos, and Marit Aure.

Brendaliz Santiago, PhD, a Postdoctoral Fellow in Dr. Quivey’s lab, won the William H. Bowen award for her oral presentation on Amino Acid Metabolism Contriutes to acid Adaptation and Virulence in S. Mutans.

Marit Aure, PhD, a Postdoctoral Associate in Dr. Ovitt’s lab, also won the William H. Bowen award for her poster presentation, Mechanisms of Acinar Cell Maintenance in the Adult Salivary Gland.

Catherine E. Ovitt, PhD, associate professor of Biomedical Genetics in EIOH’s Center for Oral Biology, delivered the keynote address, “Saving Saliva: Where do We Start?” The awards were presented immediately after her presentation.

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EIOH Expands International Partnerships

EIOH and Dammam leaders

EIOH recently hosted visitors from Saudi Arabia’s Dammam University (from left: EIOH AEGD Chair Dr. Hans Malmstrom, Dammam Associate Dean Dr. Sulaiman Alagl, EIOH Director Dr. Eli Eliav, and Dammam Dean Dr. Fahad Al-Harbi

Eastman Institute for Oral Health is expanding its global impact through new partnerships with Universities in Kuwait and Saudi Arabia to establish an advanced general dentistry faculty development and training program.

Two dentists from both Kuwait University and Dammam University will travel to Rochester and participate in a four to five- year program which requires 1) completing the two-year Advanced Education in General Dentistry program, 2) earning a Master of Science or Master of Public Health degree, 3) passing the American Board of General Dentistry exam and 4) engaging in at least two years of part-time teaching. Participants will also be enrolled in graduate courses in education at the Warner School of Education.

“We’re very excited about this unique program to educate the future educators,” said Hans Malmstrom, DDS, professor and chair, General Dentistry and AEGD program director. “This initiative fits perfectly with our mission for faculty development and training in clinical-translational research, clinical care and teaching. It also fits their need for highly trained faculty to accommodate the several dental schools they are opening in both countries.”

Serious discussions began a couple years ago when visitors from Kuwait University visited EIOH to learn more about the AEGD program and a master’s degree to prepare them for an academic career.

Shortly thereafter, Malmstrom was invited to lecture at Dammam University in neighboring Saudi Arabia about esthetic and implant dentistry, where he had the opportunity to discuss the possibility of this program with the administration there. Like Kuwait University, the School of Dentistry at the University of Dammam is expanding and also has an increasing need for qualified faculty members.

saudi map“There are numerous mutual benefits for establishing a closer collaboration with our colleagues in Kuwait and Saudi Arabia,” said EIOH Director Eli Eliav, DMD, PhD, who plans to establish similar partnerships with other international universities. “Unlike traditional study abroad programs, our curriculum will include significant training in clinical and didactic teaching, both through coursework and practice. Trainees will also get substantial involvement in research including clinical trials, teaching and practicing dentistry. The result will be comprehensive preparation for a successful career in academia.”

 

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New Denture “A World of Difference” for Patients

Dan Winagle’s dentist told him he needed extensive dental work and referred him to a specialist. The specialist referred him to Eastman Dental, where he’s been a patient for the last 15 years, originally with Dr. Gerald Graser, and more recently with Drs. Tatanya Baranovsky and Nancy Mouradian.

Dan did what most parents do – put their children’s needs ahead of their own. Medical bills for his two daughters with severe health problems didn’t leave room for costly dental implants. His untreated dental pain led to abscesses, ultimately needing several extractions. His dentists worked to keep as many of Dan’s teeth as possible, as they would serve as anchors for his new partial dentures. “Without anchors, dentures can slip out while chewing, talking, smiling or laughing, often causing embarrassment.

Within the last several months, though, Dan’s remaining teeth had to be extracted, but this time, Eastman Dental Prosthodontists placed two implants to anchor the bottom denture.

Thanks to his new implant-supported denture, Dan can once again eat foods he loves.

Thanks to his new implant-supported denture, Dan can once again eat foods he loves.

“Anyone who has a bottom denture understands the extreme frustration that goes along with it,” explained Dan, a partner in Spafford/Winagle, a financial consulting agency, specializing in retirement planning. “You have to be very careful with what foods you eat. I love raspberries and peanuts – but they get under the lower denture and it really irritates the gum. Then you have to go rinse out your dentures…it’s very embarrassing when you’re in public.

“Basically, you have to be very careful and re-learn to eat, avoiding foods you love because you’ll have problems,” he added.

“As we age, our bones shrink. Because of this, bottom dentures won’t fit as well, almost as if they are floating in your mouth,” explained Dr. Nancy Mouradian, the Prosthodontist resident who treated Winagle under the supervision of the division chair, Dr. Carlo Ercoli. “Many patients like Dan have found that implant-supported dentures allow a much better fit and better retention without the expense of full implants and crowns.”

At age 85, Dan loves going to work every day to help his clients, many of them who are retired. But now, when he meets a client out for lunch, he smiles a little brighter, and orders exactly what he wants.

“Having the partial denture supported by two implants has raspberriesbeen a world of difference! It’s like night and day,” he said. “I can eat whatever I want, and nothing gets under the denture. I can’t say enough good things about Eastman. For 15 years, I’ve always had good care from everyone who’s treated me. Dr. Baranovsky and Mouradian were both extremely caring and capable in the treatment they provided me. I cannot say enough positive things about them.”

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EIOH Resident Eliminates Patient’s Prolonged Pain

Some people believe in coincidence, while others believe that a certain chain of events is 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.

Theresa Nelson with Dr. Liu

Theresa Nelson with Dr. Xiuxin Liu

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 the 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 two-year 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 hyper-sensitized,” 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 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.

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