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In a secluded corner of St. Jude Children’s Research Hospital, a patient howls with delight, a web of neon-colored Silly String streaming across his head and torso. “This is payback for a past visit when he ambushed me,” laughs Dental Clinic employee Diana Hill, as the 14-year-old patient proudly displays his rubbery cape like a badge of honor.
Welcome to the St. Jude Dental Clinic, a place of laughter and hugs, smiles and jokes. But it’s also a place where patients come for serious treatment and education that could literally save their lives.
In spite of a staff consisting of only three employees, the clinic is a hub of constant activity. Hill and her colleagues will perform about 5,043 procedures on nearly 900 patients this year, numbers that have tripled since 2001. But many people are unaware of the clinic’s services.
“A lot of people don’t realize the importance of what we do here,” says Kathy Wortham, dental assistant. “They say, ‘Can’t the kids get their dental care at home?’ Well, the answer is no.”
Wortham says the requirements of patients at St. Jude extend far beyond the scope of most general dentists, who rarely treat children with cancer or sickle cell disease, HIV infections or genetic disorders. “The abnormal is the normal here,” she says. “Out in private practice, you almost never see any of these abnormalities.”
Although all St. Jude patients do not visit the Dental Clinic, many of them do as part of their protocols, or scientific treatment plans. Every child scheduled for a stem cell transplant must have a dental examination. During the transplant process, patients’ infection-fighting ability usually plummets. Christopher Rowland, DDS, says it’s imperative for these children to be as healthy as possible before they begin treatment.
“If kids go to transplant and have cavities or abscessed teeth, they could get terrible infections,” Rowland says, “and if they get infections, they could have serious complications. Why put kids at risk when all we have to do is do an exam?”
All patients undergoing head and neck radiation also visit the Dental Clinic. Radiation shuts down the salivary glands and puts these children at risk of developing cavities. Saliva normally bathes the teeth and washes away bacteria. But when saliva is absent, bacteria attack the teeth and cause them to deteriorate. In addition to daily, self-administered fluoride treatments, St. Jude patients undergoing head and neck radiation use toothpastes, mouthwashes and artificial saliva specifically formulated to alleviate the problems they encounter. “Without immaculate care, some of these kids are susceptible to serious problems,” Wortham says.
The Dental Clinic staff use humor to offer gentle correction to patients who balk at taking scrupulous care of their teeth. Today, a preteen from Dallas, Texas, admits he does not always floss or use fluoride. “I’m already using five different mouth rinses three times a day,” he complains.
“Well, that will keep you from getting mouth sores,” Wortham replies. “But if you want to keep your teeth, it’s really important to take care of them.
“Only brush the teeth you want to keep,” Wortham continues. “So if you don’t want to keep these two right here, don’t brush those.” Moments later, laden with a bagful of licorice toothpaste and cool flossers in fluorescent colors, the grinning boy climbs out of the examination chair and gives Wortham a hearty hug.
On a sunny Tuesday morning, the small clinic buzzes with laughter and the chatter of patients, parents, employees, a pediatric dental resident and two visiting dental students. Rowland uses dental hygiene students, residents and fellows to help clinic employees conduct more research and treat more patients; these young professionals simultaneously obtain valuable work experience.
St. Jude nurses also help Rowland and his colleagues promote dental health. Many patients undergoing chemotherapy develop mucositis, which causes mouth and throat sores. Rowland enlists nurses to help educate patients about mouth care.
Geisa Silva, DDS, chief of the Dentistry division at Hospital Araújo Jorge in Goiás, Brazil, recently spent a month at St. Jude as a guest of its International Outreach Program. “I learned many things, and I saw different types of treatment,” says Silva, who plans to use Rowland’s techniques for educating patients.
“Once a month, Chris goes to nursing orientation and teaches new nurses how to do mouth care,” Silva adds. “He is the only dentist there, and in my hospital it’s just me. It will help me a lot to make this change.”
About 14 years ago, Sue Kaste, DO, of Radiological Sciences began collaborating with Ken Hopkins, DDS, who was the St. Jude dentist at that time. She and Hopkins subsequently published some of the benchmark papers outlining the dental problems of childhood cancer patients. When Rowland arrived at St. Jude in 2002, he began working with Kaste on many projects, often involving students from the University of Tennessee Health Science Center’s College of Dentistry.
“There’s not a lot in dental literature about kids being treated for cancer,” Rowland explains. “We have tons of information at St. Jude that needs to be shared. That’s really my motivation for doing research.”
The projects are varied in scope. A recent study addressed tooth development in children with Hurler’s syndrome, a rare genetic disorder. Another project involves hundreds of orthodontists who are providing researchers with information about dental problems they have encountered in childhood cancer survivors. Yet another study looks at dental changes in children who have undergone bone marrow transplants. And an orthodontic fellow has begun studying the correlation between dental development and bone ages. Chemotherapy and other treatments can drastically affect dental development; this study will give orthodontists crucial information so that they can take better care of their patients.
“These research projects are really exciting because they benefit kids worldwide,” Kaste says. “We have the opportunity and the resources to make it happen. I’m really committed to maxing out what we can do.”
During a momentary lull in the morning’s activities, Rowland, Hill and a resident visit the hospital’s third floor to examine a 15-year-old boy from Chile. In a two-hour span they have also treated children from Egypt, Mexico, Venezuela and across the United States.
Rowland says he enjoys the variety inherent in his work and the depth of relationships he can form at St. Jude. “My wife and I originally wanted to go into the mission field, where we could spend time in an economically depressed area or another country,” he says. “The great thing about being at St. Jude is that I’m there. I’m all over the world every day: in Beirut one hour; in Jordan a few minutes later; in lower Arkansas or Louisiana or North Dakota the next hour. I have a unique opportunity to serve families who are facing suffering or death…to share with those families and pray with some of them and do things that are not normal for regular private dentistry.
“It’s not fun watching these families suffer. But when good things happen, or when parents have a peace about what’s going on, it’s an encouraging thing to me. It’s a privilege to be here.”
Throughout a long dental procedure, a teenaged patient grasps Wortham’s hand, as if for emotional support. Afterward, Wortham admits that her involvement with St. Jude patients and families feeds her soul.
“God puts us in a place for a reason,” she says. “I love these families, and it’s such a blessing to me to be here with them. Dentistry’s just a bonus.
“Yes, I go home crying sometimes, and yes, I go home laughing sometimes. But these patients and their families are the reason that every day I want to come back here.”
Reprinted from Promise magazine, autumn 2004.
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