Nothing but the Tooth

The St. Jude Dental Clinic provides specialized care and education for children undergoing treatment for life-threatening diseases.

Role-playing exercises sometimes make checkups easier to bear: Chloe Love Prosise Juca allows her furry friend to have his teeth cleaned before she takes her turn.

Cary Daniel, DDS, doesn’t like to get stern with his young dental patients, but some situations call for desperate measures.

For instance, when a 3-year-old refuses to obey his mother and grandmother as they coax him to sit still in the dentist’s chair, Daniel takes charge.

“What’s your name, little boy?” Daniel asks in his best Donald Duck voice. The boy, who loves Mickey Mouse Clubhouse, is startled for a second. Then he sits still.

“Will you open your mouth for me?”

Cary Daniel, DDS, and Diana Hill

In the hospital’s surgical suite, Cary Daniel, DDS (at left), and Diana Hill attend to a patient whose dental needs are too extensive to be treated in the clinic.

It’s a voice Daniel learned when he was about the same age as his patient, a talent passed down from his father.

“Sometimes it backfires and they go running to their mom’s knee,” Daniel says, with a grin.

It may seem odd to find a dental clinic tucked into the corner of a cancer hospital with a worldwide reputation for saving children’s lives. But the St. Jude Children’s Research Hospital Dental Clinic provides services that are far from routine. This dental care may help save the lives of children who may be hundreds or thousands of miles away from their family dentists.

The clinic’s two dentists look for potential problems, such as cavities, that could lead to serious issues down the road. Staff members also educate parents and children about the critical role dental hygiene plays in the treatment of cancer, HIV infections, sickle cell disease and other disorders. Scrupulous oral hygiene is critical for St. Jude patients, because any infection can be lethal to a child with a compromised immune system. Children undergoing treatment also are at risk for a number of dental-related issues that demand the expertise of staff specially trained to deal with such rare complications.

Why is dental care crucial for St. Jude patients?

St. Jude Dental Clinic staff members are specially trained to deal with issues children may encounter as they undergo treatment for cancer, HIV infections, sickle cell disease and other disorders.

  1. A simple cavity could quickly become a serious infection in a child undergoing therapy. Cancer and its treatment can suppress a child’s infection-fighting ability. If an infection takes hold and is not treated, it could spread and become life threatening.

  2. Chemotherapy and radiation therapy may shut down the salivary glands, giving a child a perpetually dry mouth. Because saliva helps wash away bacteria, its absence can also make a child vulnerable to infection. St. Jude Dental Clinic staff members educate patients and provide them with the special toothpastes, mouthwashes and artificial saliva necessary to prevent or treat such issues.

  3. Chemotherapy, radiation and bone marrow transplants can affect tooth growth and development. Teeth may be smaller than normal, have shorter roots or fail to develop at all. The younger the children, the more likely they are to have these kinds of problems.

  4. Poor dental health may increase the likelihood of developing mucositis, an inflammation and ulceration of the mucous membranes lining the mouth and digestive tract. A common side effect of chemotherapy and radiation, mucositis causes pain that can inhibit a child’s willingness or ability to eat. Staff members in the Dental Clinic help patients avoid or deal with mucositis. St. Jude dentists are also researching the use of laser therapy to alleviate and treat inflammation in patients with this condition.

 

Hands-on learning

Decked out head to toe in pink and sporting fake butterfly and rose tattoos, 5-year-old Brooklyn Chudy wiggles around in the dental chair, fascinated with an oversized set of choppers lying on the table beside her. Dental Clinic coordinator Diana Hill hands Brooklyn a toothbrush and invites her to demonstrate how she brushes her teeth. The pony-tailed girl from Missouri scrubs a little on the front of the teeth. Using humor and encouragement, Hill shows Brooklyn how to brush her teeth, gums and tongue.

Next, Daniel talks with Brooklyn—no Donald Duck voice necessary this time. He rubs numbing jelly on her gums and gives “sleepy medicine” for the tooth before filling a cavity. Soon the procedure is over, and Brooklyn is on her way to her next appointment.

Twelve years ago, when Chris Rowland, DDS, began practicing dentistry at St. Jude, most of his patients were either preparing to undergo bone marrow transplants or had encountered dental problems during therapy. Today, the service has expanded to many other St. Jude patients as part of their routine care. The Dental Clinic staff sees about 1,100 patients and performs approximately 5,160 procedures each year—a number that has increased dramatically since Rowland’s arrival in 2002. That means more opportunities to catch infections in early stages or teach proper dental hygiene. While Rowland and Daniel handle the dentistry, Hill and dental assistant Kim Willis educate patients about dental care.

Some patients, particularly from impoverished countries, may not have had regular access to dental care before coming to St. Jude. To educate families and reduce stress on patients, parents are encouraged to accompany their children to the examination area.

“We want parents to understand the importance of oral hygiene and dental care,” Rowland says. “If we don’t have the parents engaged, then the child might not keep it up.”

Chris Rowland, DDS, Diana Hill and Brandice Allen visit patient Lucciano Antista.

If a patient cannot go to the Dental Clinic, the staff goes to the child. From left, Chris Rowland, DDS, Diana Hill and pediatric dental resident Brandice Allen visit the hospital room of patient Lucciano Antista, who has a toothache. 

Rowland and Daniel also provide educational opportunities for medical professionals, including nursing staff, students, dental residents and fellows from around the world.

“This helps increase the standards of care for kids, no matter where they are being treated,” Rowland explains.

Gaining trust

During their time at St. Jude, patients may contend with fatigue, rounds of chemotherapy, radiation or bone marrow transplants. But just like healthy children, they frequently ask one simple question all kids want to know when they visit the dentist: “Will it hurt?”

Daniel has a reassuring answer to that inquiry. “Will it hurt? You tell me! I’m going to take my water sprayer, and my assistant is going to take Mr. Thirsty, and we’re going to wash your teeth. If anything bothers you, just raise your hand, and we’ll make it comfortable.”

About half the children who visit the clinic receive fillings, extractions and other procedures, Daniel says. But inevitably, both children and parents leave the clinic with smiles on their faces.

“That’s a great thing about my job. I get the privilege of simply proving to them that it’s not painful,” Rowland says. “It’s gratifying to take a nervous kid and make them a compliant patient with minimized fear. One of the best parts of my job is walking them through it and gaining their trust in the end.”

Sometimes patients do more than just trust their St. Jude dentist—they admire him.

“One of my patients had a teddy bear named ‘Dr. Rowland,’ and she brought the bear with her during visits,” Rowland recalls.

“I’m thankful to report that he never had any cavities.”

From Promise, Autumn 2014

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