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Bill Klaproth (Host): The dental service on ECMC’s health campus offers a full scope of general dentistry for adults and their families. Here to talk more about ECMC Dentistry, Oral Oncology and Maxillofacial Prosthetics Services is Dr. Maureen Sullivan, Chief of Department of Dentistry are Erie County Medical Center. Dr. Sullivan, thank you so much for your time. So, can you inform us of the types of general dental treatments and procedures you perform at ECMC Dentistry?

Maureen Sullivan, DDS (Guest): Sure. First of all, I would like to thank you for having me. I appreciate the opportunity to talk about our department. I’m quite proud of it. With regards to general dentistry, we have a very large dental clinic in the main hospital of the Eric County Medical Center. We have a general practice residency program where we train residents to take care of all facets of dentistry. So, for example, a patient may have urgent dental needs where they are in pain, have toothaches, what have you or they may more ideally come in regularly for general dental care for their cleanings, their fillings, crown and bridge, dentures, what have you, implants. Probably the only think that we don’t do here is general orthodontics and regular dental care for children.

Bill: Okay, so you cover all the grounds that a normal dentist would cover as far as like you said check ups or someone needing a crown or a filling or a cleaning or even urgent dental needs. So, when it comes to then oral oncology; what types of cancers can arise in the mouth? Many people may not understand this or know about this. So, tell us about that Dr. Sullivan.

Dr. Sullivan: Well, oral oncology, our department is quite robust. We have oral oncologist dentists that are trained in the diagnosis or oral and head and neck cancers. So, we have let’s see about eight dentists that screen everyday for oral cancer. Dr. Jennifer Frustino who is a DDS, PhD in our department has an oral cancer screening program where she uses various technologies to try and identify cancers early in patients that are high-risk for oral and head and neck cancers. So, what is ideal, is if a patient has an unusual lesion that’s identified by their general dentist or an ENT, or their primary care physician; they refer the patient to us and we will make every attempt to biopsy and get a diagnosis, because the earlier these cancers are found, the better the outcome.

Bill: So, early diagnosis, very important. And you mentioned patients high at risk. Who would be high at risk for oral cancer?

Dr. Sullivan: Well, a lot of patients that have smoked cigarettes or had a history of alcohol abuse, especially a combination of the two are at higher risk for an oral or head and neck cancer. Patients that have had a previous head and neck cancer or a patient who has had a long-standing lesion in their mouth or oral cavity; we would follow them for being someone who is at higher risk of developing a cancer. So, depending upon that risk and our level of suspicion, we will follow them, enroll them in the cancer screening program and we will see them often. The patients that have had for example, a previous cancer elsewhere such a patient with lung cancer, cancers of the upper aerodigestive tract; they would be at high risk also for head and neck cancer.

Bill: So, how does your dental team diagnose and treat these types of cancers?

Dr. Sullivan: Well, initially, the most important thing is to establish a diagnosis. So, what we may do is take one biopsy or several biopsies, depending on the type of lesion that we found and send it to a pathologist that we work with and has in-depth knowledge forehead and neck and oral cancers. So, getting a good diagnosis first is tantamount to getting treated quickly. So, once we have a cancer diagnosis; we would order further imaging like a CAT scan or an MRI and then we would speak with one of the head and neck surgeons for how we could get the patient treated promptly.

Bill: So, Dr. Sullivan, what is maxillofacial prosthetics? It sounds like if someone has had an oral cancer, and there’s a surgery of the mouth, you come in with a prosthetic. Can you explain this to us? Am I in the right ballpark?

Dr. Sullivan: Oh sure. Oh, you are in the park. You are in the park. So, a patient let’s say who has a cancer of their upper jaw or of their lower jaw, what might be required following the removal, is to replace the native tissues with a prosthesis. I’ll give you an example. If your- if a cancer is found in the posterior aspect of your hard palate or the anterior aspect; you may have difficulties controlling saliva or having difficulty with speech, you might have compromised swallowing. So, we would be asked to provide a prosthetic that would enable to patient to function better and more efficiently following the surgery. So, they may have a prosthesis immediately, the day of surgery, where we would modify that frequently until the patient is completely healed or completed other therapies such as chemotherapy and radiation and then once the patient has recovered from these additional therapies; then we would make him a definitive prosthesis. So, that’s a type of intraoral prosthesis. Another type of prosthetic that the maxillofacial prosthodontist fabricate are extraoral prosthesis. You can also get cancers of the head and neck of the nose or of the ear for example and a flap might not be the most ideal way to replace the tissues that are lost, so we would fabricate a prosthetic ear or prosthetic nose and sometimes a prosthetic eye.

Bill: That’s amazing. And you have an in-house lab outfitted to make various maxillofacial prosthetics?

Dr. Sullivan: Oh yeah. So, we have a full-time laboratory technician actually he’s not only one of the most gifted technicians I have ever worked with; but he’s pretty much one of the greatest guys I have every met Ed Pawenski. But anyhow, Ed is – he runs our lab and we also have three maxillofacial prosthodontists, Terry McLean, Amanda Colebeck and we just hired Paul Canallatos who just finished training in UCLA and they are really a highly skilled and highly trained team to fabricate design and the front end. We try to get - the best prosthetic we can make is when we are involved with the head and neck surgeons, the radiation oncologist, the speech and swallowing therapists, all the team at the front end at diagnosis so that we have the best ability to fabricate the best fitting prosthetic for the patient.

Bill: And when a patient –

Dr. Sullivan: We have a great team.

Bill: It sounds like it. It’s amazing. So, when a patient is fitted with a prosthetic; is that something okay well, do you follow up with them or are they pretty much set for the rest of their life? What happens? Is there wear and tear where you have to adjust it or remake it years down the road? How does that work?

Dr. Sullivan: Well, in order for it to function well and look good; they need regular care. So, I will give you an example. So, if a patient has an intraoral prosthetic, they may have several iterations before the final is made and then once the final prosthesis is made, they may undergo changes postsurgical and just changes over time to the remaining dentition or what have you that they might have to have frequent adjustments and that’s why we are here. That’s why there are so many of us. We have so many patients that need ongoing care. And not only that, but if they suffered a cancer, which caused the prosthesis, then we would be on guard constantly to be looking for any further malignancies. But yes, prosthetics need constant maintenance and after a number of years, remakes. And that’s what we would do. For extraoral prostheses such as a prosthetic nose or a prosthetic ear. Just wear and tear, exposure to the elements, it would have to be replaced every few years and we are happy to do that.

Bill: Quite a program and quite a team. And Dr. Sullivan what else do we need to know about ECMC Dentistry?

Dr. Sullivan: Well, I think for the future, we are expanding our program. We are moving into a dental clinic hopefully the beginning of September at the Buffalo General Hospital at Kaleida. Kaleida are partners at Great Lakes Health and we are looking forward to providing care for their inpatients, their employees, the patients that have no ability to have general dental care there and also, they have a large emergency room that we will support. They have skilled nursing facilities that we will support. So, we are looking forward to opening up the clinic there and expanding our program once again.

Bill: What a great service. Dr. Sullivan, thank you so much for your time today. For more information on ECMC Dentistry just visit www.ecmc.edu, that’s www.ecmc.edu. This is the True Care Health cast from Erie County Medical Center. I’m Bill Klaproth. Thanks for listening.