Day 5: The Dental Team
Integral to the success of the Iowa MOST mission is the dental team, and while not all cleft lip/cleft palate projects have them, the dental team has been a part of the project since the beginning. Dr. Bill Gates, a dentist in private practice in Durham, North Carolina, is on his 8th trip here with Iowa MOST. Joining him this year is Dr. Jeffery Markt, a dentist located in Omaha, Nebraska, and Aaron Jones, a 4th year dental student who brings Spanish fluency to the team.
Many children require dental extraction and other work prior to being able to receive cleft lip or cleft palate surgeries. Sometimes the work has to be done over a period of years and so having the program return to the same place every February helps create continuity of care and is easier for people to know when and how they can continue with follow-up procedures. There is another benefit in that when some of the parents or other adults visiting the hospital need dental work done, the team does its best to make room for them on the schedule. Cavities are a huge problem here and so many of the people have severe tooth decay and need extractions and, if possible, false teeth.
New to this year’s mission is Dr. Jeffery Markt whose specialty is making dental prostheses for cancer patients. In addition to making obturators (which create a prosthetic barrier in the mouth to allow patients with cleft palates to eat and drink more easily), Jeff made several dental prostheses and demonstrated how to they are made in the field.
The prosthesis I observed Jeff making began with an impression of the upper and lower teeth. Once this impression had been made into a mold of resin and hardened by “cooking it” in water under pressure, Jeff molded wires to wrap around a tooth on either side and sit at the base of the teeth and hold the denture in place. Then each individual false tooth is placed in wax into the denture. Once the teeth are set in wax, Jeff determined how the upper and lower would interact and then used a hand articulator to grind the teeth to the right height.
Once the prosthesis was a good fit with the mold, Bill took over the meticulous work of removing every bit of wax. In total, the entire process took two days to make and was fitted on the third day. The patient, a young woman of about 25, will have a great smile and much better mastication with her new teeth once she gets used to wearing them!