I am a maxillofacial prosthodontist/dental oncologist with more than twenty-five years of experience at Memorial Sloan-Kettering Cancer Center. I am an expert in creating prostheses to rehabilitate patients with defects or deficits of the face, jaws, and surrounding soft tissues, whether they are acquired as a result of cancer surgery or traumatic injuries, or from alterations in growth and development or congenital birth defects. I am Chief of the Dental Service at Memorial Sloan-Kettering, and am proud to participate in the premier training programs in Maxillofacial Prosthetics and Dental Oncology in the country.
I construct intraoral prostheses for defects of the hard and soft palate (obturators), resection appliances for lower jaw defects, and palatal augmentation prostheses for tongue deficits. I work closely with our head and neck surgeons and plastic surgeons when planning surgical prostheses and intraoperative dental interventions to improve or simplify their surgical procedures. These interventions may include surgical obturators, dental extractions, and intermaxillary fixation (“wiring jaws together”) to help the plastic surgeons reconstruct the lower jaw. Postoperative or interim prostheses help patients through their healing phase and adjuvant therapies such as radiation and/or chemotherapy.
Once patients have recovered and their healing is complete, I plan the fabrication of definitive or more long-term prostheses. I also provide various extraoral prostheses including ears, noses, eyes (ocular as well as orbital) and combination midfacial prostheses. I pioneered the use of osseointegrated implants in cancer patients and have used implants to support intraoral and extraoral prostheses in select patients.
As a dental oncologist, I am concerned with the effects of oral/dental disease on various cancer treatment approaches, especially bone marrow/stem cell transplant and head and neck radiation. Very often mundane dental problems can adversely affect the course of cancer therapy. A dental infection can become life-threatening in a patient whose immune system is severely compromised by high-dose chemotherapy. A thorough pre-treatment dental/oral assessment can minimize such complications. Conversely, cancer therapies often affect the oral cavity. Head and neck radiation therapy may promote post¬treatment dental disease and cause osteoradionecrosis (ORN) if dental surgery is required in irradiated bone.
Patients treated at Memorial Sloan-Kettering have among the lowest rates of ORN in the US because we extract unhealthy teeth before treatment, prescribe high-potency fluoride for patients to apply themselves, and see patients for frequent dental follow-ups. We were one of the first institutions to report on the incidence and management of bisphosphonate-related osteonecrosis of the jaws (ONJ), and have adopted a similar pre-treatment strategy in patients treated with this class of drug for metastases to bone.
In addition to my extensive clinical experience I have been active in clinical research and education. I am a Fellow of the American Academy of Maxillofacial Prosthetics and Chairman of its Research Committee and Educational Standards Committee. Over the years, I have written many papers on how various dental interventions affect the quality of life of cancer patients and I speak nationally and internationally on maxillofacial prosthetics and dental oncology.