Lance Allen was at his regular check-up when his dentist noticed what looked like burn blisters on the roof of his mouth—but Lance knew he didn’t burn it. He was sent to an oral surgeon, who took a biopsy and gave Lance the bad news. He had adenoid cystic carcinoma, an uncommon type of oral cancer. Lance was referred to the Queen’s Head and Neck Institute. Today he’s dealing with complications, but his cancer is in remission, thanks to the collaboration of many disciplines at Queen’s, not least among them the Queen’s Dental Clinic (above: Lance Allen, center, with Dental Clinic staff).
Most people probably wouldn’t think about dentistry as playing a vital role in treating cancer, but it does. Hospital dentistry is in a class of its own, and The Queen’s Medical Center has the state’s most extensive program, with many services available nowhere else in Hawaii.
Perhaps the most familiar part of the Queen’s Dental Clinic is its outpatient services, which is like a full service dental office, offering everything from teeth cleaning to fillings, and even professional teeth whitening. Unlike many dental practices, though, the Dental Clinic can do really complicated stuff you might normally have to visit multiple specialists for, including, crowns, bridges, gum surgery, and root canals.
In Lance’s case, dental work went even beyond these. Once his treatment plan was agreed upon, Daniel Alam, MD, and Christopher Klem, MD, of the Head and Neck Institute sent Lance to the Dental Clinic ahead of surgery and radiation to perform any major dental work if needed, such as surgery on the bone or removal of non-restorable teeth. This is a critically important step, because major procedures done on radiation-weakened bone greatly increase the risk of osteonecrosis, or bone death. Additionally, treatment complications are minimized with customized oral appliances to block radiation from healthy bone and tissue. Appliances also protect damage to the taste buds and salivary glands. “We do everything we can to lower the risk to patients,” explains Natalie Chien, DDS, Dental Clinic. They also helped Lance with pain management during radiation treatment.
The Dental Clinic’s outpatient business helps it provide hospital dental services critical to many types of patients. Consultations are given at the bedside for inpatients, as well as taking care of their immediate dental needs. The Dental Clinic provides critically needed emergency work on trauma patients 24/7. Its dentists perform work on some of these patients under general anesthesia in the OR (see photo, above right: dentists perform oral surgery in the SDS).
In addition to the Head and Neck Institute, the Dental Clinic collaborates with Queen’s Heart, Neuro ICU, Transplant Center, Pre-Surgery Center, Emergency Department, Interventional Radiology, inpatient hospitalists, and other hospital units.
Finally, the Dental Clinic has had a dental residency program that trains fully licensed dentists who want to go over and above what most dental schools cover. The residents develop a wide variety of highly specialized patient care, and clinical and patient management skills. They rotate through a variety of services, including general medicine, general surgery, anesthesiology, oncology, and emergency medicine, with advanced training and clinical experience in preventive dentistry, periodontics, restorative dentistry, endodontics, and oral surgery. The residents are generally recent dental school graduates who could have immediately gone into independent practice. The program accepts the cream-of-the-crop in its highly competitive program. When training is complete, the residents become members of an elite group who have the training to perform work over and above many other dentists.
The Dental Clinic has been around since the completion of the ‘Iolani Wing in 1960 (photo, above left: Dental Clinic dentists consult with a physician, circa 1965). ‘Iolani represented the leading edge in hospital design for its time. The Queen’s Emergency Room was moved from Nalani to ‘Iolani, where ambulances could back in at the proper height to deliver patients. Temporarily relocated due to renovations, the Dental Clinic staff looks forward to soon moving back into an updated space, and toward future new equipment that will enhance patient care. “Our Dental Clinic is the best in the state,” said Les Chun, MD, QHS/QMC VP of Medical Staff Services & Chief Quality Officer. “It’s the only one that takes call 24/7 for trauma patients.”
“It’s been an adventure,” said Lance. “I have an overflowing feeling of gratitude to the entire Dental Clinic staff, Drs. Alam and Klem, Radiation Oncology staff, and the Queen’s Head & Neck Cancer Survivor Support Group.”
After his treatments, Lance began to have a problem with a loose molar. At first, it was diagnosed as decay requiring a root canal, but the Dental Clinic was asked for a second opinion. They determined the tooth was actually healthy, but that Lance was suffering from osteonecrosis in the area because of the extent of his cancer, which had extended into the bone. The Dental Clinic is working to maintain Lance’s bone health with frequent checking and cleaning, and medication to increase blood flow to the bone. “They’re working to help with my bone health,” said Lance. “It’s a big thing to be helped by people with such a wealth of knowledge. The experience of the entire team [of doctors, dentists, and others] is one of the huge treasures of Queen’s.”
Queen’s Dental Clinic
- Established in 1960
- Inpatient consultations and dental work
- Oncall 24/7 for emergency dental work for trauma patients, including in the OR
- Serves patients with physical & mental disabilities
- Collaborates with the Head and Neck Institute, Queen’s Heart, Neuro ICU, Transplant Center, Pre-Surgery Center, ED, Interventional Radiology, inpatient hospitalists, and other hospital units.
- Full service dental services, including teeth cleaning, teeth whitening, cavity repair, crowns, bridges, gum surgery, and root canals
- Dental residency program
