Doctors rebuild cancer victim’s smileIlissa Swanson’s smile grew broader near the end of last year when she completed a three-year process that left her with a mouth full of teeth. Before that, she had only wiggly, dysfunctional wisps of enamel.
By: Debbie Griffin, River Falls Journal
Ilissa Swanson’s smile grew broader near the end of last year when she completed a three-year process that left her with a mouth full of teeth. Before that, she had only wiggly, dysfunctional wisps of enamel.
The perky 26-year-old New Richmond resident said when she was a small child, her late mother Theresa began bringing her to see local dentist Dr. Steve Schwalbach, who also does orthodontics. He later referred her to local oral surgeon Dr. Steve Johnson.
The two men are friends, college mates and colleagues. Both agree the young woman’s case is unique.
At 17 months old, doctors diagnosed her with acute myeloid leukemia (AML) --cancer in her bone marrow and blood.
She is amazed by her own survival, especially knowing that as a young victim of AML, the odds were stacked against her.
Government statistics show the median age for an AML patient is 67 -- the incidence rate is about seven in 200,000. A public health web site says: “This type of cancer is rare under age 40.”
Swanson explains that she underwent intensive and potent radiation treatments and a kind of chemotherapy so harsh that her parents couldn’t come into the room while she had it.
The doctors administered the drug using full protective suits and long metal tongs.
She said, “They couldn’t even touch the bag that the medicine was in.”
Through a port, doctors sent the medicine directly to her heart, the only tissue in her body strong enough to withstand the treatment.
She had spinal taps, bone biopsies and finally a bone-marrow transplant from her brother Myles when he was seven months old and she was 20 months old.
Unusually, Swanson did not need any anti-rejection drugs -- a fact she credits her mother for discovering in a casual talk with a blood-lab technician.
Swanson wishes her mom, who she says took full-and-active charge of her treatment, could see the “wonderful” results of her oral surgery.
“If it weren’t for Mom, I wouldn’t be living my life as comfortably as I am,” said Swanson.
Swanson moved to New Richmond when she was two. She said her father Tom lives nearby, and she has six siblings: Trevor, Myles, Logan, Spencer, Wynn and Sylvia.
She said her cancer treatments permanently damaged the rapidly growing cells in her body, the ones that make fingernails, hair, teeth, skin and eyes.
She’s had cataract surgery to replace her eye lenses, and, tired of being less than four feet tall, she also tried intensive growth-hormone therapy for a period.
Swanson said, “I had such a positive reaction to it that I grew six inches in the first six months,” explaining that she’s happy at her current height of about 4’ 9”.
She said before the work, she describes her mouth as having fewer teeth than normal, all of which were “wiggly.” Swanson said she’d grown accustomed to having teeth that didn’t work well.
Johnson and Schwalbach agree that her tooth buds, roots, and jaw bone were extremely underdeveloped, lacking the structure to hold teeth. Schwalbach said he’d placed braces on her natural teeth just to hold them in.
Between them, the two doctors reconstructed bone inside her mouth, widened the bridge of her mouth, inserted implants, and attached bridges and crowns to those implants.
Schwalbach said Swanson was missing all her upper teeth except the molars -- he implanted 10 teeth on her upper jaw and four on her lower jaw.
The two doctors both do pro-bono work that comes about in different ways -- through charitable organizations and sometimes unique cases like Swanson’s.
Though they have a limited number of hours to give, both knew they wanted to help the young woman to chew and smile normally.
Asked for an estimated dollar value of the work, the doctors agree it is in the neighborhood of $50,000.
The local doctors are finished with the basic process they envisioned for Swanson, though she may need additional work through the years.
Swanson said she’ll strive to come back to them and pay for more work that will continue improving the condition and appearance of her mouth and teeth.
Schwalbach, who established Associated Dentists, has practiced in River Falls 40 years in June.
He said especially considering that Swanson’s cancer treatment damaged her ‘dentician’ -- all teeth and entire mouth -- she has responded well and been a great patient.
Schwalbach says it was necessary to wait until Swanson’s bones had fully developed -- he said the waiting was probably the most difficult challenge.
The doctors say Swanson’s lack of development, especially the almost non-existent upper-mouth ridge, was the main and biggest technical issue.
Johnson has practiced for 35 years, 30 of it in River Falls, “We do oral and maxillofacial surgery,” he explained about his practice, St. Croix Oral Surgery on Second Street.
He works with cases of trauma, reconstruction, pathology, facial deformities, dental implants and wisdom teeth. The doctor explains that he specializes in the area from just below a person’s eye socket down to their lower jaw.
“We do the pre-prosthetic work,” explained Johnson.
He said the first step in Swanson’s case was reconstructing the upper jaw by grafting bone -- her mouth needed enough structure to hold implants. Johnson said physicians can graft bone from the patient or use bone that is synthetic or freeze-dried from a tissue bank.
For Swanson, they decided to avoid more surgical trauma and use a combination of synthetic and freeze-dried bone, both of which worked well, Johnson said.
He said the doctors’ process involved making wax teeth, each with a plastic splint that had radiographic markers to show where the implants would go.
An implant-software program took a scan of Swanson’s upper and lower jaw then melded the two together so professionals could look at her jaw from any angle.
Another device could tell doctors how strong the implant would be and how long it needed to heal.
The final product of the treatment was four fixed bridges in Swanson’s mouth, two on the top and two on the bottom -- all of which come together in a broad, natural-looking smile.
Swanson said she is hugely grateful to both doctors.
A caretaker to her autistic 15-year-old brother and a hobbyist cheesecake chef aspiring to be professional, she says her ‘new mouth’ gives her confidence and even more reasons to smile.
Once, she’d accepted her delicate dental situation as normal.
Now she not only has a renewed confidence as she talks and smiles, she also can’t feel the difference between the implants and her natural teeth.