The Other Face of VA Dentistry



Dr. Dai Phan evaluates the fit and skin tone of a prosthesis for Louis Matarangolo and matches it to his complexion.

Dr. Dai Phan evaluates the fit and skin tone of a prosthesis for Louis Matarangolo and matches it to his complexion.

In our patient population, it’s not uncommon for some Veterans to lose part of the oral cavity or have facial defects due to trauma, head and neck cancer, or both. These patients are normally treated by a dental specialist employed in the VA dental service. A maxillofacial prosthodontist is a dental specialist who provides prosthetic reconstruction for the oral cavity and the maxillofacial region as well.

A typical request to the maxillofacial prosthodontist is to provide an oral prosthesis to patients who are missing parts of their oral cavity, so that they can more easily eat, drink and speak. In cases where parts of the facial area need to be restored – such as a missing nose, ear or eyes – they will also be called on to provide this kind of restoration.

Louis (“Lou”) Matarangolo had part of his maxillary palate and nose removed many years ago due to a facial tumor. As a result, Louis had difficulty talking and eating, and he did not feel comfortable in public. Louis’s reconstruction called for a prosthesis to close the palatal defect and a nasal prosthesis made out of medical-grade silicone to restore the missing nose.

moulage

Dr. Phan produces a master cast “moulage” of Matarangolo’s face.

Teamwork was vital to the success of this rehabilitation. It involved a dental specialist as well as dental technicians at Dobbs Labs, Inc. in Hoover, Ala., and a maxillofacial prosthetics technician at the James J. Peters VA Medical Center in Bronx, N.Y.

My job was to provide an accurate reproduction of the defect areas and their surrounding anatomical structures, as well as measurements, so that both the dental and the nasal prostheses could be fabricated. An impression known as “facial moulage,” was taken of the entire face and sent to the prosthetics technician, along with current and past photos of the patient, so that the artificial nose would accurately reflect the patient’s pre-surgery appearance.

The dental laboratory technician created the oral prostheses from the measurements provided on the laboratory prescription. The nasal prosthesis was then waxed up and processed to match the patient’s skin tone and complexion.

pigment

Dr. Phan applies pigments to match the skin tone.

After this step, the prostheses were returned to me, and I began the process to fit them to Lou. This involved seeing how they fit when he talked, ate, and smiled – would they stay in place without dislodging? Could he breathe OK? Did he like them?

I took that feedback and gave it to the technicians, and they changed the prostheses to fit his needs.

Sometimes at the delivery visit, pigments have to be applied to ensure the seamless transition between the natural and artificial skin tones. And due to the seasonal changes that affect skin color – tan in the summer, paler skin in the winter – we developed two different nasal prostheses for him.

Two different prostheses were made to accommodate seasonal changes to skin color.

Two different prostheses were made to accommodate seasonal changes to skin color.

I find my field of work highly rewarding when I know that my service has such an impact on someone’s quality of life. Practicing maxillofacial prosthodontics allows me to combine medicine, dentistry and art into one. It gives me even more satisfaction when I am able to provide valuable service to those who gave us the freedom we have today. For our returning troops who may have maxillofacial defects sustained by wartime injuries, prosthetic reconstruction provided by VA dental services fills a gap in cases where surgical reconstruction may not be feasible.

My special thanks to the technicians at Dobbs Labs, Inc. for construction of the oral prostheses and to Sarah Wisniewski (maxillofacial prosthetic technician in training) at the James J. Peters VAMC – in Bronx, N.Y., for fabrication of the nasal prostheses.

Photographs taken by Kenneth Holt, medical media photographer, William Jennings Bryan Dorn VAMC.

phanbwfrDai C. Phan DDS, MS is currently a maxillofacial prosthodontist at the William Jennings Bryan Dorn VAMC in Columbia, South Carolina. He along with his older brother and parents escaped from Vietnam in 1978 as boat people and settled to America in 1980. He was an assistant professor in prosthodontics at the University of Tennessee at Memphis until he started his career in the VA system since 2003. Dr. Phan is an avid mentor for students seeking career in dentistry and frequently lectures in a variety of dental topics. Read about Dr. Phan’s story in the Jan/Feb 2009 edition of Vanguard, page 18.

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Dai Phan

Comments

  1. Robert Cecil    

    I can address the matter of your V.A. Fight for your benefits;
    The V.A. Is the sister of all beaucracy , to the Social Security Administration.
    Both when you approach for those entitlements you believe are yours just And True…you are DENIED.
    Both these Agencies are a complex maze of rule, regulation, and law. Both the Agencies require some one knowledgeable and willing to represent YOU.
    Vets, go to the Disabled American Vets (DAV), American Legion, Vgeterans of Foreign Wars (VFW) , etc. .
    All of these Organizations are Veterans Organization with just such people to represent You called “Field service Officers ” (FSO).
    If you feel you are entitled to more because of your service in Viet Nam , you may well find that due to the passage of years; that may well be true my friends.
    You’ll never know what you’re missing until you seek it.
    Myself, I asked the DAV Field Service Officer here in Portland in utter frustration to please help me, and help me they did!
    The hearings and appeals all Addressed by them, through and to the 100% rating in 1989.
    I am Proudly a Life Member of the DAV, and a committed member of the Amerian Legion.
    I urge you folks to seek these dedicatedeople out, and ask for their help too.

  2. Richard Kath    

    What’s the problem out there? I had a toothache on Friday and since I live a couple hundred Miles from Saginaw, Mi VA they said go to a local dentist on Monday. I did this and had all my teeth pulled out on Tuesday. Now I am going to the same local dentist for the full set of Dentures with implants.

  3. Houston    

    Nice work, Dr. Phan! You sound like an excellent
    person and mentor to young, up-and-coming dentists.

  4. Sheridan Peterson    

    Such utter hog wash. The VA clinic here in Santa Rosa, CA is state-of-the-art facilities, but I , and 88 year old World War II Marine Corps vet with grave dental problems must take public transportation some 70 miles to the UCSF dental school in San Francisco.Now because of lies printed by a SF Hospital physician in my health records and passed on the the dental school, I no longer have access to the dental school.

  5. truyện trinh thám    

    I have a friend who also lost a leg and a prosthesis fitting as he lost the will and determination. Doctors do not know which way to regain energy for the after orthopedic surgery or like me you can live happier and more energetic life not

  6. Cheryl D. Clemens    

    I care for a wonderful World War Two veteran. How would I know if he qualifies for dental or not. They have lost all of his military papers. Please help us?

  7. lee franckowiak    

    Thankyou all for your service–and thanks to those who put honest effort in the healthcare of our nations Veterans. I had to fight tooth and nail, took me 4 years to get dentures that look like horse-teeth and rip my gums bloody. Reform dental care for all Veterans–To all; talk personall to your congressmen–and American Legion leaders.

  8. Ha Tran    

    Recently what happen in this country focus a lot on Veteran Affairs Services in US.
    Dr. Phan is doing a good job for VA SMILE, that’s a lot of meaning for smile, I’m in Syracuse, if any one who want to tell more stories about VA in this country should come to Syracuse NY to see me. I will tell you more about WWII, KOREAN WAR, , and less Vietnam War in Syracuse ! Papa Don Fida is one sample in during WWII,people in Syracuse should learn and Mama Ruthy WWII VA will give you more story… what can we help this time not VA office is the HEALTHCARE SYSTEM in the country, we need to change the people and the service provide for the elderly special with the VA in Syracuse.

    1. Sheridan Peterson    

      Well said Tran.I am in full agreement.

  9. Julia Ramirez    

    My husband Viet Nam Vet served during time of Agent Orange use i tbe areas sprayed, ate, drank water, patrolled in jungles, slept and waded in the water sprayed by this poison. Diagnosed with known caused Type II Diabetes, his teeth are darkend, falling out, I just read the article stating that Vets ARE due dental “if” the dental issues are connected to the “service” disability…NO MENTION OF SO CALLED “REGS” SAYING THE MUST BE 100% DISALED!! Sounds like the ol’ “secret” list treatment again! This country OWES these men & women! There should be NO so called “regs” on the benefits for them. Cost too much…cut the freebees given to “illegals”.

  10. Thomas Ramon    

    Absolutely correct, you must be 100% disabled. The military did my dental and like you it’s all broken and decayed. I have to beg my PC to give me an antibiotic to get rid of some of the pain due to infection……………..you can totally forget about getting something other than an aspirin for the pain. With all the millions of $ being paid out in bonuses to VA admin. I wonder why they can’t just hire some more dentist or at least someone to fix fillings and broken teeth so that we can at least eat or smile without embarrasment.
    Yes, I know about the VA dental plan thats around, some of us can’t afford it. Personally I feel that I earned this benefit when I was working for Uncle Sam for $99 /mo for about a 90 hour week. 1967- 73

  11. Bill    

    Dr. Phan, I would like to thank you for what you have been through in your lifetime and for your dedication to helping my Brothers who served this great country of ours. I pray to God you and many others continue to assist all Veteran’s to a better life. Nothings says happiness ike a smile.

  12. victor m. zavala    

    Well here is a good one, the military did all my dental work and now that I am retired back in 1997, well all my the work the military did on my teeth are all broken and deca and they, the VA does not give us that dental we need even thought the military did they work and the ONLY way the VA does our dental work if you are 100%, they throw the Regs on your face, they may say they will help us on a base to base situation But at the End they hit you with the VA Regs and standard, MUST by 100%.

    1. Charity W. Rollins    

      I know how you all feel! I recently had a long time medical issue diagnosed, but because of my teeth or lack there of I can no longer eat many things especially meat. My mandible is degenerating and so my teeth are falling out. I am trying to get dental care again, but I don’t have hopes of getting this issue addressed. On another track has anyone had appointments of more than six months standing had them canceled at 7:00 am on the day of the appointment and then not be rescheduled? Just curious, just happened to me.

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