Another kind of dentistry

Another kind of dentistry

Daniel McCabe | Paul Allison is a textbook example of the benefits of perseverance. As Allison knows all too well, young professors don't always have an easy time of it securing funding for their research.

The first time he sent off an application to the Canadian Institutes for Health Research, hoping to receive support for his studies, he was turned down. The second time, he came painfully close, but was shut out again.

The third time he tried, Allison succeeded. Boy did he succeed.

The dentistry professor was recently named one of this year's three recipients of the new Peter Lougheed/CIHR Scholarships. The CIHR itself refers to the prize, co-sponsored by the Peter Lougheed Medical Research Foundation, as its "pre-eminent award" and the three professors receiving it -- all applicants for funding from the CIHR's New Investigators competition -- were the highest rated applicants from a nation-wide pool.

For Allison, that means he'll be receiving approximately $525,000 (salary support as well as a $250,000 research allowance) over a five-year period -- more money than he was asking or hoping for. Enough money to boost two separate areas of research.

The research effort he was recognized for involves examining the oral health needs of individuals with Down syndrome. It is a topic about which very little is known.

While other health problems associated with Down syndrome, such as leukemia, Alzheimer's disease and heart troubles, are well documented, oral health is a subject that hasn't been much explored. "It's an empty field," says Allison. "We're just beginning to describe the problems."

Allison is working with a clinician in France who specializes in treating patients with Down syndrome. They administered a questionnaire to parents in 250 French families with children with Down syndrome to get a sense of the kinds of treatments these children require and the sorts of oral health problems they face.

One health concern that cropped up related to tongue size. "Very often with these children, you'll see their tongues sticking out. That's because their tongues are physically larger than ours," says Allison.

The reason for that, explains Allison, is that they don't have as much control over their tongues. The muscles become relaxed and the tongue gets larger as a result. That in turn causes other problems -- it can affect how the lower teeth develop. To make room for the tongue, the lower teeth grow in such a way that they fit over the upper teeth instead of vice versa. This affects a child's ability to chew properly.

Armed with this knowledge, Allison's colleague in France is developing a simple orthodontic devise to try to help such patients gain better control over their tongues so that they won't swell up.

Allison followed up on that work with a more extensive questionnaire that targeted Canadian families with children with Down syndrome. About 2,000 questionnaires have been completed and Allison and his team are just starting to analyze the results.

"I will be in a position to describe what the problems are in Canada. I have no magic answers in my head at this point, but we'll be able to get the ball rolling in terms of describing what needs to be addressed."

That's a discussion that individuals with Down syndrome and their families will welcome. When Allison contacted the Canadian Down Syndrome Society to solicit their support for the project, he says the response was enthusiastic. "The executive director couldn't remember the last time she was asked to be involved in a project like this."

Allison has a sense of some of the problems that need to be addressed. "Many dentists feel uncomfortable dealing with these sorts of patients because they haven't received any training in this area." There is no coordinated approach to providing dental care to patients with Down syndrome. "It's very ad hoc."

The other focus of Allison's research efforts deals with another group of patients that have unique needs -- individuals with head and neck cancers.

On this front, Allison is working with nursing professor Linda Edgar who helped develop a workbook about coping skills for cancer patients. The workbook aims at building up the confidence levels of cancer patients by offering practical advice on how to handle things like fatigue, while stressing the importance of a positive attitude in the fight against illness.

"We've invested millions into the search for cures for cancer and we've had very limited success," says Allison. "That doesn't mean we should stop, but more and more research is being done on how we can improve the quality of life for these individuals, how we can address the psychological aspects of what they're dealing with."

Allison believes this approach is essential.

"There is plenty of research that shows that pessimistic patients tend to do worse. They are more likely to go into denial, to be fatalistic, to cede control over their care to their doctors.

"Optimistic people are much more likely to be involved in problem-solving approaches, to be involved in building support networks for themselves." Everything else being equal, Allison says, "you can predict who survives" in large part based on the kind of attitude patients have about their illnesses.

Edgar and her colleagues have found that their workbook and its emphasis on hope and assertiveness have helped reduce the amount of depression breast cancer patients have experienced during their illnesses. Allison wants to try that approach with patients contending with head and neck cancers.

"My personal experience is that these people tend to be a fairly fatalistic group. They are mostly older men with histories of smoking or drinking a lot. They tend to come from poor socio-economic backgrounds. Life has been quite a struggle for them and they've felt a lack of control."

Head and neck cancers are traumatic conditions. "With cancer of the tongue, you could have half your tongue removed. That affects your ability to talk and to eat. Radiotherapy affects the glands that produce saliva so that they no longer produce saliva. Believe me, we don't think of saliva very often, but it's extremely uncomfortable when you don't have it anymore. This is all on top of the trauma that's simply associated with being diagnosed with cancer."

Allison is a public health specialist but he originally trained to be a dental surgeon. After completing his residency and fulfilling all the requirements necessary for embarking on a career as a dental surgeon, Allison switched gears.

"While I was training as a resident in dental surgery in England, I started questioning the way things were done. There didn't always seem to be a rhyme or reason to it. We were doing surgeries that I found difficult to justify."

He brings up wisdom teeth extractions. "There are very strong traditions in dentistry and science hasn't always been used very much. Science says there is no need to take out wisdom teeth unless they're causing repeated infections. When you do the procedure, there is always a small risk of causing nerve damage." But wisdom tooth extraction has been a hallmark of dental practice, so it kept getting done.

Allison is more comfortable these days looking at the "big picture" from a public health perspective, but he is grateful for his background as a practicing dentist. "I combine the two types of training I received." His dental background affords him insights into the "little picture" -- what it's like to have to face the sorts of dental problems that the patient populations he studies have to contend with.