During his surgical residency at the Walter Reed National Military Medical Center, Dr. Dan Hammer focused on typical oral maxillofacial surgical procedures: wisdom tooth removal, dental implants, corrective jaw, facial trauma and infections, cleft lip and cleft palate, craniofacial surgery.
But he was also seeing many patients with severe facial trauma. This was as the number of troops in Iraq and Afghanistan had begun to wane. And as he worked through his residency, he wanted to be able to bring reconstructive skills back to the Wounded Warrior population.
That’s when he had a revelation: “If someone has a hole in their face from a bomb or they have a hole in their face because of horrific cancer, it still has to be reconstructed in the same way,” Dr. Hammer said. This led him to a fellowship focused on cancer removal and eventual reconstruction.
“If someone has a hole in their face from a bomb or they have a hole in their face because of horrific cancer, it still has to be reconstructed in the same way.”
“We were reconstructing them, but I was concerned about the functional outcome,” Dr. Hammer said. “The ability to speak, to swallow, to close their lips, to kiss their partner, a lot of these things that make us human. I wanted to learn the skillset … to bring back to the Wounded Warrior population to help them gain these outcomes.”
Dr. Hammer was commissioned into the Navy through the Health Professionals Scholarship Program. He’s “on loan” to the civilian sector for his current fellowship at John Peter Smith Hospital in Forth Worth, Texas. His plan is to couple his dental training with the competencies of microvascular reconstruction to help wounded veterans.
“I want to bring it to the Navy so we’re not just filling a hole but getting people to speak, swallow, have lips, have lip competency so they’re not drooling, hiding from public settings because they’re embarrassed,” Dr. Hammer said. “That’s why I’m here … to bring it back to the Navy.”
His work has led him to experiment with a non-operative treatment of medication-related osteonecrosis of the jaw – a side-effect of some cancer medicine that can lead to dead bone in the face and jaw. Some of the pain in cancer patients comes from bone destruction and a medication common for cancer patients stabilizes the bone structure – but the drawback is that the bone stops healing.
“So let’s say you get a tooth extracted or let’s say your mouth gets cut, if your bone can’t heal it gets exposed, it gets infected and it can die,” Dr. Hammer said.
The available treatment right now is pain medication, antibiotics, and maybe removal of dead bone – treating the symptom. If it’s really aggressive, the bone has to come out – major surgery. But then the patient is back to their ability to speak, swallow, be intimate – the human things.
The experimental treatment Dr. Hammer is working on involves dosing Vitamin E and blood vessel dilator to help get blood growth back into the area where bone isn’t dead but “struggling.”
“This is a well known complication of medication in the oral region,” Dr. Hammer said.
The treatment has the potential to “give everybody, general dentists, primary care surgeons, OMFSs, anybody who can prescribe these two drugs the ability to have a non-surgical option and maintain our patients’ quality of life.”
“If they need to get surgery to cut it out, then we always have that option,” Dr. Hammer said. “I feel better telling patient, we need to do this massive surgery because I literally tried everything because there’s nothing else out there.”
Dr. Hammer is a recipient of the 2018 10 Under 10 award. Read more about the award at ADA.org/10under10.