More than a decade ago, Cathy Hapenney underwent surgery, radiation, and chemotherapy for squamous cell cancer on her tongue and the floor of her mouth. She’s grateful her cancer was cured, but the treatment left her with ongoing and life-changing oral health problems. “It’s kind of like a hidden cancer,” she said. “It seems like treatment never stops.”

Radiation to the head and neck can damage salivary glands, in addition to killing cancer cells. “The loss of saliva is incredibly debilitating, affecting the ability to eat, swallow, and taste,” says Edward Lahey, D00, chair of the Department of Oral and Maxillofacial Surgery at Tufts University School of Dental Medicine. “Saliva is protective of teeth so people will often get rampant tooth decay and lose teeth despite hypervigilant efforts to maintain oral hygiene.”

Radiation can also cause the bone in the jaw to die, sometimes years after treatment. This happened to Hapenney, and she had to undergo surgery to reconstruct her jaw using bone from her leg. She has lost all her lower teeth and uses a feeding tube.

For now, she still has her upper teeth, but she said it’s likely she will eventually lose them as well. To preserve as much function as possible for as long as possible, Hapenney receives care from experts at the Department of Oral and Maxillofacial Surgery. 

“I’m grateful to all at Tufts Dental,” Hapenney says. “It’s so important for any head and neck cancer survivor to feel confident in their care and to see someone experienced like Dr. Oreadi.” Daniel Oreadi, DG09, DI13, associate professor in the Department of Oral and Maxillofacial Surgery, helps Hapenney maintain the health of her jaws. “He is so kind and understanding,” she says. “I feel completely comfortable with him. He is incredibly knowledgeable.”

Where Dentistry and Medicine Converge

Oreadi’s upbringing prepared him well to care for patients at the intersection of dentistry and medicine. “I come from a family of dentists and physicians,” he says. Born in the United States, he grew up in Venezuela where his dad and paternal grandfather were dentists and his uncle and maternal grandfather were physicians. When Oreadi was in dental school, he decided to essentially combine the two professions by becoming an oral and maxillofacial surgeon. 

Oral and maxillofacial surgeons receive training beyond dental school to learn how to administer anesthesia and perform surgeries ranging from extracting wisdom teeth to reconstructing damaged and missing tissues. Oreadi completed a residency in oral and maxillofacial surgery at Tufts Dental, followed by a fellowship in head and neck oncologic and reconstructive surgery at the University of Tennessee Medical Center in Knoxville. “I fell in love with the oncologic aspect of the specialty—the treatment of benign and malignant tumors and reconstruction options,” he says.

The surgeries can be complex and lengthy, especially when they involve repairing or reconstructing soft or hard tissues after removing tumors. Oral and maxillofacial surgeons often operate on teams with otolaryngologists—ear, nose, and throat doctors—on operations lasting anywhere from nine to 12 hours.

For Oreadi, surgery to remove a tumor or rebuild a jawbone is just the first step. “The negative effects of surgery, radiation, and chemotherapy can have long-lasting impacts on a patient’s overall health and function,” Oreadi says. “We can do the best job in treating disease, but our job would not be complete and successful until we bring the patient back to function that’s as normal as it can be.” That includes implants for teeth replacement wherever possible. Loss of teeth can create serious problems with the ability to speak, eat, and even socialize.

That’s why Oreadi supports the advocacy efforts of Cathy Hapenney, who is passionate about helping other survivors of head and neck cancer navigate oral health issues post-treatment.

Advocating for Others

Hapenney is working with the nonprofit Massachusetts Oncology Patients, Survivors, and Supporters (MOPSS) to get legislation passed in Massachusetts (House Bill 1258) that would require insurance companies to cover dental care needed as a result of treatment for head and neck cancer. This would include preventative care prior to treatment as well as post-treatment services such as dental implants. Some states, such as Maine, already have similar laws.

Without the legislation, some head and neck cancer survivors find that their medical insurance won’t cover dental treatment such as implants. And dental insurance—if patients have it—covers only a small percentage of the bill, which can reach tens of thousands of dollars. “Many survivors are left with significant out-of-pocket expenses for necessary dental care related to their treatment,” Hapenney says. 

In the past couple of years, Hapenney and others at MOPSS have met with virtually every head and neck surgeon in Boston and have testified before the Massachusetts legislature. “I truly believe the bill will pass, but it’s a very long process,” she said. At present, the bill is in the committee process.

Hapenney has also written a brochure about oral health after cancer treatment with tips for finding specialists and understanding medical and dental insurance.

Oreadi helped Hapenney with both projects, adding his expertise to the brochure and the suggested legislation. “Dr. Oreadi provided an invaluable review of our draft legislation from a dental professional’s perspective,” Hapenney says. “His feedback was crucial in refining the draft and ensuring it accurately addresses the clinical needs of survivors.”

Lahey says he’s inspired by how Hapenney has channeled her personal challenge into tireless work on behalf of other survivors. “What truly sets Hapenney apart is her relentless drive to improve the system for others,” Lahey says. “She has become a passionate advocate, using her own experiences to lead the charge for reform.”

Lahey is also inspired by Oreadi’s understated way of supporting Hapenney’s advocacy work, which he says exemplifies how Oreadi treats all of his patients: “It goes beyond the operating room. He cares for his patients holistically and this is a clear demonstration of that.”