Dr Tomislav Skrinjaric started his dental career at the University of Zagreb School of Dental Medicine in Croatia and is now Assistant Professor in the Department of Paediatric and Preventative Dentistry. Two years ago, he made the decision to dedicate part of his time to treating children with cancer. In a recent interview, he explained what brought about his decision and why this work is so important to him.
How long have you been practicing as a dentist? Could you please tell us about your career in a few words?
I graduated from the School of Dental Medicine, University of Zagreb, Croatia, in 2006. I started my dental career at the Department of Fixed Prosthodontics at the School of Dental Medicine, University of Zagreb, at the end of summer 2007. I spent a year and a half there. Then, in spring of 2009, I moved to the Department of Pediatric and Preventive Dentistry, where I specialized in Pediatric and Preventive Dentistry in 2012. I defended my PhD thesis in Dental Traumatology in 2013. In May 2016 I became Assistant Professor at the Department of Pediatric and Preventive Dentistry. My areas of interest are dental traumatology, dental sedation, dental materials, orofacial genetics, 3D imaging and diagnostics, and particulary, dental treatment of pediatric cancer patients. That would be it in outline.
What drew you to pediatric oncology patients? What triggered your decision to get involved with these patients?
I opted for the treatment of oncological patients after the first visit of a pediatric oncology patient. I wasn't satisfied at all with the dental treatment given by the previous dentist, or perhaps it’s more accurate to say that I was very disappointed with the quality of dental treatment. Those children are, however, going through the toughest possible struggle in their life, as are their parents. Medical treatment is quite exhausting, both physically and mentally, and their parents are suffering along with them. I think the least that a dentist can do for these patients is to provide superior, impeccable tooth restorations.
A large number of oncology patients who came to me had a poor dental status at their first visit. Many parents are generally not well-versed in an adequate regimen and the importance of oral hygiene, so their lack of information is reflected in the oral health of their children. With oncology patients, the situation is much more complex because, due to hospitalization and overall medical treatment, they are simply unable to take care of oral hygiene as much as they would really want.
For pediatric oncology patients, oral health is extremely important in their overall treatment. Especially since the smallest bacterial infection can ultimately compromise their health during their crucial medical treatment, i.e. during immunosuppression, megatherapy, and bone marrow transplantation. Therefore caries treatment, as well as endodontic treatment, require impeccable dental care.
How many ill children have you already treated?
So far, for two years since I started, I have treated about 40 pediatric oncology patients.
How much time are you investing in your Dental Aid project? Do you have a fixed schedule for dental treatment for pediatric oncology patients?
Treatment of pediatric oncology patients is difficult to plan. Dental appointments are as needed. Sometimes I have 4 or 5 patients a day, and sometimes I have no oncology patients for 3 to 4 weeks. The frequency of arrivals depends on the time I have until crucial medical treatment, whether it is bone marrow transplants, or because these children are leaving for medical treatment abroad, or due to a drastic decline in immune status.
If I have a pediatric oncology patient who requires extensive dental treatment and has only a couple of days' time, I devote myself exclusively to him. So I treat her or him day after day, and I postpone other regular patients, and put my other obligations aside. If this is a very small or uncooperative patient that needs to be urgently treated, I treat them under general anesthesia in the operating room at our other University Clinic. Then we complete the whole dental treatment in one visit.
What should a dentist pay special attention to when treating such patients?
My opinion is that dental treatment of pediatric oncology patients is the most complex and most responsible field of dentistry. Superficial treatment can ultimately compromise the health of these little children and endanger their lives. Even the success of their overall medical treatment is questionable, and with poor dental treatment the survival chance is even smaller. Therefore, the imperative is an extraordinary meticulousness and speed, resulting in impeccable dental treatment.
In addition to the exceptionally high clinical criteria for dental treatment, essential factors in the treatment of pediatric oncology patients are behavioral management and empathy for these severely ill children. Most of these patients, as well as their parents, are quite depressed because of the overall situation. I have had a lot of very uncooperative patients. Sometimes it was necessary to invest tremendous effort and patience in behavior management to succeed in making them cooperative so that we could even begin with dental treatment. Sometimes this can be psychologically extremely difficult for the dentist, primarily because of the progression of malignant illness in these small patients. Some of these patients, who were fully aware of the progression of their malignant disease and the ultimate negative outcome, were comforting their parents, who were suffering horribly from seeing ineffective drug therapy and the failure of medical treatment for their child.
Some patients have neurological outbursts due to their brain tumors. The dentist is in a situation where the patient uncontrollably shakes their head, and you have to treat an already delicate situation. For example, you treat a carious lesion directly above the pulp, so only a tenth of millimeter separates you from endodontic treatment, a tenth of millimeter from additional complications of dental treatment or possibly extraction of the tooth. You cannot afford this extra complication because you have a strictly fixed time for complete dental treatment, and you do not want to further depress this little patient with a possible tooth extraction and ruin their appearance.
Also, some pediatric oncology patients, because of their illness and overall medical treatment, have psychological outbursts in the middle of dental treatment procedure. So you have to be pretty quick and skillful in tooth restoration.
What are your aims and expectations for the project?
In addition to the dentist's expertise, the crucial part of your entire treatment is the choice of dental materials for treating the patient. There are a very wide range of dental materials on the market. Most of them are reliable. However, reliable materials are not enough for oncology patients. They not only deserve, but also require the best possible dental materials. Dental treatment of pediatric oncology patients with unreliable dental materials is at least unethical. Dental materials for the most demanding patients and the most delicate dental conditions must have by far the best physical properties, and an extremely important characteristic is biocompatibility.
VOCO dental materials are ahead of the competition in the world market because they offer the very best physical properties, i.e. extraordinary quality and longevity of dental restorations.
In addition, a very important feature of dental materials is biocompatibility, i.e. non-toxicity. The Admira Fusion series of ORMOCER nanohybrid composites is well known to have no classical monomers in their composition, and therefore do not release any toxic components into the body of severely ill and immunologically compromised children.
Also, the incredible effect of the colored compomer Twinky Star in behavior management. The ease with which I have been able to establish cooperation from some uncooperative patients, and the dental treatment procedure was really amazing.
As well as a number of other VOCO dental materials, such as Profluoride Varnish with excellent flavors, and easy-to-apply liners (Ionoseal, Calcimol LC), and some others.
All this range of dental materials gives me great confidence when I use the best possible dental materials available on the market. Therefore, I believe that these dental restorations will be of impeccable quality, and that at least from the dental aspect these small oncology patients will be completely treated and treated in the best possible way.
All this would not have been possible without the VOCO Dental Aid project, and the huge and generous donation of various VOCO dental materials for the treatment of these severely ill children. I hope that VOCO Dental Aid for dental treatment of pediatric oncology patients will continue, and will provide the best possible quality dental materials for these severely ill children.
What does your work on the project mean to you?
At the first visit, most of the oncological child patients were quite depressed by the overall situation, i.e. by the illness and exhausting medical treatment. In some uncooperative patients, the parents were pretty skeptical that we would be able to treat all the necessary teeth, especially because of the short time available. Some parents asked me immediately at the first visit to treat their children under general anesthesia, because they were skeptical that I would succeed in getting their uncooperative child to be cooperative. To overcome this obstacle, it was necessary to invest tremendous effort in behavior management. Also, I had great support in VOCO dental materials, especially in the unique Twinky Star. Twinky Star has opened up many doors in terms of cooperation.
I began treatment in phases of severe depression and uncooperative pediatric oncology patients with extensive caries lesions and a large number of damaged teeth. And I ended the treatment with the glittering smile of these severely ill patients, who were coming to my office so happy and to eager companionship. There I saw how important a healthy smile is for these children, and how happy and kind they are, in spite of so many serious problems they and their parents are struggling with in their lives. Some of these children have declared me their great friend, they were hugging me when they saw me, and they wanted to take a photograph with me for a memnto. To my great sorrow, some of my great friends are no longer among us because their malignant disease was ruthless. But those moments together I will never forget. That transformation of their mood from extremely negative to extremely positive and extremely happy, despite their severe illness, is a truly amazing and unique fulfillment for me.
The possibility that I have participated in only one small part of their life, but one very positive part of their life is an exceptional honor and extraordinary recognition for me. That is something far more than complex tooth restoration. That is why I want to dedicate myself to the treatment of pediatric oncology patients in my further career.