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Smile Oregon: Something to Grin About

 — Dr. Judah Garfinkle has built quite a name for himself creating brighter smiles.

At just 39 years of age, he’s busier than most orthodontists. He not only runs a successful, private orthodontic practice in Portland, Garfinkle Orthodontics, he also serves as the Director of Craniofacial Orthodontics at Oregon Health and Science University (OHSU), specializing in treating children born with cleft lip and palate and other craniofacial conditions.

smileA cleft palate is when the roof of the mouth does not completely close, leaving an opening that can extend into the nasal cavity. The cleft may involve either side of the palate. It can extend from the front of the mouth (hard palate) to the throat (soft palate). Often the cleft will also include the lip. Cleft lip is an abnormality in which the lip does not completely form during fetal development. The degree of the cleft lip varies, from mild (a notching of the lip) to severe (a large opening from the lip up through the nose).*  

Dr. Garfinkle’s work with these children and their families inspired him to establish the Smile Oregon foundation to help provide resources, networking opportunities and support for the families and children affected by cleft or craniofacial conditions.

Born to fix smiles

A third-generation dentist, Dr. Garfinkle’s interest in craniofacial anomalies was fostered early in his training. A University of Oregon graduate, he earned his Doctor of Dental Medicine from Harvard University and spent time in Bolivia, helping treat children with cleft lips and palates. He took greater interest in craniofacial orthodontics and surgical treatment planning during his orthodontic residency at the University of Kentucky. He then moved to Manhattan where he completed the Craniofacial Orthodontic Fellowship at New York University Medical Center, Institute of Reconstructive Plastic Surgery (IRPS).

It was in New York where Dr. Garfinkle developed his wish to start a foundation that would make it possible for every child in Oregon to get the care they deserved regardless of their ability to pay.

“It felt good contributing,” he said. “While doing missions to places like Bolivia are fun and important, there are kids in my city and state that aren’t getting the coordinated care that they deserve. Taking care of kids here is where my efforts are best spent. That’s why I started Smile Oregon, to make it possible for every child — from birth to adulthood — to get that coordinated care.”

How widespread is the condition? According to Dr. Garfinkle, an average of one in 700 are born with a cleft lip and/or cleft palate. In addition to the cosmetic abnormality in the child, problems can include feeding difficulties, ear infections and hearing loss, speech and language delay, and dental problems.

“It’s a heavy story to tell a parent,” he said. “Because they have 20 years of medical treatment and over six figures of medical costs coming over the next two decades.”

However, Dr. Garfinkle likened the situation to the story of the magic bag: When everyone is born, they are given a magic bag. They can put their problems in that bag and leave it for an evening, among all the other bags in the square. At the end of the evening, most people opt to grab their own bag back.

“With a cleft lip and palate, we know what to do, when to do it, how to do it and it’s a condition that can pretty much be erased by the time they go off to college,” Dr. Garfinkle explained.

“There are a lot of other kinds of conditions afflicting children where a doctor can’t provide that kind of help and intervention. A walk around Doernbecher Children’s Hospital can drive home how fortunate people can consider themselves.”

Mike Zahniser, a business developer for LaborWorks Industrial Staffing and a Smile Oregon board member, can testify to the relief a family can feel learning that it is a treatable condition. He and his wife were first told of their son Quin’s condition just nine weeks into the pregnancy. “We were pregnant with twins and it became the least of our worries, because we were more concerned about them surviving,” Zahniser said.

Quin is three years old, has had three surgeries and, according to his dad, it “doesn’t phase him a bit.”

“There was a lot of work during the first six months, using special baby bottles and having to explain everything to absolutely everyone you meet.”

As for his son’s appearance as he goes through these procedures, he said, “You don’t get defensive, you embrace it.”

A groundbreaking specialty

Zahniser chose Doernbecher because Dr. Garfinkle is one of the West Coast’s only specialist in Nasoalveolar

Molding (NAM). These small, baby retainers are installed weeks after birth, and help in reshaping the gums, lip and nostrils before cleft lip and palate surgery. Surgery is performed after the molding is complete, which is approximately three to six months after birth. NAM is used mainly for children with more severe clefts and it has revolutionized cleft repair. “It’s generally how I spend my Mondays — making baby retainers,” Dr. Garfinkle said.

However, that’s only the beginning.

“Between ages two and five, speech can become an issue,” Dr. Garfinkle said. “The cleft affects the soft palate, and too much air can come through the nose; so the need for speech therapy and often speech surgery is pretty common.”

At ages seven to 10, there is an alveolar bone graft, which is taking bone from the hip and placing it in the upper gums to make it a continuous arch.  A phase of orthodontics is often necessary to position the teeth properly to ensure a successful surgical outcome.

When the teeth are all in, between ages 12 and 13, braces are put on to the degree they’re needed. In the patient’s late teens, jaw, lip and nose revisions may be required.

“It takes 20 years to fix a cleft palate,” Dr. Garfinkle said. “There are certain procedures that can’t be done at one year of age, and there are certain holes in the system that have prevented complete insurance coverage.”

For example, insurance companies might cover the surgery, but not the orthodontics or speech therapy that’s needed.

To help fix that, Dr. Garfinkle wrote and advocated for Oregon House Bill 4128, which sailed through last February’s short session of the legislature without a dissenting vote. It “requires health benefit plans to cover medically necessary dental or orthodontic services for treatment of craniofacial anomalies.”

In addition to spending time with his wife and two young children, he works at the hospital and in his private practice, where about one-quarter of his patients have cleft conditions. The rest of his practice is treating adolescents and adults. He is one of Portland’s leading Invisalign doctors and just added a new intraoral camera in his office that will eliminate the need for messy and uncomfortable impressions. In his “spare time,” he writes books and journal articles, and performs research.

Plus, there’s helping Smile Oregon broaden its ability to assist children and their families. This summer, the foundation is holding its third-annual Family and Friends Walk for Smile Oregon with a band and clowns, on Saturday, July 20, at Gabriel Park in Southwest Portland. It recently held its first night event at the Children’s Museum, where more than 100 kids and their families had the run of the place. Smile Oregon is always looking for motivated and passionate individuals to get involved, so don’t hesitate to reach out. It is also possible to support Smile Oregon by donating online. Check them out at www.SmileOregon.org.

“I’m proud of Smile Oregon’s growth,” Dr. Garfinkle said. “It’s been slow and steady. We have no employees, and we have a good, strong, working board. I’m just grateful for the events, the contributions, and that Smile Oregon is helping families support one another.”

* source: OHSU


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