INTRODUCTION
My team and I were thrilled to meet Carmen when she walked through our office door on August 21, 2007. We had been volunteers for the Give Back a Smile program for four years, but we had yet to receive a patient. We were eager to help someone to change her life, and Carmen was the perfect woman for us to work with. She had heard about Give Back a Smile on television and prayed that she would qualify for the program. She was extremely nervous about having dental work done, but was also eager to find out what we could do for her.

PATIENT HISTORY
Carmen had been abused by a former boyfriend in 1999. He kicked her in the face and chest repeatedly, causing damage to her teeth and breasts. Several teeth were broken, and she had severe dental pain as a result of the trauma and resulting malocclusion. Carmen had been a model in her teenage years, but she had rarely smiled since the abuse inflicted upon her by her former boyfriend. Her broken teeth made her self-conscious about even opening her mouth in public, and she was careful not to show her teeth in photos. She hoped to regain her smile, self-confidence, and faith in society as a result of her experience with us. Tears of joy streamed down her face when I told her that we could help.

CLINICAL FINDINGS
We performed a comprehensive evaluation with a full series of radiographs, digital photos, diagnostic models, clinical examination of the teeth and periodontium, and patient interview. In addition to the broken teeth, her teeth were severely affected by tetracycline staining, heavy attrition, inadequate restorations, extensive decay, and general lack of professional dental care. This lack of dental care combined with many years of smoking had led to moderate periodontal disease and the loss of several posterior teeth. Carmen’s Shimbashi measurement was only eleven millimeters as a result of the heavy wear on her remaining teeth.

INITIAL PERIODONTAL THERAPY AND TREATMENT PLAN
The first priority was to address her periodontal disease. Comprehensive oral hygiene instruction was given, and two root planning appointments were scheduled immediately. After her teeth were thoroughly cleaned under local anesthesia, we reevaluated her periodontal health at her follow-up cleaning four weeks later. She had already improved tremendously and was very committed to following through with care, so we proceeded with our restorative treatment plan.

New diagnostic records were taken in preparation for the creation of a diagnostic wax-up. Because her dental needs were so great, we decided to do more than just repair the teeth that were damaged as a result of her abuse. Carmen needed a more comprehensive solution to her dental condition, so we opted to perform full-mouth rehabilitation. Our treatment would consist of restoring what was left of her upper and lower arches with crowns and a bridge and the eventual placement of four posterior implants or the fabrication of a lower removable partial denture.

RESTORATIVE PHASE
We prepared teeth #4 - #11 for Empress crowns and #12 and #14 for a Lava bridge. Teeth #21 through #29 were also prepared for Empress crowns. Her vertical dimension was increased from 11 to 17 millimeters, and her occlusion was restored to centric relation in the temporary stage. Carmen tolerated the procedures very well, and she was very comfortable at her one, two, and four week post-op appointments.

Her self-confidence had already increased tremendously with her temporary restorations, and she had received many compliments on her improved appearance. She was still learning to smile naturally, but this was becoming easier each day that passed as her inner joy bubbled to the surface. Carmen was looking forward to a new future filled with hope and happiness.

A little more than three months after our first consultation, we delivered exquisite porcelain restorations created by our talented ceramist, Marv Staggs, the owner of Precision Dental Restorations (PDR) in Oregon. Marv generously donated all twenty porcelain units to help Carmen create a new life for herself. His contribution was tremendously appreciated by all of us.

Carmen cried elatedly when she held up the mirror to observe her beautiful new smile. The warm hugs that she gave to my dental team and me made all of the work well worthwhile. Being able to help someone like Carmen in such a significant way was humbling for all of us. We all felt like we received much more from this experience than what we gave.

POST – OPERATIVE NOTES
Carmen has continued to maintain her new restorations with diligent home care and regular dental visits. We are all very proud of her for making the necessary changes in her life and for giving up smoking. She knows that this is a gift that she needs to make the most of, and she intends to do so.

Additionally, she has committed herself to helping other women who have been the victims of domestic violence. She will be the guest speaker at an event that we are planning to benefit the women’s shelters in our area. Her dream is to one day appear on Oprah’s television show to tell her story and to inspire other women to take control of their lives and to heal the physical and emotional wounds that have afflicted them.

My team and I feel blessed to have participated in Carmen’s dental and emotional rehabilitation. I am very fortunate to have a wonderful, loving family, a satisfying career, good health, and everything that I ever wanted out of life. I feel that it is our social responsibility to give back with the gifts and talents we possess, and the more that we have, the more that we have to give. I have tried to surround myself with people who feel the same way, and they showed that same commitment through their generous support of Carmen in her life-changing journey with us.

CARMEN’S WORDS
"Dr. Arnold and his team have given me so much. They are truly angels. To give back a smile is to give back a whole new life. I want to live that new life to the fullest and to give back to others. So few people are willing to help others, and often no one wants to get involved.

Dr. Arnold was very gentle, very compassionate, and he created a very relaxing atmosphere for my care. Fixing the external problems with my teeth went very well. This is also helping me to fix what’s on the inside.

People judge you by your appearance, and I’m happy that I no longer have to worry about laughing, smiling, or speaking when I’m with others.

I feel so good, and I’m trying to pay it forward. I want to touch as many lives as possible. I would like to appear on Oprah to draw attention to the dangers of domestic violence, and I would like to create a website that will provide support and help for victims of abuse.

I am so blessed and am forever grateful."