Amanda found full dental treatment

Amanda has reason to be happy at Clemson University, where she is a student and an active participant in campus life.

One of the first things you’ll notice about Amanda Altemus is her big smile.

She is a proud Clemson Tiger and excited to talk about her place in the university’s post-secondary education program for students with developmental disabilities. When she’s not studying, she loves supporting the Clemson football team, watching YouTube videos and listening to music.

It’s an exciting time for the 21-year-old, but Amanda hasn’t always felt comfortable sharing that big smile. He was missing a few teeth and had a bite that didn’t work properly. By the time Amanda was 11, her teeth had severe wear patterns and she was self-conscious about her appearance. She needed a long-term dental plan, rather than relying on the advice of separate specialists.

Finding the right way forward

Amanda had several common dental features in people with Down syndrome: a short upper jaw, an underbite, missing teeth and short tooth roots.

She wore braces in fifth grade, but her bite was soon misaligned again because her teeth had shifted and several adult teeth had yet to surface. She eventually had baby teeth removed and underwent jaw surgery to allow the impacted adult teeth to emerge. Once these working steps were completed, her parents were ready to seek out a comprehensive dental treatment that would give her a functional bite and a smile she would be proud of.

Amanda and her parents, Dawne and Chris, didn’t have to look far. Dawne knew Boston Children’s Hospital well, accompanying Amanda for years to appointments coordinated by the Down syndrome program. At various times in Amanda’s life, she was treated by the Department of Neurology; Department of gastroenterology, hepatology and nutrition; the orthopedic center; and the sleep center.

It made sense, Dawne recalls, to turn to the Department of Dentistry. “We’ve had great experiences with all of these specialists and appreciated the way they work as a team,” says Dawne. “I knew if anyone was going to solve this problem, it would be Boston Children’s.”

Suggest treatments that are best for Amanda

Even though Amanda’s teeth were misaligned, Marc Ackerman, DMDdirector of the Orthodontic program, thought she should stop wearing braces because the strain they would cause would have done her upper teeth more harm than good. Instead, he briefly had her wear an upper retainer, thinking it would be an ideal bridge until Amanda, then 12, matured and could possibly have dental implants.

But Dr. Ackerman wasn’t finished. As part of the Sleep Apnea and Special Surgery Program – a small team that also includes Pulmonologist Umakanth Khatwa, MD, and Ear, Nose and Throat Specialist Gi Soo Lee, MD, EdM – he wanted Amanda to get a better night’s sleep. He knew that while a palate expander is typically used to align cross joints, it can sometimes also treat sleep apnea, which troubled Amanda for a while. On behalf of the team, Dr. Ackerman had Amanda wear one, and sure enough, the device reduced nasal airway resistance and allowed her to sleep soundly.

Amanda Altemus is flanked by prosthodontist Aram Kim, DMD, on her left and Marie Courtois, clinic supervisor of the prosthodontics program, on her right.
Amanda appreciated the treatment she received from staff at Boston’s Department of Children’s Dentistry, including prosthodontist Aram Kim, DMD, (left) and Marie Courtois, the clinic supervisor for the prosthodontics program.

When Amanda reached the appropriate age for dental implants, Aram Kim, DMDAssociate in the Department of Dentistry Prosthodontics program, not recommended as Amanda’s upper jaw would not support such work. Dr. Kim also thought it was important to recognize Amanda’s desire to feel good about her appearance, so she came up with a less invasive solution that would still create a full set of teeth: an upper removable denture. It fits over his existing teeth, holds them in place and creates the same kind of end-to-end smile that implants would have. Additionally, his lower teeth were crowned to align his bite.

Going to college with more than a new smile

“She wanted to have that smile,” Dawne said. “I know she was motivated.” Indeed, Amanda now smiles unreservedly. She also has a bite that allows her to finally eat hard foods like toasted bagels. Dental work instilled a confidence in her that followed her to Clemson, where she is always planning something new, like her recent enrollment in a swing dance class.

Dawne is thrilled with the end results of Amanda’s dental work. She is also pleased with how the dental team “treated Amanda with respect, spoke to her directly and appreciated her responses. It gave me hope. It reinforced how I want people to interact with my young adult daughter. They saw Amanda “not as a disabled person, but as a young woman who wanted to go through life with teeth like everyone else”.

Learn more about the Department of Dentistry Where make an appointment.


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