Outside the Box
Photo by Nerissa Johnson.

Charles Knable

Meticulous attention fosters healing from jawbone disorder.

Charles and Cheryl Knable grew up in neighboring communities in the northeastern United States. While Cheryl and Charles actually hail from different states, their hometowns are so small and close geographically that most everybody living there knows one another.

“Charles was born in Chambersburg, Pennsylvania, and I was born in Hagerstown, Maryland,” Cheryl elaborates. “He’s four years older than me, but we both came from farm families, and farmers up there stick together.

“We’ve been married for thirty years, and we lived in a little town outside of Chambersburg called Needmore. It’s right near the Maryland, West Virginia, Pennsylvania line. But we’ve lived in Florida for the past twenty-five years.”

While living in Pennsylvania, Charles worked in construction. When he and Cheryl moved south, Charles got a job with the city of Cocoa Beach. Both jobs stressed his lower back, so when he first experienced back pain, he and Cheryl weren’t concerned. But they became alarmed when Charles’ pain continued and then intensified.

“We went to multiple doctors,” Cheryl states. “They attributed Charles’ pain to the construction work he did when he was younger. They diagnosed a pinched sciatic nerve, bulging disc and narrowing in his spinal canal. But the pain kept getting worse, to the point Charles couldn’t walk.

“We went multiple times to pain management. We went to an orthopedic specialist and went back and forth to the hospital. Finally, the pain got so bad that Charles couldn’t take it anymore, so I took him to the emergency room. The ER doctor told us he had stage four cancer.”

Cheryl took Charles to Shands Hospital in Gainesville, where they discovered Charles’ prostate-specific antigen (PSA) level was extremely high. Cheryl, who is a nurse, put two and two together and figured out that Charles had metastatic cancer in his bones from a previous bout with prostate cancer.

“The doctors at Shands told me Charles had six months to live because his cancer was so advanced,” Cheryl shares. “He had chemotherapy treatment, and the doctors gave Charles a medication that deteriorated his jawbone and caused necrosis, or cell death, in his jaw.

“I called dentists in Orlando, Gainesville, everywhere, looking for someone who would treat the jaw problem, but they pretty much wrote us off. They said, Put him under hospice care. He only has six months to live. But my husband is young. He’s only fifty-four. He wanted to fight, and Dr. Bucaj was the only dentist who said he’d give treatment a try. He was our saving grace.”

Better Bone Turnover

“Charles presented with an advanced stage of cancer and what is called bisphosphonate osteonecrosis of the jaw,” describes Alfons Bucaj, DMD, at Dental Implant Center of Vero Beach. “Necrotic bone occurs when the healing rate is not balanced.

Charles and I greatly appreciate Dr. Bucaj. He finds answers when everybody else gives up.” – Cheryl

“Scientifically, there are osteoblasts, which are cells that deposit new bone, and osteoclasts that take away old bone. Osteonecrosis occurs when these cells are not operating in flux with each other, so there is more bone lost than bone gained.”

Confirming a suspicion Cheryl had regarding the cause of her husband’s jaw problem, Dr. Bucaj told the couple that osteonecrosis is a side effect of the medication Charles was taking to fight his cancer.

“I argued with Charles’ oncologists to take him off the medication,’’ Cheryl says. “I told them it was causing his bottom teeth to fall out, but they said it wasn’t the medicine causing it. But sure enough, Dr. Bucaj said, Cheryl, you were right.”

Dr. Bucaj also told the couple that most dentists are reluctant to treat cases such as Charles’ because of the areas of the jaw already affected by osteonecrosis heal poorly and because there is no clear evidence of how to best treat those areas.

Charles’ necrotic bone was in his lower jaw, and prior to visiting Dr. Bucaj, he had already had two infected lower teeth removed. Dr. Bucaj thus began his treatment by removing Charles’ remaining lower teeth, which were seen by the body as foreign objects in his mouth.

After removing the teeth, Dr. Bucaj closely examined Charles’ lower jaw every ten days for eight months until Charles’ healing was complete. During those visits, Dr. Bucaj typically ground down any protruding bone. That got rid of the dead tissue and allowed for regrowth.

“We dispense medications when needed in these cases, but meticulous postoperative evaluations are the main treatment for patients with osteonecrosis of the jaw,” stresses Dr. Bucaj.

“Charles is doing much better now,” the dentist reports. “His healing is perfect. He is now prepared for the reconstruction phase of his treatment. We plan to place dental implants into his healed jaw to support a fixed prosthetic. We can do that because now his bone turnover is excellent. This will provide a nice result for Charles. His is a great case for everybody to learn from.”

“Well Worth It”

Cheryl confirms that Dr. Bucaj worked very closely with Charles after Charles’ teeth were removed.

“Dr. Bucaj told us it would take up to a year for Charles’ bone to heal,” she says. “And here we are at the one-year mark, and Charles’ bone structure has grown back strong and healthy. Now, he’s ready for dental implants.

“Finally, Charles is going to get teeth on his lower jaw so he can eat. He’s been stuck eating soft and pureed food, but Dr. Bucaj is making him a whole bottom set of teeth secured by implants. That will allow him to chew his food.”

As a nurse and as a wife, Cheryl was impressed by Dr. Bucaj’s ability to explain the problem in a way that Charles could understand, and she’s thankful for his willingness to treat him when other dentists wouldn’t touch him.

“Dr. Bucaj is so knowledgeable,” Cheryl relates. “I’m in the medical field, so I understood the medical terms he was using, but when Dr. Bucaj spoke to my husband, he spoke on a level Charles could understand.

“Charles and I greatly appreciate Dr. Bucaj. He finds answers when everybody else gives up. They want to go to a textbook and find the answers instead of thinking outside the box like Dr. Bucaj does.

“We live on Merritt Island, so Vero Beach is quite a distance for us to go to visit Dr. Bucaj, but it’s well worth it.”

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    • Dental Implant Center of Vero Beach

      Dentist Al Bucaj, DMD, in Vero Beach, Florida practices a full scope of general and cosmetic dentistry with expertise ranging from porcelain veneers to dental implants, crowns and bridges. Dr. Bucaj can now correct a wide variety of what were... Read More

    • Alfons Bucaj, DMD

      Alfons Bucaj, DMD, is a diplomate of the International Congress of Oral Implantologists and the American Board of Oral Implantology. He is also an Associate Fellow of the American Academy of Implant Dentistry. Dr. Bucaj graduated from Nova So... Read More