LONGMONT — A day in the life of an oral surgeon can range from pulling a wisdom tooth to restoring a face smashed on a windshield.
But until early 1975, when Dr. Gregg Kalbfleisch hung a shingle here as Longmont’s first full-time oral and maxillofacial surgeon, this kind of care often involved a commute.
“I remember in my early college years going to Denver for my own third molar extraction,” said Dr. Alfred Carr, an ear nose and throat physician who started practicing in Longmont a few years later.
However, Kalbfleisch’s long-term success in town had more to do with his personality and ability than with the service vacuum, Carr said.
“He’s smooth, and patients sense that confidence,” he said.
Confidence comes from learning how to better manage a patient’s pre-surgery fear and post-surgery pain as much as from surgical skill, according to Dr. Larry Nissen, past president of the Rosemont, Ill.-based American Association of Oral and Maxillofacial Surgeons.
“There’s nobody who wants to come to my office,” he said by phone from his private practice in Merritt Island, Fla. “We all want to go to the shopping mall or the movies instead.”
That is true until injury, disease or deformity forces the issue.
Patients then reluctantly show up to visit an oral surgeon in spite of their fear.
Worried people don’t always talk about it, Kalbfleisch said. But fear often explains why people stop looking him in the eye or start telling him they’re fine with just about anything if it doesn’t involve their mouth.
“And it’s not uncommon for it to be some big, bruiser football player,” Kalbfleisch said.
To soften the specter of surgery, Kalbfleisch tries to spend enough time talking with patients about risks, benefits, costs and recovery details.
“It solves problems for me to talk to people,” he said. “But the word is ‘try.’”
The original burnt-orange and lemon-yellow furniture in Kalbfleisch’s waiting room is long gone, exchanged for almond-hued varieties.
And in July his one-man practice doubled in size when he hired Dr. Douglas Squire to share the growing workload. Six support staff now buzz around the busy office.
But since year one, when Kalbfleisch arrived in Longmont as a 28-year-old fresh from his residency at the University of Missouri at Kansas City, the biggest changes have involved procedural breakthroughs, he said.
In the late 1970s Kalbfleisch joined oral surgeons nationwide in performing dental implant surgery. The procedure calls for inserting a threaded titanium screw in the upper or lower jaw — wherever the tooth or teeth have been removed because of injury, disease or age.
After approximately four months, the oral surgeon will check for osseo-integration, for the bone to have grown around the peg. If the implant is successful, the oral surgeon will then operate to remove the gum tissue covering the screw top so a dentist can anchor a crown on it.
This process gives patients more permanent alternatives to dentures or a bridge, Kalbfleisch said.
Other advances include surgical techniques to correct over- and under-bites.
Like his colleagues, Kalbfleisch still uses plaster casts of the teeth and jaws as a three-dimensional surgery planning aid. He also studies X-rays and traces various jaw angles, such as the one from the pituitary gland to the nose bridge to the upper and lower jaws.
Ideally, the upper jaw should be a few degrees more open than the lower jaw, Kalbfleisch said. But the wider the percentage difference between the upper and lower jaws, the greater the protrusion and potential for bite problems.
Any angle wider than 4 degrees will likely limit the bite correction that an orthodontist can do without collaborating with an oral surgeon, he added.
Today’s techniques allow oral surgeons to correct bite problems by shifting bone pieces and inserting titanium plates in one or both jaws without wiring those jaws shut during the recovery phase.
Kalbfleisch said the Longmont community has been a great place for his kids and his business to grow up.
But things could have turned out differently for the city’s first oral surgeon.
Kalbfleisch remembers that another board-certified oral surgeon was scoping out the city for his practice in 1975 and hoping to sign a lease on an office that July.
“Then someone told me about this guy from Kansas and said, ‘Do you think there’s room for two of you in town?’” said Dr. Boyd Tomasetti, an oral and maxillofacial surgeon at Rocky Mountain Oral and Maxillofacial Surgery in Littleton.
“He was about the 23rd or 24th guy (practicing) in the state, and I was right behind him,” Tomasetti said. “Now there’s about 105 of us in the state society.”
As he did in his first year, Kalbfleisch still works through the noon lunch hour most days. And he still prefers casual office attire to the traditional tie and white coat.
But his practice has not kept him chained to the profession.
Over the past three decades, he has regularly stepped away from it all to serve the community in other capacities — as past president of the Ed & Ruth Lehman YMCA of Longmont and the Colorado Society of Oral and Maxillofacial Surgeons — and to play.
Play highlights include sailing across the Atlantic from France to the Caribbean with his wife, son and some good friends in 2003.
The year before, Kalbfleisch, his wife and two daughters made a church mission trip to Jamaica. Kalbfleisch donned scrubs and operated every day there with his family working alongside him.
Still, he found doing complicated surgeries in primitive conditions rewarding in some unexpected ways.
“People down there pay you in mangos,” he said.
Pam Mellskog can be reached at 303-684-5224, or by e-mail at firstname.lastname@example.org.