Check the date!

Have you noticed that many toothpastes now have expiration dates? This is because all toothpastes containing fluoride are regulated by the Food and Drug Administration, which now requires expiration dates. Up to that date, normally two years after manufacture, all the fluoride must be available to bind to tooth enamel, hardening it against the acid that causes cavities. Once that date is past, some of the fluoride ions may have bound with the caking agents into a salt or a crystal and thus aren’t available to bind to tooth enamel. Also, depending on the length of time and temperature of storage, the paste could separate so that an uneven amount of fluoride or flavoring agent is expressed at each squeeze. The viscosity might change and the toothpaste might not have the same consistency. So, check the date!

Dr. Shapiro in the news

What Price Beauty: The Cost of Teeth-Whitening

I was recently interviewed for an article on teeth whitening on the website “mainstreet.” The article is a very good summary of bleaching options available. Check out the link: http://mainstreet.com/article/money/budgeting/what-price-beauty-cost-teeth-whitening to learn what I have to say about teeth whitening. I also have reprints in the office.

I just came back from two fabulous weekends of learning at The Rosenthal Institute’s Aesthetic Advantage Program at the NYU College of Dentistry. While I was there I studied the latest cosmetic techniques with the best dentists in the U.S. It was an inspiring experience.

Tongue map or not

Do you remember being taught that the tongue is a “map” divided into sections according to taste receptors? The tip of the tongue is for sweet, sides for sour and salty, and the back of the tongue for bitter. But recent studies show that the tongue map is wrong! We do know that there are at least five basic tastes: sweet, sour, salty, bitter and the recently discovered “umami”. Umami means “savory” in Japanese and can be detected in miso, soy sauce and other Asian foods, in particular those with monosodium glutamate. Scientists believe that there may be receptors for still other flavors. In a 2006 study in the journal Nature, scientists reported that receptors for the basic tastes are found in distinct cells and that these cells are not localized but spread throughout the tongue. Still other studies show that some parts of the tongue may be more sensitive to certain flavors and that there may be differences in how men and women detect sour, salty and bitter flavors.

Bisphenol-A, or BPA, and Dental Sealants

Bisphenol-A, or BPA, is widely used in making hard, clear plastic called polycarbonate. The National Toxicology Program, part of the Department of health and Human Services, has raised concerns about BPA, particularly over childhood exposure to traces that leach from polycarbonate baby bottles and the linings of infant formula cans. BPA has estrogenlike effects, and animal studies have suggested that exposure may accelerate puberty and raise a potential risk of cancer.

Traces of BPA have also been found in dental sealants. Some studies show that any exposure from the BPA in sealants is negligible and temporary. Other studies have found no detectable levels of BPA in most American-made sealants. Exposure to any BPA in sealants can be limited by polishing the tooth surface after the sealant is applied and rinsing at the end of the procedure. The study found that detectable amounts of BPA were not released from three products: Helioseal from Ivoclar Vivadent; Seal-Rite from the Pulpdent Corporation and Conseal from SDI.

Sealants prevent the growth of decay-causing bacteria in the grooves of molars and are a useful part of preventive dental practice. But concerned parents concerned about BPA exposure should ask their dentists what type of sealant they use and whether it has been tested for BPA. In my office I only use Helioseal from Ivoclar which does not release BPA according to both a March review article in the Journal of the Canadian Dental Association and a 2006 article in The Journal of the American Dental Association.

Shark’s Teeth

When sharks lose a tooth, another erupts.
It’s a great thing for a predator that relies on its teeth to make a living,” says Ellen Pikitch, of the Institute for Ocean Conservation Science at the Stony Brook University School of Marine and Atmospheric Sciences. The record-holder is probably the sand tiger shark which can produce 40,000 teeth over a lifetime – assuming it lives that long, a problem in these days of over-fishing. She maintains that sharks play a pivotal role in our ocean ecosystem and it’s not ok to kill them for food or sport or just because people think sharks are dangerous killers. Take away sharks, she says, and we end up compromising the ocean’s immune system. Her office displays handcarved wooden sharks with authentic teeth and the jawbone of a bronze whaler shark – one of the confirmed handful of people-eaters.

Dental Treatment and Your Pregnancy

A new study shows that pregnant women can safely undergo essential dental treatment and receive local anesthesia at 13 to 21 weeks’ gestation. Obstetricians generally consider dental care safe for pregnant women but supporting clinical trial evidence had been lacking. To address this issue, researchers at the U. of Minnesota School of Dentistry compared safety outcomes from a trial in which pregnant women received scaling and root planning (deep cleaning) and essential dental treatment. The women’s medical records were reviewed to monitor for adverse reactions. The results of the study showed that periodontal treatment, essential dental treatment and use of local anesthetics were not associated with an increased risk of adverse outcomes.

During pregnancy, the body’s hormone levels rise considerably. Gingivitis, especially common during the second to eighth months of pregnancy, may cause red, puffy or tender gums that tend to bleed when brushed. This sensitivity is an exaggerated response to plaque and is caused by an increased level of progesterone in the system. We may recommend more frequent cleanings during the second trimester or early third trimester to help you avoid problems.

It’s especially important to maintain good oral health during pregnancy. Studies indicate that pregnant women who have severe periodontal (gum) disease may be at increased risk for pre-term delivery, which in turn increases the risk of having a low-birthweight baby.

If you are planning a pregnancy, be sure to schedule a dental checkup. If you are pregnant, don’t forget to continue your regular dental visits, and call our East Setauket dental office if you notice any changes in your mouth during your pregnancy.

Lead in Your Dental Crowns?

You may have heard recent news reports about lead in dental crowns made in overseas Chinese laboratories. Previously most Americans had given little thought to where their dental restorations were being made - but now patients are asking questions.

The new global economy is changing everything, and that includes the dental profession... or SOME of the dental profession. Cheap overseas labor and shrinking profit margins have forced some dentists to outsource their laboratory work to foreign laboratories. These dentists are typically those who participate in low-fee "managed care" insurance programs such as HMOs. When a dentist signs a contract with these plans, he or she must agree to the insurance company's fee schedule, which is typically 50% or even LESS than their normal fees. But to remain in business, corners MUST be cut if these dentists are reducing their fees by 50% or more. One way to lower expenses is by sending laboratory work to China.

Always check where your dental crowns are being made. Remember that, “The bitterness of poor quality is remembered long after the sweetness of low price has faded from memory.” In the case of lead-contaminated dental crowns, poor quality may have negative effects on your health.

In my dental office I use only American dental laboratories that do not outsource their crowns and which follow strict quality standards. We use only certified, high-quality materials and laboratories.

Dental Implant or Not?

Two prospective patients came into the office recently with the same complaint. Both were missing all of their teeth and were wearing old, ill-fitting dentures. Their dentures were loose, they had trouble eating foods they would have liked, their faces had that sunken-in look and they were in constant pain.

Their previous dentists recommended dental implants to stabilize the dentures. The problem was that as they were both retired and on fixed incomes they could not afford implants. What to do? Yes, implants are a wonderful service and have revolutionized what we can do to improve lives. I love implants! But due to the laboratory and materials costs involved, they are expensive.

My approach is different from most other dentists. I make new, custom-fitted dentures for the patient and tell them that if the new denture doesn’t fit and function well, we can then add implants. My experience is that the denture patient does very well with the new dentures and rarely decides to go ahead with the implants. Implants are always an option but they don’t have to be the first option. I believe that patients like these can be well served with well-fitting dentures.

For more information on dental implants and dentures, visit www.drterryshapiro.com.

New York State in the Dental News

“A child can't learn when he or she has a toothache,”
says Amy Paulin, a Democratic state Assemblywoman from Westchester County. Thus she was instrumental in passage of a new state law that requires school districts across New York State to ask parents to take their children for a dental examination before they begin school.

The new law is effective for the 2008-09 school year and families will be asked to voluntarily present a dental health certificate when a child enters pre-kindergarten, kindergarten or first grade in public school. The certificate must contain a report of a comprehensive dental examination performed on the child.

The law will only require schools to request parents take their children for a dental check-up twice in elementary school and twice in the secondary grades. There is no requirement that families do so. There is also no requirement that school districts follow up with families who do not turn in dental health certificates.

A dental examination assesses untreated dental disease and addresses good oral health, all of which can affect a child's performance in school. Hopefully the new law will raise awareness about dental health and encourage regular dental care. The new law with its voluntary compliance is the first step to better dental health for all of our children.

Infant Teeth

When they were a year old, I gave the twins their first toothbrushes - green for Rehaan and yellow for Naseem. They each gleefully grabbed their brush, stuck it in their mouth and started brushing. It looked like they knew what they were doing! Maybe they liked the feel of the bristles against their teeth. In any case, hopefully they were accomplishing something. My hope was that they were establishing a habit. Their parents were concerned that they would swallow the toothpaste but I told them that they really did not have to put any toothpaste on the brush or just a speck if they really wanted to. The brushing action alone was enough to clean the teeth. Parents should assist the brushing until the child is old enough to accomplish the task without supervision. Parents or caregivers should use a piece of gauze to regularly clean the infant teeth as soon as they erupt. It's also a good idea to introduce a young child to floss so they get into the habit of cleaning in between the teeth. And don't forget a healthy diet and regular twice yearly visits to the dentist.

Girl in a Boat

It was my day off and I was checking out some daylilies when the text message came. It was the Director of the Chamber of Commerce asking if I could help out a girl with a toothache out on a boat in the Sound. This was a first. So I called the girl back and she said that she was from Vermont and sailing down the east coast about three hours outside of Port Jefferson Harbor. The wind was down and they were waiting for it to pick up. (Already I was feeling seasick.) Her lower left molar had been throbbing for three days and she was clocking the Ibuprofen. Her symptoms sounded like a pulpitis and probably a root canal was in order. I felt that the prudent course of action was to refer her to an endodontist who could diagnose and treat the offending tooth quickly and easily. I gave her the name, and at length she docked, took a taxi to his office, had the work completed and set sail to continue her journey.

So What’s With the White Spots?

You’ve all seen it – those bright white spots on otherwise healthy, straight front teeth. Well, the offending teeth just had bonded orthodontic brackets removed after two years of “wearing braces.” Sometimes the white spots are just an unavoidable byproduct of the bonding procedure. Or sometimes the spots can be a result of poor home care, of accumulated plaque that has decalcified the teeth. So what to do?

It is not easy to mask those white spots. We have bleached these teeth but not always successfully. Sometimes the white spots whiten still more and the situation doesn’t get better. We have prepared the area and bonded composite to the offending areas. This has met with success but the patient has to beware of coffee, red wine and smoking. Bonding will last for several years before it stains and has to be replaced. Another option is veneers – esthetically superior to bonding and long lasting without color change. Veneers are more expensive and are not reversible – which means that the tooth cannot not be restored to its original state and must always be covered.

A difficult choice and up to the patient and her parents to make!

Maryland Bridge to the Rescue

I was at a barbeque last weekend (the first of the summer) and was intrigued by a young man - a nice looking fellow who never smiled, not even once. Of course I wanted to check out his smile but he never gave me a chance. Then after he had a few beers he got up the courage to take me aside so he could confide that he was missing his upper left bicuspid. He was so embarrassed by this hole in his mouth that he refused to smile. He knew that he needed an implant but he said that he couldn't afford one. He also said that he didn't want to cut down the two teeth on either side to make a bridge and that would be too expensive in any event. He didn't know what to do. And on top of this, he was getting married. I suggested that he come to the office so we could determine if a Maryland Bridge would be an appropriate treatment for him.

A Maryland Bridge is a bonded bridge that consists of a replacement tooth with two metal connectors that bond to the teeth on either side. The teeth don't have to be cut down and the cost is minimal. The procedure is totally reversible so if his financial situation changes in the future, the bridge can be removed without damage to his teeth and an implant placed. You have to be careful with a Maryland Bridge; it isn't as strong as the more expensive options and it may not last as long. But with careful diagnosis and placement on the part of the dentist and proper home care on the part of the patient, the Maryland Bridge can be a great choice!

Accident on a Slide

While on a walk last week I stopped at the neighborhood playground to watch a 9 year old girl zoom full speed down the slide. A second later she was on her face and had broken her newly erupted front tooth in half. She was hysterical, her mom was hysterical but I ran to the rescue, swooping up the tooth fragment and hydrating it. Talk about being at the right place at the right time! It was a Sunday and I offered to open the office for them. Back in the office, I carefully cleaned off the tooth and fragment and bonded it back in place. As good as new and one happy patient!

If you or a family member breaks a tooth, rinse the mouth with warm water to clean the area. Use cold compresses to keep any swelling down. Call your dentist immediately.

If a tooth is knocked out or is broken in half, as happened to the girl on the slide, rinse off the tooth or tooth fragment in water if it is dirty. Do not scrub it or remove any attached tissue fragments. If possible, gently insert and hold the tooth in its socket. If that isn’t possible, put the tooth in a cup of milk and get to the dentist as quickly as possible. Remember to take the tooth or fragment with you!

Story of a Parrot

A patient sent me a text message Sunday morning that she would have to cancel Monday's appointment because her parrot was dying and might be in the hospital. That is the first time that an appointment was cancelled for a sick parrot. My daughter-in-law told me that parrots live a very long time - up to 80 years. A friend of hers who is parent to a parrot wanted to provide for her pet bird in her will but she was having trouble finding an appropriate guardian.

Getting back to teeth, of course parrots don't have teeth but rather a beak with which to begin the digestive process. Nevertheless, animal dentistry is commonly performed on other pets who do have teeth, including cats, dogs and horses.

If you do have a pet with teeth, it is important that you take care of the animal's oral health, including keeping the teeth clean, a proper diet and regular visits to the veterinarian. Periodontal disease is the most common condition seen by veterinarians. They also see fractured teeth, abscesses, and oral tumors. These conditions can be painful for the animal and affect proper function. Veterinary dental specialists are trained to diagnose and treat dental disease.

Bisphosphonates and Osteonecrosis

Several of my long time patients are taking Fosamax or Boniva to prevent further bone loss. No one wants to lose inches or suffer with broken bones. I prefer to manage with regular weight-bearing exercise, a diet rich in fruits and vegetables and calcium supplements but this is up to you and your physician. There has been a lot of talk in the media about a rare condition called osteonecrosis of the jaw which has been linked to use of bisphosphonate medications.

It is important that you distinguish between the bisphosphonate medications (such as Fosamax, Actonel, Boniva) are taken orally to treat osteoporosis and others (such as Aredia, Bonefos, Didronel or Zometa) which are administered intravenously as part of cancer therapy.

In rare instances, some individuals receiving intravenous bisphosphonates for cancer treatment have developed osteonecrosis of the jaw, or destruction of the jawbone. Still more rarely, osteonecrosis of the jawbone has occurred in patients taking oral bisphosphonates.

Patients currently receiving intravenous bisphosphonates should avoid invasive dental procedures if possible. The risk of osteonecrosis of the jaw in patients using oral bisphosphonates appears to be low, but be sure to let your dentist know if you use any bisphosphonate medication. It is up to you and your physician whether to discontinue use of the bisphosphonate medication before dental surgery procedures. The consensus is that good oral hygiene and regular dental care will help to lower your risk of developing osteonecrosis.