General or Cosmetic Dentist?

People who come to my East Setauket dental office for cosmetic dentistry often ask if I also do general dentistry. The answer is, “Yes.” I believe that it is a mistake for cosmetic dentists to limit their practice to cosmetic procedures. A dentist cannot ignore a patient’s dental health, and that is what a cosmetic dentist might do if he/she just does cosmetic dentistry.

Back teeth matter! You cannot just place veneers on the front teeth without addressing the health of the back teeth. Each tooth has a function, and all of the teeth must function in harmony. When dental cosmetics fails it is often because the back teeth were not considered in the treatment plan. And I am pleased that my cosmetic patients are so pleased with my cosmetic dentistry and the care that I provide that they want to continue as my patient and send the rest of their family for their general dental needs – and yes I treat children also!

For more about cosmetic and family dentistry visit http://www.drterryshapiro.com.

Dental Customs of the Daasanatch Tribe

Several dental colleagues of mine recently went on a mission to Northern Kenya to perform desperately needed dental services. They told of a local tribal custom of taking infants 1-2 weeks old to a village elder who removes the child’s primary canine toothbuds. The villagers believe that if these teeth are not removed, the child’s head will develop abnormally and the child will be susceptible to disease. Another custom is that of taking 10 year olds to have their lower front teeth removed so that a space is created. No anesthesia is used. The missing lower front teeth identify a member of the Daasanatch tribe from the village of Illeret.

Low income and low education levels are related to poor dental health. These villagers live in temporary mud houses called manyattas. There is an elementary school but education is sporadic because the people are nomads seeking new pastures for their livestock. There is a high incidence of hepatitis, tuberculosis and HIV/AIDS. The average life span is 40-50 years.

For more information on dental health visit http://www.drterryshapiro.com.

A blog reader on teeth

I received the following email from a Blog Reader in South Carolina: “I definitely agree [not to look for bargains in dentistry] --you get what you pay for with dentistry. I chose quality--I have heard horror stories and it just seemed silly to look for cheap dentistry. Yes--everyone--make sure you get excellent dentists--its your health and your life--treat yourself well. I like your blog too--I'll spread the word!”

I couldn’t have said it better myself! For more about excellent dentistry visit http://www.drterryshapiro.com

Tooth Sensitivity?

People often come to my East Setauket dental office and complain of sensitive teeth. Tooth sensitivity may be caused by erosion of the enamel outer layer of the teeth and exposure of the more sensitive dentin layer. This erosion may be caused by aggressive tooth brushing or acidic foods and drinks. Some toothpastes, mouth washes, or tooth-whitening products can also cause tooth erosion. Bulimia and acid reflux can also severely erode the teeth.

Some patients manage sensitive teeth by simply avoiding cold foods and drinks. Other patients avoid brushing the sensitive areas. I recommend that patients use a desensitizing toothpaste, such as Denquel or Sensodyne. Patients should also use a soft-bristled toothbrush. In the office I apply a fluoride varnish to the sensitive areas and this helps to reduce sensitivity. A hard toothbrush may wear away the enamel. It is important to practice good oral hygiene: floss every day and brush at least two times a day for 2-3 minutes. Hold the toothbrush at a 45 degree angle and brush gently in a circular motion. Hold the toothbrush in your fingertips instead of in the palm. Avoid very acidic foods and beverages. Visit the dentist to be sure that the sensitivity is not due to dental caries, a cracked tooth or gum disease.

Fluoride and Dental Decay

In 1901 a dentist named Frederick S. McKay noticed that many of his patients had brown, mottled teeth that were resistant to decay. He collected water samples from towns where brown, mottled teeth were prevalent, and he found concentrations of fluoride as high as 12 parts per million in the water supply. Chemists then did studies and determined that it was the fluoride in the water that caused the brown teeth. But it wasn't until 1938 that researchers confirmed McKay's conclusion that drinking water containing fluoride resulted in a reduction of tooth decay.

In 1941 the New York Times reported that children who drank water with 1 part per million of fluoride had 1/2 to 1/3 less tooth decay than children drinking non-fluoridated water. In 1944 New York State conducted a study in which they fluoridated the Newburgh water and compared the lower decay rate to the decay rate in Kingston which did not have fluoridated water. In the early 1950's the U.S. Department of Health officially recommended fluoridation, and many of the nation's water supplies were then fluoridated. But fluoridation was controversial in New York City and didn't begin in the City until 1965.

Today more than 60 percent of Americans use fluoridated water. However Suffolk County water is not fluoridated. The Suffolk County Water Authority website states: “We do not add fluoride or vitamins to the water we deliver to you. Our water delivery system has over 500 wells and over 5,000 miles of water mains (pipes) located throughout Suffolk County. Most of our system is interconnected so that your water can come from multiple wells. This makes it impossible to provide fluoride at consistent levels, and too much fluoride can be harmful.” (http://www.scwa.com/FactOrMyth.cfm) For more about fluoridation visit http://www.drterryshapiro.com/wellness.html.

The Mini-Implant

I recently made a new set of dentures for a very sharp lady of 85 years. But she had a very resorbed lower arch and consequently had a lot of trouble keeping her lower denture in place. It would have been too much of a physical strain for her to have conventional implants placed. So we elected to place two mini-implants. The mini-implant or SDI (small-diameter implant) is an alternative to the conventional implant for patients who cannot tolerate surgery for conventional implants or who may have other physical or financial limitations. This particular lady did very well with the SDI placement and is enjoying the increased stability that the implant attachments now add to her lower denture.

Conventional diameter implants received FDA clearance in the late 1970's and are now considered a routine part of modern dentistry. The SDI only received FDA clearance for long-term use in 1997. This was just 12 years ago so the SDI is still somewhat controversial. Nevertheless, research shows that the SDI's are more than 90% successful. If the situation is appropriate and the implant is carefully placed, I believe that it can be a great service to the patient. In my East Setauket office the SDI is most often used to support a lower denture for people without any lower teeth. Visit my website at http://www.drterryshapiro.com to learn more about implant options.

Dental Cosmetics and Dental Health

A prospective patient came into my East Setauket dental office recently to ask about porcelain veneers. She was unhappy with how her front teeth looked. She had some composite bonding that was stained and chipped. Her teeth had spread out, there were spaces in between her teeth, and she noticed that she had loose teeth. She thought that her problem was just cosmetic, and she was concerned that her insurance company would not cover elective cosmetic procedures.

I took some close up digital photographs of her smile, as I usually do for consultations. We then discussed her photographs which I had enlarged on the computer screen. She could see the condition of her back teeth and the condition of her gums, and she began to realize that she had other problems that contributed to her unattractive smile. We took xrays to confirm that she had defective fillings and decay in her back teeth and she had the bone loss associated with gum disease.

My point is that what may appear to be solely cosmetic is often a symptom of underlying dental disease. Her needed dental work was not only cosmetic, and she was able to collect her insurance benefits. She completed the treatment, is now in good dental health and has a lovely smile!

"A Dental Shift: Implants Instead of Bridges"

The columnist Jane Brody wrote a wonderful piece about implants in Tuesday’s New York Times. I couldn’t have written it better myself, and I only found one error! (She says that implants usually take about eight weeks to integrate to bone – but I would say that 3 to 6 months is more predictable.) She writes about her own tooth problems and about the first molar that she lost when she was in her 20’s and the resulting bridge that had to be replaced several times in the subsequent years. She recently elected to have implants placed in order to replace the two teeth that were now missing due to decay and gum disease. She gives the reasons that implants are superior to the conventional bridge: A bridge is not as permanent as an implant, the bridge is harder to keep clean, implants do not decay, and adjacent teeth do not have to be reduced for supporting crowns.

The implant procedure involves surgical placement by a periodontist or an oral surgeon of a titanium screw, or implant, into the jawbone. The implant then has to integrate with the bone from three to six months, at which time the restorative dentist attaches an abutment, which is a connector to which a crown is then cemented. The restorative dentist needs to do the treatment plan and closely coordinate the treatment with the periodontist or oral surgeon.

Almost 500,000 implants are placed in the United States each year! A patient’s health and quality of bone will affect their suitability for implants. A patient who smokes or who is a diabetic has a poorer blood supply and this will lessen the chance of success. Brody’s article can be found at http://www.nytimes.com/2009/11/17/health/17brod.html?_r=1

To learn more about implants and crowns and bridges visit http://www.drterryshapiro.com/implants.html.

Bottom Teeth Missing: What are the options?

So you don’t have any bottom teeth and are not sure what to do? Here are some options:

1. Conventional Denture: A denture needs to be comfortable and stable and aesthetic while allowing the patient to chew and speak normally. The conventionl denture is the least expensive option but it is also the least retentive option. Studies comparing conventional dentures to implant supported overdentures demonstrate a higher satisfaction with the implant retained dentures compared to conventional dentures. But if finances or health are limitations to implants, the conventional denture may well meet an individual’s needs and is not necessarily an inferior treatment.

2. Mini-Implant Retained Overdenture: If there is not enough bone for a standard size implant and grafting is not an option for health or financial considerations, the mini-implant retained denture is an option. Typically four mini-implants are placed and then fitted to the removable denture.

3. Attachment-Retained Implant Overdenture: Typically 2 – 4 implants are placed and fitted to the removable denture. These regular sized implants are more stable than the mini-implants, but grafting may be needed and the cost is higher.

4. Bar-Retained Implant Overdenture: The bar-retained implant overdenture connects 4-5 implants with a connecting bar. The connecting bar adds retention.

5. Implant-Retained Fixed Prosthesis: With the implant-retained fixed prosthesis, implants are placed so that fixed bridgework can be attached. The removable denture is entirely eliminated! This option is the most comfortable and life-like for the patient – but it is also the most expensive option. The patient needs to have adequate bone and the appropriate height for fixed bridgework – not too little and not too much space between the upper and lower ridges.

6. Which option to choose is something for you and your dentist to decide depending on your goals, your physical condition and financial considerations. The dentist needs to do a careful assessment and have considerable experience in performing complex dentistry. If you would like more information about options to replace missing bottom teeth please contact our East Setauket dental office and we’ll be happy to offer a consultation.

Subway Flossing

This week’s attention grabber in The New York Times, is an article “Don’t Forget to Floss. (But, Please, Not on the Subway)” by Lion Calandra. The accompanying cartoon features a man sitting on a crowded subway with a length of floss in his teeth. Of course, I’m excited to see anyone floss – no matter where! But I guess the article does have a point – public flossing is unsanitary. The flosser pulls up plaque and bacteria that can be infectious. And to make matters worse, the flossers often toss the used floss on the floor.

The writer lists other personal grooming activities that are better done in private: like plucking eyebrows, squeezing pimples, clipping fingernails – all of which she has witnessed on the Long Island Railroad or New York City subways. The author blames YouTube for taking private moments and opening them up for public viewing. So what to do? Obligatory classes for adults on personal grooming and public health? A special railroad car reserved for personal grooming – like we used to have smoking cars reserved for smokers? What next? See http://cityroom.blogs.nytimes.com/2009/11/09/public-grooming-stirs-vigorous-debate/?scp=1&sq=shapiro%20floss&st=cse

For more information about dental health visit www.drterryshapiro.com.

Dental Anxiety

A successful dentist needs to be sensitive to his/her patient’s fears. I spend a lot of time making my patients comfortable. But sometimes patients are very anxious and feel pain even before we begin a procedure.

I just read about a new approach to deal with this problem. This psysiological/psychological maneuver is credited to Allan S, Berger, MD, Professor of Clinical Psychiatry at Georgetown University. He suggests that the anxious patent hold 3 to 4 cubes of ice (wrapped in toweling) in his hands. The dentist then tells the patient to massage the ice, especially using the thumb. At the same time, he tells the patient to count in his mind backwards from 100 to one. Any dental procedure or injection of anesthesia should be delayed until the palms and the thumbs are numb. The patient should feel less pain.

An interesting approach! – and one that I certainly will implement in my East Setauket dental office and monitor to see if it works as promised.

Lifetime of a Dental Crown

The other day a patient asked me how long a dental crown (cap) should last. He had come into my Long Island office with two broken crowns that were about 15 years old. Well, the answer is that all crowns and patients are not alike. A crown should last 10-15 years, but I have a patient who had simply gorgeous gold crowns made some 40 years ago in California that still look as beautiful as they did the day they were inserted. And on the other hand, I have a patient who lost two crowns after only two years because they were poorly made by a dentist right here in Suffolk County.

For a crown to serve well, the dentist has to prepare the tooth properly so that all decay is removed and the tooth is the proper shape to retain a crown. He/she has to take a very accurate impression, make a well-fitting provisional crown, fit the crown properly when it comes back from the dental laboratory and cement the crown carefully. All of this takes careful attention to detail and cannot be rushed. All too often dentists skip a step or cut corners and this will affect the longevity of the crown – and ultimately the life of the tooth.

The dentist must also use the services of a superior dental laboratory that also pays attention to detail and uses finer materials. All too often, dentists who charge less for a crown, can do so because they send their work to inferior dental laboratories.

Another important factor in the life of a crown is the patient. The crown needs to be taken care of with proper brushing and flossing and regular visits to the dentist. If the patient neglects his/her dental health, this will definitely have an adverse effect on the crown. The patient’s systemic health is also a factor. Diabetes and smoking are associated with gum disease which in turn affects the crown and tooth.

For more information about dental crowns and bridges visit drterryshapiro.com.

Caring for Your Dentures

Plaque and calculus can buildup on dentures if a patient has poor denture hygiene. This can be harmful to the oral tissues and can lead to oral Candida and other oral pathologies. Brushing the dentures removes plaque and food debris. Regular toothpaste is too abrasive for dentures so be sure to use a denture toothpaste. You should remove the dentures after eating and brush them with a denture brush and denture toothpaste over a sink filled with water or over a towel to protect the dentures from breaking if they should fall.

In addition to brushing them, dentures should be soaked daily to keep them clean. Soaking the dentures allows the denture cleaner to penetrate the denture and kill bacteria. To keep your dentures fresh-looking and odor-free be sure to brush and soak your dentures daily.

It’s a good idea to leave the dentures out of the mouth at night to rest the oral tissues and allow blood flow to return to normal. When dentures are out of the mouth, they should be soaked in a soaking solution or water to prevent them from drying out.

Denture wearers should visit the dentist for regular checkups at least once a year. Tissues under the dentures can change and the dentures can become ill-fitting and further damage the tissues.

A denture is not permanent. It will wear over time and will loosen as the ridge undergoes changes. Dentures should be replaced every 7 to 10 years. A reline might also be needed every 2 -3 years depending on the amount of ridge resorption.

Call our East Setauket dental office and we will be happy to evaluate your existing dentures for a reline or possible replacement.

Partial Dentures are Not All Alike

Did you know that there are different kinds of partial dentures? Do you know what you are paying for when your dentist tells you that he/she is making you a partial denture? You need to ask what kind of partial denture you are getting. There are all-acrylic partial dentures, acrylic partial dentures with wrought-wire clasps, flexible partial dentures, cast metal partial dentures, semi-precision partial dentures and precision partial dentures - just to name a few! The dentist needs to do a careful diagnosis and treatment plan and discuss with the patient the pros and cons of each of the options. The dentist needs to take superior impressions and bite registrations and pour superior models.

>The acrylic partial denture is the least expensive - that is the advantage, but there are many disadvantages, such as lack of retention and lack of durability. The acrylic denture is made of plastic and often incorporates wrought-wire clasps for added retention. Acrylic dentures are often prescribed as a temporary device when an immediate denture is required - as, for example, if a front tooth is lost, the acrylic denture will serve as replacement while a more permanent solution is being fabricated. We also use it sometimes to replace a tooth while an implant is healing. It also might be used when finances are a limiting factor.

>The flexible partial denture is made entirely of acrylic and instead of incorporating wire clasps like the acrylic denture, it incorporates flexible tooth colored clasps. Valplast is one such product. The flexible partial denture is thus more aesthetic than the acrylic denture and is more durable. It is a more permanent solution when aesthetics is a concern, for example if a front tooth has to be clasped for retention. Although the flexible partial will loosen and discolor in time and is not indicted for a smoker, it can serve quite well for a number of years.

A variation is the Virginia Partial which we have used with great success. This is a tissue born, acrylic-based denture that uses a soft silicone band around any remaining teeth. The flexible band replaces metal clasps. The result is greater aesthetics and comfort for the patient.

>The cast metal partial denture is superior to the acrylic and flexible partial dentures in that it fits better and is more durable. It will serve a patient well for many years. Our cast frameworks are made by Lab One - a very fine denture laboratory in Norfolk, Virginia. They also make our fabulous dentures. The metal clasps are cast with the metal framework and fit snugly around the teeth. The metal framework also fits snugly on the residual ridge. The metal denture is comfortable and durable and can be aesthetic depending on which teeth are missing and the skill of the dentist and technician.

>The precision partial denture is the Rolls Royce of partial dentures. The precision attachment is a precision-machined male and female, or lock and key, housing to connect the removable partial denture to a fixed bridge. The female part of the attachment is connected to a fixed crown and the male part is attached to the partial denture. The two parts are machined to fit with precision. The precision partial denture is most aesthetic as there are no clasps and it is most comfortable as the connectors are precisely manufactured to fit. The disadvantage is the higher cost to accomplish this superior device and that the nearby teeth would have to have crowns.

The semi-precision partial denture is similar to the precision type but is not as precisely machined and is therefore somewhat less expensive.

>In our Long Island dental office, we always discuss with our patients the advantages and disadvantages of each option and help the patient decide which option is best for their particular situation. Regardless of the choice, it takes great skill, caring and judgment on the part of the dentist and dental technician to deliver a superior product.

Technology in the Dental Office

Our East Setauket dental office is excited to have just upgraded our digital radiography system to the Dexis Platinum System. This system uses an even smaller intra-oral sensor so it is more comfortable for the patient, and it uses even less radiation than the earlier digital system. The resolution of the new system is much better so we can see incipient decay and other pathologies. The integration to our practice management system as well as the hardware interface are both improved. Altogether a huge advance of technology!

We first integrated digital radiography into the practice several years ago to better serve our dental patients, and patients are even happier with this upgrade. Digital xrays appear instantly enlarged on the computer screen – no waiting for developing! We can enhance the images and compare older and most recent images side by side and point out areas of concern to the patient. We can email digital x-rays and digital photographs for consultation with specialists – periodontists, oral surgeons, or orthodontists – and get an instant opinion. Digital radiography is also “green,” preventing harmful chemicals from being released into the environment and reducing the cost of containment and disposal.

I am surprised that only 40% of dentists nationally have implemented digital radiography. I couldn’t imagine practicing today with old fashioned xray film! Learn more about advances in dental technology at www.drterryshapiro.com

Dental Implants and Full Mouth Reconstruction

I’ve started traveling to NYU each Friday for the post-graduate training in dental implants and full mouth reconstruction that I’ve been telling my dental patients about. What is full mouth reconstruction, you ask? Sounds like I am remodeling a house. Well there is some similarity. Think about how much abuse your teeth, muscles and jaw take day after day chewing, chopping, tearing, grinding. Think about teeth that have been lost and not replaced. Think about decay not addressed or gum disease not treated. Well all of this can take a toll. Repairing the damage can be very complex. Full mouth reconstruction may be required. Full mouth reconstruction is the process of restoring the teeth to their natural condition. It takes a lot of training, skill and planning for a dentist to do this kind of complex dentistry. Not for the dentist who puts on roller skates and rushes from one patient to the next.

Full mouth reconstruction usually requires a combination of crowns, bridges, implants, or overdentures. It may include periodontal treatment, orthodontic treatment, oral surgery or root canal treatment. Fundamental to this sophisticated approach is occlusion, that is, how the teeth come together. We study how to plan and sequence cases efficiently and predictably with a focus on dental aesthetics.

For more information about Full Mouth Reconstruction visit www.drterryshapiro.com.

A Careeer in Dentistry

A recent poll taken of physicians revealed that many physicians are not happy with medicine as a career choice. If they had the opportunity, they would pursue another occupation. This got me thinking about dentistry. I love what I do – I have great satisfaction in helping people with their dental needs, giving them healthy, good-looking smiles. It is gratifying that patients appreciate the care and skill that goes into my work. I look forward to going to my Long Island dental office to see my patients and find out how they are doing. Dentistry is challenging and I enjoy the life-long learning required of the excellent practitioner.

I’m not sure that my dental colleagues always agree with me. I hear a lot of grousing about regulations, increased costs and the stress of practicing dentistry. All of this is true, but I firmly believe that the benefits – the good that we do – outweigh the stress. Dentistry is a wonderful profession and I don’t regret choosing it for my career. I wouldn’t want to do anything else.

This is also a wonderful time to be a dentist. There have been so many advances in treatment options and we can do so much more for our patients. We have implants and veneers and invisible braces and new composite bonding materials that give our patients better options than before. We can make people look better and feel better about themselves – what can be better than that!

Straighten Teeth with Invisalign?

The Invisalign treatment consists of a series of aligners that are changed approximately every two weeks. Each aligner is custom made to gradually move your teeth into place. The advantages of Invisalign are many. They are clear, so hardly noticeable. They are removable for good oral hygiene so you can brush and floss normally. You can also eat what you want because the Aligners are removable.

But Invisalign won’t solve every malocclusion (bad bite). You need to have a careful examination and diagnosis before we can tell you whether Invisalign will straighten your teeth. Come to our Long Island dental office and we’ll tell you if Invisalign is right for you!

A Woman Dentist

Today women comprise 35.5 percent of all new active private dental practitioners compared to 19.2 percent of all active private dentists. A dentist is a new dentist if she graduated from dental school in the last ten years. Things have certainly changed! When I graduated from dental school women comprised 10% of the class, up from 3% in the years before. But many women dentists work only part-time in order to combine work with family responsibilities. Often women work as associates rather than managing their own practices.

For over 86 years, the American Association of Women Dentists has supported women in dentistry. It was initially a social group, but it adapted to changing times and member concerns. For example, the AAWD guided members after World War II when women dentists lost positions they held while the men were overseas. The AAWD is today a national network for employment opportunities and scientific exchange.

Why go to a woman dentist? Studies show that women spend more time with their patients, communicate better and are more compassionate.

For more information about dental health visit www.drterryshapiro.com.

Dental Anxiety and Red Hair

Red hair color is caused by variants of the melanocortin-1 receptor (MC1R) gene. People with the MC1R gene variants experience more dental anxiety than do people without the MC1R gene variants. They are also more likely to avoid dental treatment than those without the variants. The MC1R gene that is found in people with red hair is also part of the pathway that processes pain and anxiety. Thus the connection between red hair and fear of dental pain. Local anesthesia is less effective for MC1R redheads, and this lack of effectiveness may lead to increased anxiety for the patient and consequently, dental avoidance.

Approximately 11 – 20% of the population experiences dental anxiety with another 45% reporting moderate degrees of dental fear. Despite advances in technology to reduce discomfort, these fears persist and prevent people from seeking dental health.

A recent study reported in the July, 2009 Journal of the American Dental Association concluded that the natural red hair color and MC1R gene variants are associated with increased dental care-related anxiety, fear of dental pain and avoidance of dental care. In my Long Island dental office I evaluate all patients for dental care-related anxiety and take appropriate steps to make sure they are comfortable. I’ll now take extra special care with my red-haired patients!

For more valuable dental information go to drterryshapiro.com

What is a family dentist?

The family doctor may be a thing of the past, but the family dentist has not gone the way of the dial phone. So what is a family dentist? A family dentist is typically a solo practitioner whom you and your entire family can see for your dental needs. A family dentist does not work for a large practice where the dentist you saw at your last visit is no longer working, or where you see a different dentist for each appointment and there is a large and chaotic staff that only knows you as a number. A family dentist is part of the community and supports community activities. He/she is a fixture in the community and can be relied upon year after year to take good care of you and your family through good times and bad.

I’ve had the good fortune to have practiced at the same location in our beautiful Three Village area for over 20 years. I have seen my young patients grow up, marry, and become parents themselves, as other patients have aged and become grandparents. I have shared holidays, celebrations and some difficult moments with my dental family. My patients know they can always reach me, and my door is always open to take care of any dental emergency. I also act as an advocate for my patients. I may refer them to a specialist for particular procedures, such as periodontal or oral surgery, and I communicate directly with the referral doctor to be sure that my patients are well taken care of. I discuss recommended treatment with the patient and help them to make a decision that’s right for them. I call my patients after each visit to my office to see if they have any concerns. I am always available to speak to them on the phone or on email. I am responsible for the quality of the work that comes out of my office, and for the quality of the supplies and the cleanliness of the office. My office is a reflection of me. That’s why one goes to a family dentist!

For more valuable dental information go to drterryshapiro.com

Wash Your Hands!

As you probably know, the first line of defense against flu is to wash your hands frequently and keep them away from your face. But did you know that it was a French dentist, Arnauld Gilles, who first advocated hand washing for infection control back in 1621? His book “The Flower of Remedies Against the Toothache,” was the first French text on dentistry, and Gilles described himself as an "Operator for the Teeth." In his book Gilles speaks out against practitioners who treated patients without cleaning and washing their hands, thus carrying infections from one patient to the next.

Unfortunately Gilles’ recommendation to wash your hands was ignored by his medical colleagues. And it wasn’t until two centuries later, in the mid-nineteenth century, that Joseph Lister began to disinfect surgical instruments and Louis Pasteur showed the connection of bacteria to disease. But even 200 years after Gilles wrote his book, these ideas were considered revolutionary and provoked fierce opposition from the medical profession.

In my Long Island dental office we use strict sterilization and surface disinfection procedures and use disposable items when we can. For more valuable dental information go to www.DrTerryShapiro.com

Affordable Dentistry

As a Long Island family dentist I believe it is crucial for our nation’s health that dentistry be affordable. High costs must not stand in the way of the public receiving quality dental care. So I focus my attention on making my dentistry affordable. I did not raise my fees this year. I do a careful diagnosis and treatment plan for each patient which I review with the patient before restorative work is begun. I present alternative treatment plans so the patient can choose a plan that fits into their budget. We work out a manageable payment plan and arrange for financing if needed. We maximize any insurance benefits due the patient. Open communication and trust are the keys to success. No hidden fees!
What can you do? Don’t neglect your dental health. A neglected mouth is very expensive to restore to health. The regular dental visit is the best investment you can make.

For more valuable dental information go to www.DrTerryShapiro.com

Your Dental Health and Radiation Treatments

I was witness to a sad story in my East Setauket dental office today. A patient whom I had not seen for a year came in for a checkup appointment. In the time I had not seen him, he had undergone radiation treatments and several surgeries for squamous cell carcinomas of his head and neck. Unfortunately his oncologist did not advise him to seek dental care before the treatments began. Nor was he warned of the dental risks associated with radiation therapy. He now has serious dental decay and infections in several teeth.

Oncologists need to tell their patients to visit their dentist before beginning radiation therapy. The oncologist also needs to speak to the patient’s dentist in order to inform the dentist of the type of therapy, the location and dosage and number of treatments. The saliva of these patients is reduced in volume, thus losing its protection against dental decay. I thus want to see these patients on an emergency basis as soon as I learn of pending radiation treatments.

We perform a thorough oral examination, periodontal scaling and root planning and educate the patient about the risks of radiation therapy. We stress with them the importance of meticulous oral hygiene during and after the radiation treatments. I prescribe preventive oral therapies for these patients. We recommend removing any teeth that are questionable. If teeth are removed before radiation therapy, we expect that healing will be normal. But if the teeth are removed after therapy, there is a high chance of osteoradionecrosis – exposed bone and delayed healing. Hyperbaric oxygen may then be delivered to encourage healing. We also restore any decayed teeth. When radiation therapy begins, the patient needs to be fee of infection and decay. We want to see them at frequent intervals to monitor any change in their dental health.

For more valuable dental information go to www.DrTerryShapiro.com

February was National Pet Dental Health Month

Did you forget? You may not know that gum disease (periodontitis) can affect your pet. Many veterinary dentists recommend a full examination of the mouth when a pet is spayed or neutered. This is a great time to do the dental exam because the patient is already anesthetized. Dental xrays are also indicated and may reveal tumors of the jaw bones or other pathologies.

Dentists in the Media

A dental cartoon with the caption "The last moments of Dr. Steven Puckett, D.D.S." appears in the February 23 edition of The New Yorker Magazine. The cartoon is a picture of a dentist who while being confronted by a shark says, "Hmm .. crowding, gum recession, and a high lip line." I laughed out loud! As a dentist, I can't help myself from evaluating people's dentition when they dare bare their teeth. Here the dentist in the cartoon is appraising the shark's teeth as he is about to be devoured. I love it!

Dental cartoons typically make disparaging comments about dentists and focus on the “p” word (i.e. pain). This bothers me as it reinforces people's fears and may encourage them to avoid proper dental care. Dentists are often the butt of comedians and situation comedies. Who can forget "The Little House of Horrors" or "The Marathon Man"?

I also read this week that Nickelodeon will introduce “Glenn Martin DDS” - an animated series about the dysfunctional family of an eccentric dentist.” I kid you not. Uh, oh … can’t wait to see this one!

"A Nation of People with Bad Teeth"

In 1940 the author George Orwell called the British, "A nation of people with bad teeth." Sugery tea may have been the culprit but today tooth decay among 12 year olds in England is among the lowest in Europe. But a survey this month of English dental patients and dentists showed that the British have a predilection for do-it-yourself dentistry. Six percent of English patients admitted to self-treatment. One took out 14 of his teeth with pliers and another used Super Glue to re-cement a crown. This self-treatment may be a result of a shortage of dentists offering dental services through the National Health Service – and the long wait time to get an appointment.

Whitening your Teeth at the mall?

Have you noticed those teeth whitening kiosks at the mall? These kiosks are manned by unlicensed individuals who are hired by "tooth whitening companies." These salespeople take a weekend training session and then go out to the mall to sell white teeth. This is a big problem. Whitening teeth is a dental procedure and it requires knowledge to recognize when whitening is appropriate for a given patient. Before whitening teeth, a dental practitioner needs to recognize gum disease, decay, stained fillings, and other oral conditions. Dentists go to dental school, to dental residencies, and take long hours of continuing education in order to be proficient in their field.

The State of Tennessee has taken the lead in requiring whitening treatments to be performed only by licensed dentists, dental hygienists, or registered dental assistants supervised by a dentist. The unanimous ruling was recently handed down by the Tennessee Board of Dentistry because of complaints to the state about the kiosks. The board oversees and regulates dental safety issues in the state. For our public’s safety, lets hope that New York State will follow the standards set by Tennessee and outlaw the illegal practice of dentistry in the state’s malls!

You Have TMJ, I Have TMJ, We all Have TMJ!

What a misnomer! The TMJ is the temporomandibular joint connecting the mandible, or lower jaw, to the skull. We all have it! Put your fingers in front of your ears and open and close; you will feel the TMJ. The condyle, or tip of the mandible, should rotate and slide evenly and smoothly down the maxillary slope. If the two sides are uneven, if you hear a pop or click, or feel pain, or if your jaw locks at times, you MAY have a disfunction of the joint, or TMJ disfunction. That is the proper terminology! Saying “I have TMJ” is like saying “I have knee,” or “I have shoulder.” How to treat it? First, you need a very careful diagnosis of the problem. Second, you need to explore the many noninvasive treatment modalities that may alleviate some of the symptoms.

Newfangled Oral Cancer Screening Devices?

Ever since I started practicing dentistry I have included a visual oral cancer examination for my patients. This includes examining the soft tissues, the tongue and the back of the mouth for suspicious lesions. Last year over 35,000 Americans were diagnosed with oral cancer and over 7,000 died from the disease. But survival rates are very high for cases that are detected early. In recent years several screening devices have become available. Two popular systems are VELscope and ViziLite Plus. I did use each of these systems for a time but returned to the visual exam after reading several studies that showed these adjuncts to be of no value in detecting oral cancer. My patients know that I keep abreast of medical and dental literature and do what I think is best for them!

Buyer Beware

The other day I received an email from an acquaintance who wrote in part “Our insurance allows us two cleanings/check ups a year for only $5. I wouldn't sacrifice our dental health for money however someone we know … is on our plan so I just switched to him. I haven't seen him yet. The last person off the plan we went to, was awful. Before we got this plan, we had been going for years to our best friends … We only left them because even with the huge discounts they gave us, they certainly couldn't come close to $5 a cleaning.”

I wrote back, “Unfortunately sacrificing your dental health for money is exactly what you are doing. Dentists on a plan need to sacrifice quality and cut corners (at the patient's expense) in order to compensate for the poor reimbursement that they receive from the insurance company. You should go back to your family dentist who will look after your best interest. Going "on plan" may save you money in the short run but will cost much, much more in the long run. I have seen this time and time again - dental disasters that could have been avoided with quality care.

The moral: Don’t look for bargains on parachutes or dental care.

I Hate My Dentures

Yesterday a patient came into the office to tell us how happy she is with the new dentures that I had just completed for her. She was glowing, said that she felt like a movie star and how happy she was to be able to smile again. She was so happy to be able to chew and was surprised at how comfortable the dentures felt. She said that she was very grateful that she had come to my office for her treatment.

She confided in us that she had searched You Tube under “I Hate My Dentures” and found horror videos featuring denture failures. She was glad that she wasn’t experiencing any of the horrors. I have to confide that I also checked out these videos after she told me about them. In contrast, I carefully design each denture and let the patient wear a “trial denture” before going to finalization. That way, patients are always satisfied and I have the gratification knowing that I delivered dentures that fit and function well and look great! No one hates my dentures – I make sure of that.

For more information about full and partial dentures visit www.drterryshapiro.com.

Update on Osteoporosis Drugs and Dental Treatment

The January 1 issue of the Journal of the American Dental Association reports on a new study showing that the proportion of people taking oral osteoporosis drugs who develop a jaw condition called osteonecrosis of the jaw (ONJ) may be much higher than previously thought. ONJ is characterized by pain, soft-tissue swelling, infection, loose teeth and exposed bone.

Previous reports had indicated that the risk of developing (ONJ) from bisphosphonates in pill form were “negligible,” although there was a noted risk in people taking the higher-dose intravenous form of the drug.

The USC School of Dentistry’s database showed that nine of 208 patients taking Fosamax had active ONJ, a prevalence of about 4 percent. All were patients who had undergone some kind of dental procedure, such as having a tooth removed. The jaw complication has been seen in patients taking Fosamax for as little as one year. It seems to occur most frequently after routine tooth extraction.

Although no one is sure why bisphosphonates seem to have this effect only on jaw bones, the authors speculated that the drugs may make it easier for bacteria to adhere to bone that is exposed after a tooth extraction.

At the USC School of Dentistry patients are put on anti-microbial, anti-fungal rinse one week pre-operatively or post-operatively if they have been on bisphosphonates six months or longer. In my office we routinely ask patients if they are taking osteoporosis drugs and if so, we prescribe the anti-microbial, anti-fungal rinse before we begin dental procedures.

Oral Cancer Self-Examination

We do an oral cancer examination and screening for our patients at every dental examination visit. But you can also perform an oral cancer self-examination between your dental visits to check for any early signs of oral cancer. If you are concerned about any of your findings, call your dentist immediately for an evaluation.

Oral Cancer Self-Examination Steps:

1. Press along the sides and front of your neck and feel for any tenderness or lumps. Do the same on your face. Your face and neck are symmetrical, so notice any bumps or swelling.

2. Pull your upper lip up and look for any sores and/or color changes on your lips and gums. Repeat this on your lower lip.

3. Use your fingers to pull out your cheek and look for any color changes such as red, white, or dark patches. Put your index finger on the inside and your thumb on the outside of your cheeks to feel for any lumps. Repeat on the other cheek.

4. Tilt your head back and open your mouth wide to see if there are any lumps or color changes.

5. Grab your tongue with a cotton gauze and examine for any swellings or color changes. Look at the top, back, and each side of your tongue.

6. Look at the underside of your tongue and the floor of your mouth (Touching the roof of your mouth with your tongue during this portion of the exam will allow you to see these areas better). See if there are any color changes or lumps. Using one finger inside your mouth and one finger on the outside (corresponding to the same place), feel for any unusual bumps, swelling, or tenderness.

For more information about dental care, visit www.drterryshapiro.com.