It’s winter and several of our East Setauket dental patients went off to warmer climates for scuba diving. I’ve never gone diving – sounds scary - but I am tempted to learn this sport so I can see the fabulously colored sea life. I read recently that pressure changes during diving can cause damage to your dental fillings. A case was reported in an article in JADA titled “Dental Restoration Dislodgment and Fracture During Scuba Diving: A Case of Barotrauma.” http://jada.ada.org/cgi/content/abstract/140/9/1118. Barotrauma is a term used to describe an injury caused by a rapid or extreme change in air pressure. Areas within the body (such as your teeth) can be especially affected by barotrauma.

The article explains that three of a patient’s fillings fractured or dislodged while he was scuba diving at a depth of 35 meters. His dentist later replaced the broken fillings with new fillings and crowns.

Inadequate fillings can predispose patients to barotrauma. To prevent barotrauma-related damage to the teeth, you need to be sure your dentist places high-quality restorations that do not trap air beneath them. People who are exposed to barometric stress should know the causes of barotrauma. They need to be aware of the importance of regular dental checkups to help avoid barotrauma-related dental problems.

“Talking Teeth” is the name of a bi-weekly radio program on 91.5 AM hosted by my good friend and colleague (and mentor) Dr. Dean Vafiadis. On this program Dr. Dean discusses issues of dental health. Tonight’s topic was implants; two weeks ago it was periodontal disease; the next topic will be “teeth in an hour.” Dr. Dean is an excellent speaker – always informative and entertaining. He calls the program “Talking Teeth” because he says that teeth talk to him. That may sound funny to the public, but I know what he means. Teeth do talk to me too! They tell me a lot about your habits and your life style. I can tell if a tooth is happy or unhappy or if it needs attention. So check out Dr. Dean’s radio program if you want to learn more about what the best dentistry can do for you.

New regulations in Massachusetts require that preschools add toothbrush time to the school day.  Children who eat a meal at day care or attend for more than four hours will be supervised brushing their teeth and  educated about oral health.   The Massachusetts Department of Early Education and Care established the regulations to help prevent dental disease.  According to a 2003 study, one in four Massachusetts kindergartners have tooth decay.

So, brushing at school sounds good in theory.  But in practice?  How do two teachers help 30 four year olds without the motor skills to brush correctly?  How do they maintain sanitation? How do the children spit out? Avoid spreading germs?  Keep the brushes clean and replaced when worn? Avoid swallowing toothpaste?  Seems ill advised to me.  How about focusing on what the children eat for lunch instead?  Perhaps if the children ate an apple for dessert instead of Hostess Cupcakes they would not have so much plaque and dental decay.

More on children’s dental health at http://drterryshapiro.com/children.html.

Last February I posted a blog entry called “Teeth Whitening at the Mall” (See http://drterryshapiro.com/blog/?p=27.) I spoke about the dangers of having whitening (a dental procedure) done by unlicensed individuals. I mentioned that the State of Tennessee had outlawed this practice and that I hoped New York State (and that includes Long Island) would follow the standards set by Tennessee and outlaw the illegal practice of dentistry in the state’s malls.

Here we are just one year later, and New York State has done just that in their new guidelines just published! The guidelines from the New York State Board For Dentistry state:

“Recently, consumers in New York State have been exposed to a significant number of products involving teeth whitening. While certain over-the-counter products may be safe, other products available for self application or through retail outlets have the potential to cause harm.

“Underlying dental health conditions may make a patient a poor candidate for certain teeth whitening processes. These processes may not be effective, and may actually do harm to a patient’s teeth and gums. The application of teeth whitening products in a retail outlet, not subject to the infection control requirements of a dental office, creates a risk of disease transmission for the consumer and individuals working in such an establishment.

“The application of teeth whitening products by or with the assistance of someone who is not a licensed dentist or dental hygienist may constitute the illegal practice of the profession of dentistry, which is a crime. The State Board for Dentistry office will refer any allegations of the illegal practice of dentistry to the Office of Professional Discipline for investigation.

“Individuals should consult with a licensed dental health professional and have their overall dental health evaluated before making decisions regarding teeth whitening products and services.”

Read more about teeth whitening at http://www.drterryshapiro.com/teethwhitening.html.

It’s been a while since you visited the dentist.  So you call my East Setauket dental office and this is what you can expect!  Does a voice pick up our line and say: “hold please?” or “to speak to the receptionist press 1, to speak to the assistant press 2.”  No!  My receptionist, May Paone, answers the phone and with her friendly voice asks, “how can I help you?”  She will spend time learning about you and will schedule an appointment for you to see us within days.  If it’s an emergency we’ll see you as soon as you can get to the office, even after hours or weekends.

May will send you an email confirming the appointment. She will send a link to our website that has a link to mapquest to help you find the office and a link to patient forms for you to fill out in advance and email back to us.  She will let me know that a new patient has called and I will call you that evening to ask what I can do to help you.

When you arrive at the office, you will be warmly greeted by name and will be escorted into my office - no waiting - we respect your time.  We will chat some more about your concerns.  I often will take close up photos of your teeth to help us see what we can do to help. Photos are a great education tool for the patient and for me.  I also have videos on implants, dentures, crowns and other procedures that help to explain what we can do.  We don’t charge for this consult.

If you decide to proceed, we explain that xrays and a comprehensive exam will be needed.  We will tell you ahead of time what the costs will be.  We take a full set of xrays so we can see each tooth and the surrounding bone.  The comprehensive exam includes an oral cancer screening and periodontal assessment.  Once we have collected the data, I develop alternative treatment plans depending on your desires, finances and health.  All of the options are thoroughly discussed with you so you know the choices and associated fees. We work to make the dentistry affordable, and we offer financing and credit.  I also continually review my fees and recognize that times are tight. We don’t want people to delay getting necessary dental work done.

Once you make a decision, we can schedule the necessary appointments.   I give you my cell phone number so I can always be reached.  If I am away, my answering service sends me a text message the instant you call, so I can call you right back or I can always be reached via email.  After every dental appointment in our office, May or I will call you to ask how you are feeling.  When treatment is complete, we schedule you for a checkup appointment so we can maintain your dental health.  We ask for input from you so we can modify our procedures to best serve our patients.

In my office you are not just a chart or tooth number.  You will not be asked to wait.  You will not be told it’s your fault.  You will not be told “wait and it will get better.” You will not be seen by a different person every time you come to the office.  You will see me - and May and Linda Gomez - who have been my teammates for over two years.  Our goal is to do our very best for you. This is why we are different.

I was just about to place a composite filling today when my patient asked if the composite material contained bisphenol-A (BPA).  I was embarrassed to admit that I didn’t know.  I did post a blog article about BPA and sealants on my blog and I do use a sealant that does not have BPA. But composite was a different matter.    I just wasn’t sure about dental composites.

The composite that I use is Renamel by Cosmodent, and it is a very fine product.  I checked their catalog, but there was no mention of bisphenol-A, making me think that the product did contain BPA, or they would have announced that it did not.  Then my question was whether there was a composite available that did not contain BPA, and was there any health danger for the patient if composite does contain BPA.

I checked the American Dental Association website for their information on BPA at http://www.bisphenol-a.org/human/dental.html

http://www.ada.org/prof/resources/positions/statements/bisphenola.asp. They defended the use of dental composites, as I would expect, saying that there is no evidence that they are unsafe. From the ADA website: “Based on current research the Association agrees with the authoritative government agencies that the low-level of BPA exposure that may result from dental sealants and composites poses no known health threat.”

But rinse well after a composite is placed – it can’t hurt!

Parents often ask when their children should have their first dental visit. I like to tell them to bring the children to our office when the parents have a checkup visit so the children become familiarized with the office. Our East Setauket dental office is child friendly. Don’t wait until your child is in pain or has a problem before seeing the dentist.

Your child should see the dentist when their first tooth comes in. You can clean your baby’s gums with a clean, damp cloth. Help your toddler brush his/her teeth and only use a pea-size dab of toothpaste. Get your child accustomed to flossing. Don’t put your child to sleep with a bottle or let them fall asleep while they are nursing.  Children should eat healthy foods – fruits, vegetables – and limit sugars and starches, sodas and juices.

Regular dental visits are the best prevention. We place sealants to protect young teeth from decay. We also make mouthguards for children who are active in sports.

You realize that it’s not a good idea to neglect your dental health, but with so many other pressing expenses in this time of recession, teeth just can’t be a priority for many people. So I have been trying to help people get through the recession with minimal impact on their dental health.

To make things easier for people who might be working longer hours to make ends meet, my East Setauket dental office offers convenient hours: early morning, evening and Saturday hours. Some people are putting off their dental care until they have a pressing dental problem, so we are seeing more emergencies. We always make time for these emergencies, any time, any day. We are also seeing more children because although people may put off their own dental needs, they don’t want their children to develop dental problems. We enjoy our young visitors and make their visits affordable.

We also offer financing options and payment plans to make it easier to manage the cost of treatment. I have reviewed our fees and have reduced some fee services to make it easier for people to get the care they need without our sacrificing quality. Hopefully we’ll all get through this together – and Happy 2010!

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!

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.