Well now I really have heard everything – this time it’s “do-it-yourself orthodontics.”  What next? Do your own fillings? Make your own crowns or dentures? Is the dentist and dental office a thing of the past? I first heard of “Straighter Teeth, by Mail” several weeks ago when I read an article in The New York Times about remote orthodontics.

By now most people have heard of Invisalign which can straighten teeth by use of successive clear plastic aligners instead of traditional metal orthodontic brackets and wires.  But Invisalign is not within everyone’s budget. So an enterprising dental entrepreneur decided that the dentist and orthodontist were superfluous. People could insert the aligners on their own, with online support. The at-home cost is considerably less than the in-office cost. The client simply purchases a kit to make the dental impressions at home. A how-to video shows the client how to mix the putty, put it in stock trays and take impressions of his teeth. The impressions get mailed to the “Do-it-Yourself” company and a series of clear aligners is made to correct crowded teeth or teeth that are too spread out. A customer representative guides the patient through the process.

This may sound easy and inexpensive – but beware of dental bargains. A thorough exam and xrays are essential before beginning tooth movement. The patient cannot self-diagnose gum disease or decay which must be treated before any tooth movement should begin. Sometimes the misalignment of the teeth is too severe for Invisalign and certainly too severe for do-it-yourself. There needs to be a careful diagnosis and treatment plan and continued supervision by a dental professional. The do-it-yourself program may seem like a bargain, but it could be nothing more than a waste of money.

The Food and Drug Administration considers aligners to be a prescription item. They have approved more than ten kinds. But the FDA does not regulate the practice of dentistry; it is up to the states and their dental boards to decide what is appropriate care.  Recently the American Association of Orthodontists warned people against tooth movement without an initial exam and continuing supervision by an orthodontist.  “Our concern is that patients who don’t see an orthodontist for regular checkups and/or for a complete diagnosis are more likely to be harmed,” said Dr. Rolf Behrents, a spokesman for the AAO.

It is a truth universally acknowledged (thank you Jane Austin) that a lower denture is difficult to stabilize and difficult for the individual to wear comfortably.  In my office I work hard to provide a lower denture that fits well, functions well and is comfortable. But if a person has excessive bone loss or strong musculature, the lower denture may be a problem.  Today the standard of care for a person without lower teeth is really the implant overdenture.  Minimally we place two implants in the lower jaw, let them integrate with the bone for several months, then attach what are called Locators. A housing is then added to the denture base that snaps into the Locators. Since the denture snaps into the Locators, the denture is very stable. It takes some strength to remove! No more wobbly lower denture, no more denture adhesive!

I always discuss the advantages of the overdenture and let the patient make the decision. The implants do add to the cost of the denture service. Sometimes people elect to try to wear the denture and add the implants later, if needed. Often cost is a factor. But when we do add the implants, the “wow” factor is amazing. People love the overdenture and it is a life-changer.

Betty had been wearing dentures for many years and had significant bone loss. She was ready for an overdenture. She had bone grafts, then healing, then placement of the implants, then more healing until we placed the Locators and housing. She is thrilled. For the first time, she has a comfortable, secure lower denture.  Listen to what Betty has to say about her overdenture on our youtube channel.

Rita has been wearing dentures for over 30 years.  She is 74 years old, fit, healthy and very active. She wanted her dentures to be comfortable, look natural, and she wanted to be able to eat out with her friends.  I’m impressed that she managed to keep her existing dentures in her mouth – even with a tube of denture adhesive, they flopped all over.

When dentures don’t fit properly, the lower jaw moves forward and the face collapses so the chin and nose begin to approach each other.  If you look at Rita’s original lower denture teeth (below), you can see how the jaw has moved forward. The lower teeth overlap the top teeth, instead of the top teeth overlapping the lower teeth. This is not attractive and it is not comfortable for the jaw.  Over time, as the upper and lower teeth rub against each other, the teeth begin to wear. As they wear, the teeth shorten and not enough tooth shows.  The face collapses. This is an aged dentition.


Old Dentures

We made a new set of dentures for Rita.  See (below) how much tooth shows now.  See how the upper teeth overlap the bottom teeth. See how the teeth are not worn down. All of this increases her facial height so her chin and nose are at nearly normal distance from each other, her face is filled out, and she has fewer wrinkles around the mouth.  She also has whiter teeth as a bonus!


New Dentures

A long-time patient came into the office last week for his six-month exam and cleaning. He was concerned that his teeth were not as white as they once were. As we age, our teeth also age and become darker – more yellow or more grey. This is what had happened to John and he wanted his teeth lightened. He asked about banana peel teeth whitening. The banana peel teeth whitening?  What is that? I had never heard of this. He explained that he had heard from several sources that he could rub a banana peel over his teeth and they would lighten. Now (as they say) I have heard of everything!


I needed to check this out so went to the internet. There were over 3,000 results for the search “banana peel whitens teeth”!  From what I can gather, the fad began with a Pinterest pin in 2012- now removed. Glamour Health & Diet then reported on the Pinterest claim that to “whiten teeth with banana peel is very safe and healthy for teeth as banana peels are a wonderful source of minerals and vitamins. They do not have the abrasiveness that other natural whiteners have and best of all they are inexpensive. Brush your teeth as usual with a natural toothpaste or you can use the banana peel first and then brush. Take a piece of the inside of the banana peel and gently rub around on your teeth for about 2 minutes.”  The Glamour article goes on to say that a Colorado dentist tried the banana peel whitening system for himself and after 14 days his teeth looked the same as when he began.  The author also tried it without results.


I have to admit that I was curious, so I bought some bananas and also tried the treatment. My teeth could use some whitening but bananas did not do the job. Bananas are inexpensive and a healthy food, but I am sorry to say that they do not whiten teeth.  In our office we whiten teeth with professional whitening gel and custom take-home trays.



For many years, people who had prosthetic joints were advised to take prophylactic antibiotics before undergoing dental procedures. The antibiotics were to help prevent orthopedic implant infections. It was presumed that bacteria from the mouth could infect the artificial knee or hip joint. But a recent 2014 panel formed by the American Dental Association Council on Scientific Affairs determined that there was not a demonstrated association between dental procedures and prosthetic joint infection (PJI). They voiced concern about antibiotic resistance, adverse drug reactions and costs of prescribing antibiotics for PJI prevention.  The 2014 panel recommended that prophylactic  antibiotics not be prescribed prior to dental procedures to prevent prosthetic joint infection for patients with prosthetic joint implants.

It has been my experience that orthopedic physicians do not necessarily follow the advice of the scientific panel. There may be individual circumstances for which antibiotic treatment might be advised.  As always, check with your physician if you have an artificial joint.

Mary did not like her smile. Her front teeth were dark and uneven. She was ready for some cosmetic dentistry to give her a smile she could be proud of. We spoke about placing veneers on several of her front teeth but she wanted to see how we could improve her smile with minimal dentistry. I felt that we could achieve what she wanted by placing porcelain veneers on her two front teeth. The veneers would lengthen and brighten her smile. She is so happy with how her teeth look that she is now considering placing veneers and crowns on her other teeth that could also use restoration.


Before: Broken teeth, stained and decayed.


After: Porcelain veneers to brighten her smile.

Yes, “Painless Parker” did exist.  “Painless” was a dentist who practiced in Brooklyn from 1897 until he moved to San Francisco in 1912 where he continued to practice for several more years. Parker was born in New Brunswick, Canada and attended Temple University dental school. He may not have been the best dentist, but he was a pro at advertising. The outside of the Flatbush Avenue building that housed his dental office blazed with the alliterative: “Proclaimed by Public, Press and Pulpit”; “Painless Parker Is Positively Perfect”; “Pains and Pangs Positively Prevented.” The dental association was not amused by his false claims. Born Edgar Rudolph Randolph Parker, he legally changed his name to “Painless” in 1915 because of complaints of false advertising.


Parker was the quintessential snake-oil salesman with goatee, top hat and cutaway coat.  Early in his career he hired a former manager for P.T. Barnum and traveled through Canada and Alaska with dancing girls and a tent show.


He established the first and, hopefully, last sidewalk dental show. He employed a brass band, bespangled women and contortionists who would perform a sideshow to drum up patients. Dr. Parker would be on-hand to speak out on the horrors of tooth decay and then he would ask for volunteers to come forth to sit in his portable dental chair. One of his assistants would volunteer, and the doctor would pretend to extract a tooth without causing pain. He would afterwards display a palmed tooth to the astonished audience.  But back in his office when Dr. Parker pulled a real tooth, he would tap his foot to signal to the band to play and thereby drown out the screams of the unlucky patient.


Parker founded a dental chain, owned a yacht and made and lost several fortunes in what he called “the noble tooth-plumbing profession.” His life was an inspiration for the character of Painless Potter, the frontier dentist played by Bob Hope in “The Paleface.”  Parker died in 1952 when dental advertising was still illegal. Today advertising by professionals is legal. Lets hope that dentists today employ truth-in-advertising.



When Andrew was a child he fractured both of his upper front teeth. He had crowns placed on both teeth in the early 1980’s. As you can see below, the crowns are squat and too bright for the surrounding teeth and the gums are uneven. The crowns look very artificial and he was unhappy with the looks.   Not only were the teeth ugly – but they were causing enormous wear of the lower front teeth because the crowns were in the way and he was grinding and clenching his teeth.  Andrew needed a makeover!  We removed the old crowns, placed new all-ceramic crowns on the upper front teeth and placed porcelain veneers on the lower front teeth. Andrew is thrilled – he looks wonderful!



Before: ugly crowns, worn down lower teeth


After: new crowns and veneers – very natural looking

This is what Andrew wrote to us after the work was completed:

Thanks to Dr. Terry and her great staff!!  Special thanks to Peter Kouvaris, Master Ceramist for his excellent work on my crowns. Dr. Terry is an absolute professional and she uses only the best Lab. They literally saved my mouth and my smile! Her approach to my problem was the absolute right one. Other dentists could not even handle my problem, but Dr. Terry took the time, she did not rush, she called me after visits to discuss the right plan of action and to see how I was feeling because she really cares.  Dr. Terry and Peter Kouvaris Lab…. THANK YOU!!

It’s a cliche: the British have really bad teeth. A reference to British teeth always gets a laugh from the American audience. I’ve checked out the situation and maybe yes, maybe no. Are British teeth really in worse shape than other people’s? Probably not. But in 2012 the New Republic raised a ruckus when it placed a photo-shopped portrait of Kate Middleton, Duchess of Cambridge with rotting teeth. The picture is on the cover of the July 8, 2012 edition of the magazine and it is meant to be a sign of the decay of Britain, the featured story. This special issue of the magazine ran with the title ‘Something’s Rotten. The Last Days of Britain’ next to the picture. The photo really is a shocker and shows how ugly teeth can spoil a lovely face.

The British newspaper, The Daily Mail, voiced outrage at the lack of respect for British royalty. Then other media and social media weighed in on the appropriateness of altering the royal image and whether the cover photo showed disrespect for the British royalty.
I always thought Kate had a beautiful smile and I wasn’t sure if she had had any cosmetic dentistry done. So I went on an internet hunt and searched for clues. According to the British periodical, Mail Online: “Last year the pearly white Duchess spent thousands of pounds having her teeth polished and turned to give her the perfect smile.” A French dentist used a “hidden brace to make Kate’s teeth appear a little out of line, un-American and therefore beautifully natural. ‘He did some little micro-rotations on Kate,’ the dentist Bernard Touati revealed. ‘That’s why they look so good – because they are not perfectly aligned. The problem in the United States is they have very artificial vision. But what we like is a natural healthy smile, but not artificial.'”  Yes, I do agree with him that natural is best and that is what I strive for. The dentist also whitens teeth and has an office in London’s Wimpole Street as well as in Paris and Geneva.

Here is Kate’s naturally beautiful smile, before any cosmetics were done:



Kate’s husband, Prince William, Duke of Cambridge has his mother, Princess Diana’s teeth – incisors too large and a narrow buccal corridor. Maybe he had his premolars removed for orthodontic treatment? I think his mother, the late Princess Diana almost certainly did. His younger brother, Prince Henry of Wales, could use braces to close the spaces between his front teeth. The boys’ father, Prince Charles, has scraggly, yellow teeth.  Just look below at a cartoon of Prince Charles, complete with bad teeth, which appeared several years ago on the cartoon series The Simpsons:



And look at how a royal fan weighs in:


Marilyn is 87 and lives in an assisted living home.  She is active and feisty: loves to play cards and billiards. She dresses with great care, but she had a habit of removing her denture – probably because it didn’t fit or wasn’t comfortable. So last week she removed it in the dining room and placed it in a napkin (NEVER do this, I tell my patients!). A denture wrapped in a napkin is looking to get discarded – and that is just what happened. Marilyn was without her teeth and she was, understandably, very upset.


Her daughter read on the internet that I make great fitting dentures in just four visits. She called me and she asked if I could make a denture in even less time so Marilyn could have teeth sooner rather than later. I told them to come in the next day, and I would have a new denture for her in four days. They were both thrilled. I condensed the fabrication process into one visit but I couldn’t guarantee that we would be happy with the result. I explained to them that if we weren’t happy with the teeth, then this denture would be counted as a temporary denture, and it would take just a few more visits to make a denture that satisfied us all.


The next day mother and daughter came in for mom’s visit – I took impressions and measurements. I consulted with my fabulous denture laboratory. Four days later I delivered a new denture, and the result was spectacular – looks great, fits snugly and functions well. Let’s just hope Marilyn doesn’t take this denture out and place it in a napkin! But if it is lost, at least I always put the owner’s name on the inside.


Marilyn lost her upper teeth!


Now Marilyn can smile again!