Two prospective patients came into the office recently with the same emergency situation.  Both were edentulous (no 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 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 many 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.

“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.

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.

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, returned to the boat and set sail to continue her journey.

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!

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!

I did make a Maryland Bridge for Alex and - all smiles - he sent me a wedding photo.

A patient sent me a text message Sunday morning that she would have to postpone Monday’s appointment because her parrot was dying and might be in the hospital. That is the first time that a patient had to change an appointment to care for a sick parrot. Poor 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.

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!

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.