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Suppose you had lost all of your upper or lower teeth. What are the options?

1. The simplest, least costly but most prone to problems, is the conventional denture.

2. An improvement is the overdenture in which the denture snaps into two or more implant attachments. See my blog entry and video of  April 14, 2015.

3. Even better is the hybrid denture. For the hybrid denture, several implants, (typically six) are placed in the arch.  A prosthesis that is screwed into the implants is constructed. It is a fixed prosthesis as far as the patient is concerned, but the dentist can remove it for maintenance.  Thus we call it a hybrid, or fixed/removable.

     The hybrid is a wonderful service. The teeth function like natural teeth. However the hybrid and surrounding tissues need to be kept clean.  Calculus and plaque can lead to gingival inflammation and peri-implantitis with eventual loss of the implants. I instruct the patient to use a water pic from outside and inside, as well as running floss under the hybrid denture and use of an end tufted toothbrush.  The patient also needs to return to the office at six month intervals so we can professionally clean the hybrid and remove it as necessary.  The acrylic teeth can also chip or fracture. We supply a temporary hybrid so the patient can wear this if the denture needs to be repaired. Acrylic teeth may have to be repaired in five to seven years. If the hybrid opposes natural teeth, we may also make a night guard to protect the hybrid from breakage.

     Alan had upper and lower hybrids that were made seven years ago in another office. The teeth had chipped and they were heavily stained as well as being a vehicle for heavy calculus and plaque.  I removed the hybrids and constructed new ones.  This took several visits but look how wonderful he looks now!  He is more comfortable and can function better too. He promises to return regularly.  He went back to Florida for the winter, his spare hybrids in hand.

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New hybrids

The Pygmie people live near the equator in the African rain forest.  Teeth filing or sharpening is a painful custom of these Pygmies of the Congo Basin.  The practice began over 500 years ago in order to make the indigenous people less attractive to the slave traders, as they thought.  The sharpened teeth were also an aid in eating meat.  Some of their descendants continue the practice today as teeth sharpening has become an integral part of the Pygmy culture.  The procedure takes about 45 minutes and is performed on all six upper front teeth. The people use a knife or hammer to chisel away the tooth until they achieve the desired shape. The procedure is very painful.  At the same time, lacking sugar, these indigenous people did not have any tooth decay in the seventeenth century.

Sadly, in 1904 the American explorer Samuel Verner brought back several Pygmies to exhibit at the St. Louse World’s Fair.  One of the Pygmies, Ota Benga, was later exhibited at the Bronx Zoo.  The New York Times  reported on the exhibit with the headline “Bushman Shares Cage with Bronx Park Apes.”  Today the official website of the New York City Department of Parks & Recreation describes this human exhibit as “misguided.” Certainly a better apology is needed for this horrific chapter of our history.

Two lovely stories told to us at the office.

 

First story: Jaime sat down in our chair and said she had something exciting to tell us – but Linda, May and I all had to be present. What could it be? We had known Jaime for over two years and knew her to be a lovely person but she had never confided in us the story she was about to tell us now. She began: in 1963 she had a daughter out-of-wedlock. She gave the child up for adoption. She thought of the child every day for over 50 years and always wanted to know how she was and what kind of person she turned out to be. In those days the adoption records were sealed and she had no way of knowing who adopted the child.

 

Speed forward to 2015 when adoption records have been unsealed.  Jaime was contacted by a woman born on the same date in 1963 and at the same hospital. This was her daughter. They met each other and caught up. The daughter had been adopted by loving parents and grew up to be a wonderful, loving adult, married with two children. Jaime, who didn’t have any other children, now has a ready made family. It is a lovely story!

 

Second story: Michael came to the office for a new patient consult. Right away I saw that he did not have any teeth and was not wearing dentures. He had lost his teeth over the years from decay and periodontal disease. He never had dentures made because he had a dental phobia.  But he had a story he wanted to tell me. He grew up in the United States but was born in England.  Recently he received a call from an English woman who turned out to be his sister. He never knew that he had a sister living abroad.  The story is complicated about why he did not know this. He wanted to skype her but he wouldn’t do so as he was without teeth.

 

He wanted dentures so he could meet his long-lost sister.  He was anxious to get started so we took impressions that evening and three weeks later he had teeth. He was so happy that he could taste food again and smile broadly. This amateur artist drew my picture and wrote me a lovely note: “I wanted to thank you and your staff for improving my life – so much. I don’t have the words to articulate how grateful I am so I thought a drawing of you. Have a great holiday season with an even better New Year.”  Thanks Mike – you make my day!

 

Funny how both of these stories have to do with lost relatives. One story has everything to do with teeth; one has nothing to do with teeth. Both stories show how important family is! Happy New Year!

Michael’s teeth were removed one by one over the years until all were missing. Out of fear, he never had dentures made. He grew a long and wide mustache to hide the fact that he had no teeth. He never smiled. He ate only soft foods. But recently he learned that he had a sister living in Europe whom he had never met.  He was anxious to meet her through skype but he was embarrassed that he had no teeth. He contacted me and we sat down to talk. He was excited to begin the process of getting dentures (implants were not an option for health and financial reasons.) We scheduled four appointments over four weeks and we delivered his new dentures on time. He couldn’t have been happier! The dentures were very tight – almost difficult to remove. They were comfortable – he wore them all day and he said that he didn’t know he had anything foreign in his mouth. He was amazed at all he could eat and that he could taste food again. He was so appreciative that he wrote me a lovely review in Google:

“From my first appointment which was about five appointments ago I can tell you by far Dr. Shapiro is the best Dentist you would ever meet. Doctor Shapiro and her staff Linda & May are extremely professional.  My first impression – I was excited to find such a technically up-to-date Dentist. Before my first visit was over it was clear to me Doctor Shapiro and her staff not only possess superb dentistry skills. They understand patients’ needs which (in addition to doing a great job on my teeth) they provide really well. The information they provide and the way it is communicated is so comforting. Scheduling appointments and billing was easy and well thought-out.   I have to tell you the truth. I never dreamed in a million years that I would be saying these words but after my first appointment I said to my wife “I am looking forward to next week’s dental appointment”. I want to thank Doctor Shapiro, May and Linda for all that they have done but for now all I can do is smile.” Michael Serrano

Dentistry is a wonderful profession. How often does a person get the chance to change someone’s life?

Sharon wasn’t happy with her smile. Her teeth seemed too small; her gums seemed too large. She wanted a makeover. She thought crowns would do the trick. We took some photos and talked about her smile.  As we spoke, she began to see that her gums were the problem – not her teeth.  Her overlarge gums covered her teeth such that the teeth appeared small.  She needed some periodontal work – what we call a “crown lengthening procedure” to scallop the bone and gums above the natural teeth.  I referred her to a periodontist who specializes in recontouring bone and supporting tissues. The work took one visit. The gums then took a couple of weeks to heal. The results were spectacular!  Sharon looks fabulous – her old teeth like new!

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See how her gums cover her teeth.

The lateral incisors look too small and she has what we call a “gummy” look.

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Now look what a beautiful smile she has!  The teeth are the same but the excess gum tissue was removed.

Sometimes a simple procedure can make a huge difference.

It’s all about proper diagnosis and treatment planning.

Jay is a hero. He was at the World Trade Center on September 11, 2001 – now 14 years ago. He saw horrific images. He then spent the following four years supervising cleanup at the site. Four of his co-workers subsequently passed away from rare cancers contracted from the pollution. Jay had his yearly checkups and was grateful every year that he passed his physical and was healthy.

 

Jay came into my office last month because he wanted a new smile – his teeth had dark black/brown stains and were severely eroded. He was very unhappy with his teeth. We spoke about this and I was very puzzled: what had caused this severe erosion? I had never seen anything quite this severe. Did he have any habits, did he suck on lemons? or anything acidic to cause this destruction of his enamel? My questions had triggered a memory and he lit up – it was the World Trade Center, he said. While he was on the cleanup he had a strong, acidic taste in his mouth that he couldn’t get rid of. He would rinse and brush his teeth but the taste stayed with him. He had never before made the connection but he said that the teeth damage had begun during that time. Before Sept. 11 his teeth were normal. I did some investigation about World Trade disabilities.  There is some data on dental damage but it is not something that has been a focus among so many other disabilities of the survivors and responders.

 

After completing a full dental examination I determined that most of Jay’s teeth could be saved as the roots and gums were healthy. We scheduled two appointments, one to place temporary crowns on the upper teeth and one appointment to place temporary crowns on the lower teeth. He was thrilled with the transformation.  Permanent crowns still to come!

 

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 Severely eroded teeth

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Temporary Crowns

Remember when your teeth were bright white? Just look at some old photos – what happened to that sparkly smile? Despite your best efforts to brush and floss regularly, there are structural changes that make teeth appear more yellow as we grow older. First, the outer coating of the tooth (the enamel) gradually becomes thinner. The layer underneath (the dentin) becomes thicker. The dentin is naturally a yellow/brown color so as the enamel thins, the color of the dentin begins to show through more and more. The enamel thins out because of wear and tear and acidic foods.

In addition, once the dentin is exposed, foods that stain the teeth are more easily absorbed by dentin than by enamel.  There is also a natural laying down of secondary dentin that affects the light-transmitting property of teeth, resulting in a gradual darkening of the teeth as we age.

Some of the color change is unavoidable. But other causes, like dry mouth and acid reflux, can be treated.  Other causes to be avoided are excess sugar, acids and alcohol, bulimia and tooth grinding and clenching.  Some foods also discolor the teeth: blackberries, grapes, tea, coffee and red wine. Tobacco will also certainly stain the teeth, as well as contributing to gum disease.

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Selfies are posted to Facebook and sent as text messages. Whether they are traveling or relaxing close to home, people want to insert themselves into their photos. And now we have the dental selfie. Recently people have been emailing me selfies of their teeth and gums. Sometimes the selfies come from patients of record and sometimes from people I don’t know.

A couple of weeks ago a young man sent me a selfie of his crooked front teeth. He wanted to know what he could do to straighten them. I suggested that he call the office and make an appointment for a consultation. It is just not possible to diagnose and treatment plan from a selfie! But I also get selfies from people who are undergoing treatment.

A woman who just had several teeth extracted and dentures placed sent me a selfie of her ulcerated gums. (Look below at her selfie.)  The photo confirmed that she was suffering from denture sores – just what I had diagnosed from our recent visits and conversations.  I reassured her, gave her some additional directions and sent an online prescription to the pharmacy. I have been reading that online medical diagnosis has also been a growing issue.

I haven’t yet asked a patient to send me a selfie – but who knows, this may be in the not too distant future.

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A Dental Selfie

Here is a Question: Is it better to floss before or after brushing your teeth?

I had a hard time finding any studies that addressed this question.  But flossing first doesn’t seem to necessarily be better for your oral health than flossing after brushing. Neverhelesss dentists still weigh in on this matter.

One spokesman of the American Dental Association, Dr. Edmond R. Hewlett, recommends flossing first. His reasoning is that flossing is unpleasant so do it first to avoid the temptation to skip it.  This seemed a very unscientific rational to me – plus people who really do floss regularly don’t find it unpleasant. Diehard flossers (I confess that I am one also) love cleaning out plaque in between their teeth and don’t feel clean unless they do so.

In contrast, Dr. Philippe Hujoel, a professor of oral health sciences at the University of Washington in Seattle, recommends brushing with a fluoride toothpaste, then flossing. That way the floss will maneuver the fluoride in between the teeth.

Flossing reduces gum inflammation, or gingivitis, which can progress to periodontal disease and loss of teeth.  It is not clear what effect flossing has on dental decay. Technique is crucial for flossing to reduce plaque. You need to guide the floss along the curve of the gum line at the base of each tooth as well as flossing up and down each tooth.

After 17 years on North Country Road in Setauket, Anne Marie’s Farm stand is slated to move. The owners, Mary Ann and Joe Deriso, lost their lease and needed to find a new location for their organic fruits, vegetables and plants. They are sad to leave our neighborhood where they have become a much-loved presence, but they look forward to making new friendships at their new location at 680 Old Town Road near Jayne Boulevard in Port Jefferson Station. They also hope that many of their regular customers will make the trip across Route 347 to the new farm stand.

As many know, I am a firm advocate of local, organically grown produce. I have been a regular customer at Annne Marie’s. I always look forward to their fresh strawberries in early June (hopefully coming up next week!), corn in July, tomatoes in August. Mary Ann, Joe, Dottie Sottichio and the rest of the staff are always friendly, asking about family and work. I watched her children grow up, get married and have families of their own. Mary Ann would discuss dental issues with me and she taught me a lot about customer service. If I were hesitant about buying an uncommon vegetable, she would give it to me and say “try this, see if you like it.”  If an item, say eggplants, were looking a little worn out, she would say, “take these, no charge – I’ll have to throw them out anyway.” Or if something didn’t taste quite right, say a cantaloupe, she would replace it, again without charge. If a bill came to $20.00 and change, she would round it off to $20. She knew her customers and cared about us.

People cared about her also – so much so that Setauket Artists sponsored a benefit art sale this past weekend. And in 2011 the Village Times Herald newspaper awarded Mary Ann The Woman of the Year in Business award. Read what the Village Times Herald had to say about the relocation. Truly a business to emulate. A lost resource for Setauket – a gain for Port Jefferson Station.  Best of luck to the Derisos.

IMG_2089Anne Marie’s Farmstand in East Setauket


IMG_2088Mary Ann Deriso and Dotty Sottichio