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A year ago New York State passed a bill requiring that all prescriptions for controlled and non-controlled drugs that are issued by medical and dental practitioners to pharmacies be submitted electronically. Practitioners asked for a delay but now as of March 27, 2016 the New York State requirement has taken effect.  We updated our software last year to include e-prescribing so we have been on-board for a year. I love e-prescribing! It is easy to transmit a prescription electronically with our software and e-prescribing protects the patient.  We can check dosages and history for a given patient – errors are much less likely.

This electronic prescribing requirement is intended to address the misuse of controlled drugs. Electronic prescribing software provides us with a more complete picture of a patient’s prescription history, in addition to options and doses. Prescriptions are transmitted immediately to the patient’s pharmacy to be filled. This will eliminate errors resulting from poor handwriting or a misunderstanding.  Electronic prescriptions are tamper-proof and stolen prescription pads will not be accepted. E-prescribing software improves drug safety by enabling the dentist to automatically check drug dosges, adverse reactions and duplicate drugs. Access to the patient’s medication history is available to us on the spot.  Our e-prescribing software is linked to our Dentrix practice management system. It is seamless.

There are times when electronic transmission is not practical and then paper prescription pads may be used. For example a prescription that will be filled by a patient in a state other than New York will require a paper script.  Another example might be a power or Internet failure.

We are compliant. The future is here!

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I was out of the office last Friday and Saturday taking a two day course called “Incorporating Full Arch Immediate Loading into Your Practice: An Interdisciplinary Team Approach.” What a mouth full!  Translation: “Full Arch Immediate Loading” is the term dentists use to describe placement of implants for someone who has no teeth or failing teeth and attachment of a tooth bridge to the implants on the same visit. What this means is that a person may arrive in the dental surgeon’s office in the morning, have remaining failed teeth removed and leave the office several hours later with a full complement of teeth or sometimes have teeth placed the next day. This is truly amazing dentistry!

The “interdisciplinary team approach” refers to the dental team: restorative dentist, implant surgeon, and laboratory technician.  All of the players plan the procedure very carefully with models and cat scans to be sure that the patient is a candidate for this type of dentistry.   The procedure is worked out carefully beforehand so it all proceeds without a hitch.  The patient will go home with a provisional bridge – the permanent bridge is placed several months later.  We call this a “hybrid” because it is an implant bridge that is fixed for the patient but which the dentist can remove periodically to clean, repair if necessary, and to be sure that everything is solidly attached.

The course was given by a dentist and oral surgeon who came to Long Island from Westchester with their patient. We had a lecture, some hands-on exercises and a live patient demonstration. This is an excellent way to learn dental procedures. The course was given at Marotta Dental Laboratory, located in Farmingdale  – excellent dental technicians who are very experienced in doing this type of dentistry. I accompanied Dr. Edward Brant, a periodontis/implantologist from Saint James whom I work with on a regular basis. The implant system we used was from the Straumann Company which sponsored the event and donated their expertise. Straumann, a Swiss company, is the largest implant company in the world and has its American headquarters in Andover, Mass.

Truly an outstanding couple of days!

Judy slipped and fell on the ice during our January snowstorm. Today the temperature climbed to 7o degrees – a record for early March so it is hard to remember that we were knee-deep in snow just two months ago.  My daffodils and crocuses are in bloom today.  But getting back to January and Judy’s fall.  Unfortunately she fell facedown, and she fractured two front teeth.  As you can see below, the right front tooth was beginning to darken from the trauma. You can also see fracture lines in that tooth and the one to the right of it.  One of the traumatized teeth required root canal, the other did not.  She then elected to have veneers placed on all four front teeth to cover and protect the fractured and discolored teeth and to achieve the beautiful smile that she had long wanted.  We lightened her tooth color and removed the space between the two front teeth. A nice result!

 

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Fractured Teeth Needing Restoration

X01265A2Repaired with Porcelain Tooth Veneers

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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