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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

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.

02teeth2-tmagArticleDo no harm!

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.

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A model of four implants on the lower jaw showing how a denture fits over the implants.

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.

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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!

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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.

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Before: Broken teeth, stained and decayed.

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After: Porcelain veneers to brighten her smile.