Today’s knowledgeable dental patients often know that excellent cosmetic dentistry is a partnership between the dentist and the dental ceramist.  The ceramist who fabricates my porcelain tooth veneers and crowns is Peter Kouvaris.  Peter has been a ceramic artist for more than 20 years.  He was the Cosmetic Designer at the JK Dental Laboratory and recently opened his own dental studio in New York City: Peter Kouvaris Dental Studio at  http://peterkouvaris.com/.

Peter is a member of the prestigious Oral Design International, a group of dental ceramists who have studied under Master Willi Geller.  Willi Geller resides in Switzerland and is considered to be the world’s leading dental ceramist.  He was one of the first ceramists who realized that teeth reflect and refract light like prisms because of layers of tooth dentin and enamel.  He invented a buildup technique which involves layering different density of porcelain in different colors and degrees of translucence. His method is used by a highly trained and talented group of 80 ceramists and is used to create beautiful, life-like veneers, crowns and implant crowns.  Peter Kouvaris is one of Willi Geller’s proteges.

Not every dentist can or will work with an oral design ceramist.  The dentist needs to have advanced training and needs to work at a higher level and with increased attention to detail.  Excellent cosmetic dentistry is a collaboration between the cosmetic dentist and the dental ceramist.

Patients have been asking me about the mini implant. They have heard that it is less expensive than the standard implant. But is the mini a viable alternative to the full-sized implant?

The most popular mini implant, the MDI, is manufactured by IMTEC, a 3M Company, http://www.imtec.com/implants/products_MDI.php. In 2003 the FDA approved the MDI mini implant as a long term method to stabilize dentures. The MDI implant has a narrow diameter (1.8 mm) compared to the 3.5-6 mm standard implant. The MDI implant acts like the root of a tooth with an attached ball that seats into a denture. This ball and socket stabilizes the denture.

Mini implants are also sometimes used to support crowns when there is not enough room for a standard sized implant. But this use does not have FDA approval and is still controversial. Some general dentists are placing mini implants after attending a one or two day MDI certification course. This also may not be in the patient’s best interest.

The mini implant typically costs a third of the cost of a standard implant. It is an alternative to the standard implant when cost is a major factor but you need to know that the major success of the mini implant is with the stabilization of full and partial dentures. The MDI does not have the range of use of the standard implant that can replace almost any tooth in the mouth. According to IMTEC, the MDI implant was designed as an alternative for patients who can’t tolerate the conventional implant surgery or afford the traditional implant. I haven’t been able to find comparison studies and IMTEC doesn’t claim that the MDI is as good or better than the conventional implant – just an alternative if the conventional implant is not an option for the patient. The patient needs to understand that these are not comparable products.

In a 2006 review article in the Journal of the American Dental Association, Dr. Gordon Christensen concluded that “Continuing research is needed for further verification of the acceptability of mini-implants.” http://jada.ada.org/cgi/content/full/137/3/387.  The jury is still out!

I was at Barnes and Noble last weekend and glancing through A ticket to the Circus written by Norris Church Mailer, the wife of the late novelist Norman Mailer. Even though I have read several of Mailer’s novels, naturally my attention was drawn to his wife’s discussion of his teeth. Apparently towards the end of his life he had to undergo bypass surgery and his surgeons told him to have all of his teeth removed in order to prevent infection. (Seems extreme.) She writes that that was the beginning of his decline. “His dental implants didn’t take, and he was forced to wear false teeth that never quite fit. He began to lose weight.”

Don’t let this happen to you! Be sure to get quality dental care - take care of your teeth – and keep them for life!

I’ve seen it too many times: a healthy, young adult with ten to twelve blackened teeth, crumbled and decayed down to the gumline.  It is a horrific, tragic sight. The cause?  Too often it is Methamphetamine use. The first anecdotal accounts of “methmouth,” as it has come to be called, started to appear in the dental literature several years ago. It struck a cord of recognition – yes, I had also seen this debilitating decay in several patients at my East Setauket dental office.

Methamphetamine is a powerful psychostimulant that has become prevalent because it is easy to manufacture and relatively less expensive than other illicit substances. Over 12 million Americans have tried methamphetamine at least once and most users are between 18 and 34 years.

A recent study in the Journal of the American Dental Association examined the relationship between meth use and dental decay (http://jada.ada.org/cgi/content/full/141/3/307). The study confirmed what dentists have seen anecdotally, and the authors conclude that “overt dental disease is one of the key distinguishing comorbidities in meth users who otherwise generally are healthy.” They also found that, contrary to common belief, people who smoke or inhale meth have less dental disease than those who inject meth. More research needs to be done to determine the scientific basis for the connection of meth and dental disease.

The meth users that I have seen in my dental office were concerned about their dental appearance, a fact also borne out by the JADA study. Dentists can thus play an important role in the early detection of meth use. Dentists can also play a role in the recovery process by restoring patients’ dentition and helping them regain a positive self-image.

In January, while listening to President Obama’s State of the Union address, I was startled when I heard him say “root canal.” He was speaking about the bank bailout and he said: “I hated it. You hated it. It was about as popular as a root canal.”

Now, as a dentist I am very sensitive about comments that place dentistry in an unfavorable light or that reinforce fears that people may have about dental treatment. So I was dismayed at the President’s choice of words. I was relieved to note that the American Association of Endodontists (AAE) was also dismayed and  issued the following statement: “While we certainly understand the president’s intent, people need to know that root canals don’t cause pain; they relieve it. Root canals may sound daunting, but endodontists can do this procedure quickly, efficiently, and with virtually no pain involved. The result is a restored natural tooth that can at a lifetime.”

I couldn’t have offered a better defense of the root canal! Root canal treatments save more than 17 million teeth every year. I wonder if the President offered an apology to the AAE!

What happened to the Removable Partial Denture? Now that implants are an integral part of modern dental treatment, have dentists discarded the removable partial denture (RPD)? All too often it seems that this is the case in a lot of dental offices. But I find that new patients often come into my East Setauket dental office looking for other less expensive options to replacing missing teeth. They have lost their back teeth and are unhappy with how they look and function.

Their previous dentist recommended implants and left it at that, without presenting other options. If the patient could not afford implants, the patient was left without a solution. Well, the removable partial denture is a solution for people who do not have the finances for implants. It can also be an interim solution until the patient has the financial means for implant placement.

Yes, there are limitations to the removable partial denture – it takes getting used to, some metal may be visible, the bone will continue to deteriorate. It’s not as good as implants - but is it better than nothing? You bet it is! For more information on types of removable partial dentures that we provide in our Long Island dental office see http://drterryshapiro.com/blog/?p=91.

Last March I wrote a blog article called “Denture Creams and Imbalance” about zinc-containing denture adhesives and possible neurological side effects if use of these adhesives is excessive. Well, today I received a notice from GlaxoSmithKline alerting dental professionals to “the potential health risk from long-term excessive use of GSK’s zinc-containing denture adhesives Super Poligrip ‘Original’, Super Poligrip ‘Ultra Fresh’, and Super Poligrip ‘Extra Care’”. GSK has “voluntarily stopped the manufacture, distribution and advertising of these products.”

Excessive levels of zinc from over-use of these products may lead to sensory disturbance, weakness and difficulty walking. There are zinc free alternative adhesives such as Super Poligrip ‘Free’, Super Poligrip ‘Comfort Seal Strips’, and Super Poligrip ‘Powder’. How amusing that every one of GSK’s products is labeled “Super”!

In general, patients use denture adhesives to support ill-fitting dentures. But they are not doing themselves a favor. Ill-fitting dentures cause bone loss and mucosal inflammation. You may need a denture reline, rebase or new dentures. Your bone resorbs over time and dentures do not last forever. Denture wearers are advised to come to our East Setauket dental office for regular examination visits.

So you really think you are too old for cosmetic dentistry? Well, you should know that cosmetic dentistry can brighten a smile of any age. Multiple modalities are available to the dental professional today, ranging from relatively inexpensive teeth bleaching, recontouring, and bonding to more complex procedures consisting of veneers, ceramic crowns and implants.

A simple whitening procedure can brighten teeth that are yellow or gray from age. There are several options from drugstore brighteners to custom dental trays or in-office whitening, depending on your budget and the quality of whitening desired. Tooth whitening corrects brown, yellow and mottled teeth and can brighten a dull smile.

Another simple procedure is the recontouring or reshaping of chipped or misaligned teeth. With recontouring and reshaping, crowded or chipped teeth can sometimes easily and non-invasively be corrected in one visit.

Composite bonding is another procedure that can be used to close a space between teeth or to repair chipped or cracked teeth. It is often non-invasive and anesthetic is not always needed. The composite material is chemically bonded to the tooth and polished to match the remaining tooth surface. Worn out silver fillings can also be replaced with tooth-colored bonded composite restorations.

The above are all relatively non-complex cosmetic procedures.  For a more long-lasting solution, the modern porcelain veneer offers the most esthetic result.  The porcelain veneer is a thin shell of ceramic that bonds  to the front surface of the teeth. The porcelain veneer does not stain or discolor. Veneers can close spaces, straighten crowded teeth, and cover discolored and chipped teeth. Placing custom veneers requires a high degree of technical skill as well as attention to cosmetic detail. Veneers require less tooth reduction than conventional crowns and can conservatively transform a smile.

If too much tooth is missing or damaged for a composite or porcelain veneer then an esthetic crown may be the answer. Today we have all-ceramic crowns and Zirconia crowns that are more life-like than the porcelain-to-metal crowns in use for the past 30 years. When carefully crafted by a talented cosmetic dentist and cosmetic dental laboratory, the all-ceramic crown is undetectable.

People are always embarrassed when their smile uncovers a missing tooth. Today the dental implant is a durable replacement that feels and functions like the missing tooth because the implant replaces the root as well as the tooth. The dental implant is surgically placed into the bone and fuses with the bone in a process called osseointegration. Restored dental implants are a very conservative way to replace teeth and help preserve facial structure.

Another less-costly option to replace a missing tooth is the bonded bridge for areas of light function or the conventional bridge, both of which can be fabricated of all-ceramic materials.

Some cosmetic procedures are elective, but other times the unsightly teeth are symptomatic of underlying dental disease. So a cosmetic procedure may also be an investment in your dental health and might even be covered by your dental insurance.  Teeth bleaching, recontouring, composite bonding, porcelain veneers, all-ceramic crowns and implants are all cosmetic procedures, sometimes just different ways to solve a problem. Call our East Setauket dental office, come in for a free consult, and explore what is the right solution for you!

I was at a business meeting this morning speaking to a man with a rather large gap between his two front teeth. We started talking about teeth, and he asked me if I knew that a gap between the teeth had become quite fashionable. I didn’t, so I went onto Google to check this out.

Sure enough a website on global fashion called Refinery29 features an article this month called “Gap Teeth: The Latest Must-Have Accessory?” http://www.refinery29.com/gap-teeth-the-latest-musthave.php. The article includes photos of several models and actresses who flaunt their teeth gaps, including Lauren Hutton, Lara Stone, Georgia Jagger and Anna Paquin. As the author writes, these are “all beauts who know how to work a good gap.” Maybe so, but I can’t help but think their beauty would be enhanced by some excellent cosmetic dentistry.

Unfortunately and all too often, un-cosmetic dentistry, done by dentists without the proper training and experience, gives people an unnatural look. The author adds, “More and more (blessed be!), it seems those hideously super-sized, glow-in-the-dark veneers are being replaced by normal beautifully imperfect canines.” What she may not know is that well-crafted veneers are beautiful and natural looking and undetectable. Check out our veneers and see how naturally beautiful they look.

“Talking Teeth” is the name of a bi-weekly radio program on 91.5 AM hosted by my good friend and colleague (and mentor) Dr. Dean Vafiadis. On this program Dr. Dean discusses issues of dental health. Tonight’s topic was implants; two weeks ago it was periodontal disease; the next topic will be “teeth in an hour.” Dr. Dean is an excellent speaker – always informative and entertaining. He calls the program “Talking Teeth” because he says that teeth talk to him. That may sound funny to the public, but I know what he means. Teeth do talk to me too! They tell me a lot about your habits and your life style. I can tell if a tooth is happy or unhappy or if it needs attention. So check out Dr. Dean’s radio program if you want to learn more about what the best dentistry can do for you.