It’s time for summer sports - so don’t let an injury spoil your fun!  Protect yourself and your children with a mouth guard. A mouth guard acts as a cushion and will help to prevent a tooth from being knocked out or fractured and prevent trauma to the soft tissue and jaw bone. By absorbing the shock of a blow, the mouth guard may also help prevent a concussion of the brain or dislocation of the temporomandibular joint (TMJ). A mouth guard is required for several sports: field hockey, football, ice hockey, lacrosse and boxing. It is also recommended for many other sports, such as baseball, basketball, racquetball and soccer.

There are several types of mouth guards. The least expensive is a Stock Mouth Guard, usually bought at a sports store. This type of pre-formed appliance is bulky and it cannot be adjusted. It fits poorly and it can easily be dislodged. Another type of appliance is the Boil and Bite appliance. It is also relatively inexpensive and fits better than the stock appliance. But it deteriorates over time and the fit is still not the best.

I recommend a Custom Fitted Appliance for my Long Island dental patients who are athletic. The custom appliance has the most accurate fit and it is the most comfortable. It also provides the best protection and is the most durable. In order to provide this appliance, I take impressions of the mouth and my laboratory fabricates a custom mouth piece.

Mouth guards should only be worn while playing sports. Check the mouth guard for damage after you wear it. If it is damaged, it should be replaced. Don’t chew on the mouth guard. Keep it clean with toothbrush and toothpaste so there is no bacteria buildup. Have a safe and happy summer!

My East Setauket dental office now accepts CareCredit - offering low monthly payment options, no up-front costs and no pre-payment penalties so you can get the dentistry you need and want.  CareCredit can help you obtain dental services such as crowns, bridges, dentures, implants, veneers, and root canals.  We also offer financing through CitiBank and of course we accept all major credit cards.  So we not only offer quality, gentle dentistry – but affordable dentistry too.

An excellent article about teeth grinding and clenching titled ‘Dealing with the Nightly Grind’ appeared in today’s New York Times. The article links an increase in teeth grinding to the increased stress felt by middle aged men in this recession. Normal chewing places 68 pounds of pressure per square inch on the molar teeth but grinding can place 900 pounds of pressure on the teeth!  Traditionally it is predominantly women who seek treatment for bruxism, but those of us in the dental profession are struck by the recent increase of men seeking treatment.  Normally 10-15 percent of the population grinds their teeth.

I will usually ask my East Setauket dental patients if they are sleeping well. I ask if they have headaches. I will ask if they bite their tongue or if the muscles around their mouth feel sore.  Tooth grinding, also called bruxism, can break teeth or loosen them and might feel like a toothache.  Tooth grinding can often be prevented with an occlusal (night) guard that we make in our dental office. But a patient may not know that he is grinding or clenching. A dentist who has training in occlusion or esthetics can see signs of tooth wear that the patient may not be aware of. I will take photos of the teeth to point out the wear patterns on a patient’s teeth.

Sometimes a patient is not concerned and doesn’t want to wear a night guard. This presents a problem. Click on the mouth guard link in this website for a photo of severely worn teeth. This patient refused to believe that he had a problem and wouldn’t wear a nightguard – but he is silently grinding his teeth down to the gumline. Don’t let this happen to you!

It’s been a while since you visited the dentist.  So you call my East Setauket dental office and this is what you can expect!  Does a voice pick up our line and say: “hold please?” or “to speak to the receptionist press 1, to speak to the assistant press 2.”  No!  My receptionist, May Paone, answers the phone and with her friendly voice asks, “how can I help you?”  She will spend time learning about you and will schedule an appointment for you to see us within days.  If it’s an emergency we’ll see you as soon as you can get to the office, even after hours or weekends.

May will send you an email confirming the appointment. She will send a link to our website that has a link to mapquest to help you find the office and a link to patient forms for you to fill out in advance and email back to us.  She will let me know that a new patient has called and I will call you that evening to ask what I can do to help you.

When you arrive at the office, you will be warmly greeted by name and will be escorted into my office - no waiting - we respect your time.  We will chat some more about your concerns.  I often will take close up photos of your teeth to help us see what we can do to help. Photos are a great education tool for the patient and for me.  I also have videos on implants, dentures, crowns and other procedures that help to explain what we can do.  We don’t charge for this consult.

If you decide to proceed, we explain that xrays and a comprehensive exam will be needed.  We will tell you ahead of time what the costs will be.  We take a full set of xrays so we can see each tooth and the surrounding bone.  The comprehensive exam includes an oral cancer screening and periodontal assessment.  Once we have collected the data, I develop alternative treatment plans depending on your desires, finances and health.  All of the options are thoroughly discussed with you so you know the choices and associated fees. We work to make the dentistry affordable, and we offer financing and credit.  I also continually review my fees and recognize that times are tight. We don’t want people to delay getting necessary dental work done.

Once you make a decision, we can schedule the necessary appointments.   I give you my cell phone number so I can always be reached.  If I am away, my answering service sends me a text message the instant you call, so I can call you right back or I can always be reached via email.  After every dental appointment in our office, May or I will call you to ask how you are feeling.  When treatment is complete, we schedule you for a checkup appointment so we can maintain your dental health.  We ask for input from you so we can modify our procedures to best serve our patients.

In my office you are not just a chart or tooth number.  You will not be asked to wait.  You will not be told it’s your fault.  You will not be told “wait and it will get better.” You will not be seen by a different person every time you come to the office.  You will see me - and May and Linda Gomez - who have been my teammates for over two years.  Our goal is to do our very best for you. This is why we are different.

I was just about to place a composite filling today when my patient asked if the composite material contained bisphenol-A (BPA).  I was embarrassed to admit that I didn’t know.  I did post a blog article about BPA and sealants on my blog and I do use a sealant that does not have BPA. But composite was a different matter.    I just wasn’t sure about dental composites.

The composite that I use is Renamel by Cosmodent, and it is a very fine product.  I checked their catalog, but there was no mention of bisphenol-A, making me think that the product did contain BPA, or they would have announced that it did not.  Then my question was whether there was a composite available that did not contain BPA, and was there any health danger for the patient if composite does contain BPA.

I checked the American Dental Association website for their information on BPA at http://www.bisphenol-a.org/human/dental.html

http://www.ada.org/prof/resources/positions/statements/bisphenola.asp. They defended the use of dental composites, as I would expect, saying that there is no evidence that they are unsafe. From the ADA website: “Based on current research the Association agrees with the authoritative government agencies that the low-level of BPA exposure that may result from dental sealants and composites poses no known health threat.”

But rinse well after a composite is placed – it can’t hurt!

You realize that it’s not a good idea to neglect your dental health, but with so many other pressing expenses in this time of recession, teeth just can’t be a priority for many people. So I have been trying to help people get through the recession with minimal impact on their dental health.

To make things easier for people who might be working longer hours to make ends meet, my East Setauket dental office offers convenient hours: early morning, evening and Saturday hours. Some people are putting off their dental care until they have a pressing dental problem, so we are seeing more emergencies. We always make time for these emergencies, any time, any day. We are also seeing more children because although people may put off their own dental needs, they don’t want their children to develop dental problems. We enjoy our young visitors and make their visits affordable.

We also offer financing options and payment plans to make it easier to manage the cost of treatment. I have reviewed our fees and have reduced some fee services to make it easier for people to get the care they need without our sacrificing quality. Hopefully we’ll all get through this together – and Happy 2010!

People who come to my East Setauket dental office for cosmetic dentistry often ask if I also do general dentistry. The answer is, “Yes.” I believe that it is a mistake for cosmetic dentists to limit their practice to cosmetic procedures. A dentist cannot ignore a patient’s dental health, and that is what a cosmetic dentist might do if he/she just does cosmetic dentistry.

Back teeth matter! You cannot just place veneers on the front teeth without addressing the health of the back teeth. Each tooth has a function, and all of the teeth must function in harmony. When dental cosmetics fails it is often because the back teeth were not considered in the treatment plan. And I am pleased that my cosmetic patients are so pleased with my cosmetic dentistry and the care that I provide that they want to continue as my patient and send the rest of their family for their general dental needs – and yes I treat children also!

People often come to my East Setauket dental office and complain of sensitive teeth. Tooth sensitivity may be caused by erosion of the enamel outer layer of the teeth and exposure of the more sensitive dentin layer. This erosion may be caused by aggressive tooth brushing or acidic foods and drinks. Some toothpastes, mouth washes, or tooth-whitening products can also cause tooth erosion. Bulimia and acid reflux can also severely erode the teeth.

Some patients manage sensitive teeth by simply avoiding cold foods and drinks. Other patients avoid brushing the sensitive areas. I recommend that patients use a desensitizing toothpaste, such as Denquel or Sensodyne. In the office I apply a fluoride varnish to the sensitive areas and this helps to reduce sensitivity. Patients should also use a soft-bristled toothbrush. A hard toothbrush may wear away the enamel. It is important to practice good oral hygiene: floss every day and brush at least two times a day for 2-3 minutes. Hold the toothbrush at a 45 degree angle and brush gently in a circular motion. Hold the toothbrush in your fingertips instead of in the palm. Avoid very acidic foods and beverages. Visit the dentist to be sure that the sensitivity is not due to dental caries, a cracked tooth or gum disease.

In 1901 a dentist named Frederick S. McKay noticed that many of his patients had brown, mottled teeth that were resistant to decay. He collected water samples from towns where brown, mottled teeth were prevalent, and he found concentrations of fluoride as high as 12 parts per million in the water supply. Chemists then did studies and determined that it was the fluoride in the water that caused the brown teeth. But it wasn’t until 1938 that researchers confirmed McKay’s conclusion that drinking water containing fluoride resulted in a reduction of tooth decay.

In 1941 the New York Times reported that children who drank water with 1 part per million of fluoride had 1/2 to 1/3 less tooth decay than children drinking non-fluoridated water. In 1944 New York State conducted a study in which they fluoridated the Newburgh water and compared the lower decay rate to the decay rate in Kingston which did not have fluoridated water. In the early 1950’s the U.S. Department of Health officially recommended fluoridation, and many of the nation’s water supplies were then fluoridated. But fluoridation was controversial in New York City and didn’t begin in the City until 1965.

Today more than 60 percent of Americans use fluoridated water. However Suffolk County water is not fluoridated. The Suffolk County Water Authority website states: “We do not add fluoride or vitamins to the water we deliver to you. Our water delivery system has over 500 wells and over 5,000 miles of water mains (pipes) located throughout Suffolk County. Most of our system is interconnected so that your water can come from multiple wells. This makes it impossible to provide fluoride at consistent levels, and too much fluoride can be harmful.” (http://www.scwa.com/FactOrMyth.cfm) For more about fluoridation visit http://www.drterryshapiro.com/wellness.html.

A successful dentist needs to be sensitive to his/her patient’s fears. I spend a lot of time making my patients comfortable. But sometimes patients are very anxious and feel pain even before we begin a procedure.

I just read about a new approach to deal with this problem. This psysiological/psychological maneuver is credited to Allan S, Berger, MD, Professor of Clinical Psychiatry at Georgetown University. He suggests that the anxious patent hold 3 to 4 cubes of ice (wrapped in toweling) in his hands. The dentist then tells the patient to massage the ice, especially using the thumb. At the same time, he tells the patient to count in his mind backwards from 100 to one. Any dental procedure or injection of anesthesia should be delayed until the palms and the thumbs are numb. The patient should feel less pain.

An interesting approach! – and one that I certainly will implement in my East Setauket dental office and monitor to see if it works as promised.