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!

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!

Last week the warning was about denture adhesives; this week the warning is about denture cleansers! The Food and Drug Administration has alerted dental professionals to two safety problems that have occurred in patients who use denture cleansers.

One problem is the risk of allergic reactions to the cleansers. Symptoms may include gum tenderness, rash, difficulty breathing and low blood pressure. Another problem is possible misuse of the products. “Mouthwash” is mentioned as an ingredient in denture cleansers – perhaps confusing patients who may think they can rinse their mouths, gargle or swallow the cleanser. This can cause bleaching of the tissues, damage to the gums, vomiting, seizures and hypotension.

The FDA has requested that manufacturers of denture cleansers place a warning on their labeling about allergic reactions and is asking that the manufacturers investigate alternative ingredients.

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.

A letter to the editor in last week’s New York Times was written by a woman who played college ice hockey in the 1970’s at Brown University, the only women’s college ice hockey team in the U.S at the time. She relates that she encouraged her brother, a varsity hockey player at Colby College, to “get some girls out onto the ice for us to play.” He did, and one of them was their friend Linda Krohn. When Linda’s mother found out she insisted that Linda stop playing hockey so she wouldn’t lose her teeth. The letter adds: “Now I smile with glee that Linda’s daughter, Lindsey Vonn, races down mountains at world-class speeds and that women’s ice hockey is in the Olympics, too.”

And Lindsey still has her teeth! After a recent accident on the ice that left blood streaming down her face she said: “I was just confused. At the bottom I didn’t know what had happened and I was hoping I hadn’t lost any teeth. I am just glad it wasn’t anything major, just a cut.” Vonn said she wears a protective mouthguard which saved her teeth and saved a huge dental bill. Read about athletic guards at: drterryshapiro.com/mouthguards.html.

After her shin injury at the Olympics she said: “My shin was still very painful, but I feel like the injury is finally progressing a bit. The pain level has gone down from a sharp debilitating pain to something that I feel I may be able to grit my teeth through. So that really puts a smile on my face!:)”. I find it intriguing that she used the term “grit my teeth through” because when I look closely at her teeth I see signs of tooth wear – likely from gritting her teeth.

It’s winter and several of our East Setauket dental patients went off to warmer climates for scuba diving. I’ve never gone diving – sounds scary - but I am tempted to learn this sport so I can see the fabulously colored sea life. I read recently that pressure changes during diving can cause damage to your dental fillings. A case was reported in an article in JADA titled “Dental Restoration Dislodgment and Fracture During Scuba Diving: A Case of Barotrauma.” http://jada.ada.org/cgi/content/abstract/140/9/1118. Barotrauma is a term used to describe an injury caused by a rapid or extreme change in air pressure. Areas within the body (such as your teeth) can be especially affected by barotrauma.

The article explains that three of a patient’s fillings fractured or dislodged while he was scuba diving at a depth of 35 meters. His dentist later replaced the broken fillings with new fillings and crowns.

Inadequate fillings can predispose patients to barotrauma. To prevent barotrauma-related damage to the teeth, you need to be sure your dentist places high-quality restorations that do not trap air beneath them. People who are exposed to barometric stress should know the causes of barotrauma. They need to be aware of the importance of regular dental checkups to help avoid barotrauma-related dental problems.

Last February I posted a blog entry called “Teeth Whitening at the Mall” (See http://drterryshapiro.com/blog/?p=27.) I spoke about the dangers of having whitening (a dental procedure) done by unlicensed individuals. I mentioned that the State of Tennessee had outlawed this practice and that I hoped New York State (and that includes Long Island) would follow the standards set by Tennessee and outlaw the illegal practice of dentistry in the state’s malls.

Here we are just one year later, and New York State has done just that in their new guidelines just published! The guidelines from the New York State Board For Dentistry state:

“Recently, consumers in New York State have been exposed to a significant number of products involving teeth whitening. While certain over-the-counter products may be safe, other products available for self application or through retail outlets have the potential to cause harm.

“Underlying dental health conditions may make a patient a poor candidate for certain teeth whitening processes. These processes may not be effective, and may actually do harm to a patient’s teeth and gums. The application of teeth whitening products in a retail outlet, not subject to the infection control requirements of a dental office, creates a risk of disease transmission for the consumer and individuals working in such an establishment.

“The application of teeth whitening products by or with the assistance of someone who is not a licensed dentist or dental hygienist may constitute the illegal practice of the profession of dentistry, which is a crime. The State Board for Dentistry office will refer any allegations of the illegal practice of dentistry to the Office of Professional Discipline for investigation.

“Individuals should consult with a licensed dental health professional and have their overall dental health evaluated before making decisions regarding teeth whitening products and services.”

Read more about teeth whitening at http://www.drterryshapiro.com/teethwhitening.html.

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!

Our East Setauket dental office is excited to have just upgraded our digital radiography system to the Dexis Platinum System. This system uses an even smaller intra-oral sensor so it is more comfortable for the patient, and it uses even less radiation than the earlier digital system. The resolution of the new system is much better so we can see incipient decay and other pathologies. The integration to our practice management system as well as the hardware interface are both improved. Altogether a huge advance of technology!

We first integrated digital radiography into the practice several years ago to better serve our dental patients, and patients are even happier with this upgrade. Digital xrays appear instantly enlarged on the computer screen – no waiting for developing! We can enhance the images and compare older and most recent images side by side and point out areas of concern to the patient. We can email digital x-rays and digital photographs for consultation with specialists – periodontists, oral surgeons, or orthodontists – and get an instant opinion. Digital radiography is also “green,” preventing harmful chemicals from being released into the environment and reducing the cost of containment and disposal. I am surprised that only 40% of dentists nationally have implemented digital radiography. I couldn’t imagine practicing today with old fashioned xray film!

The Invisalign treatment consists of a series of aligners that are changed approximately every two weeks. Each aligner is custom made to gradually move your teeth into place. The advantages of Invisalign are many. They are clear, so hardly noticeable. They are removable for good oral hygiene so you can brush and floss normally. You can also eat what you want because the Aligners are removable.

But Invisalign won’t solve every malocclusion (bad bite). You need to have a careful examination and diagnosis before we can tell you whether Invisalign will straighten your teeth. Come to our Long Island dental office and we’ll tell you if Invisalign is right for you!