I recently came across an excellent article on the Mayo Clinic website at: http://www.mayoclinic.com/health/dental/DE00001.  The article “Oral Health: A window to your overall health,” discusses the connection between oral health and overall health.  It explains that your mouth may harbor the first signs of disease and that diseases of the mouth, such as gum disease, can cause problems in other parts of the body.
Your mouth is loaded with bacteria which can be kept under control with brushing, flossing and regular dental visits. Saliva also defends against bacteria because it contains enzymes that destroy bacteria. But if the bacteria are not kept in control, a gum infection, or periodontitis, can result.  Gum disease may provide bacteria with a means to enter your bloodstream. Dental treatment might also be a means whereby bacteria can enter the bloodstream.
•     Research has shown that heart disease, stroke and clogged arteries may be linked to oral health and periodontal disease.
•    Gum disease has also been linked to premature births.
•    Diabetes increases your risk of gum disease and oral infections. And poor oral health can make your diabetes more difficult to control.  Oral infections can cause your blood sugar to rise, requiring more insulin for its control.
•    People who have HIV/AIDS often exhibit oral manifestations, including ulcers, dry mouth and painful fungal, viral or bacterial lesions. One of the first signs of AIDS may be severe gum infection.
•    The first stages of osteoporosis, or bone loss, may manifest in loss of supporting bone of the teeth, resulting in loose teeth.
•    Other conditions that may first exhibit in your mouth include Sjogren’s syndrome, some cancers, eating disorders, sexually transmitted diseases and substance abuse.

The relationship between your oral health and your overall health provides another good reason to take care of your teeth and gums.  An investment in your oral health is an investment in your overall health!

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!

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!

An overwhelming majority of people who have periodontal (gum) disease are also at high risk for diabetes and should have screening for diabetes. A recent study showed that 93% of subjects who had gum disease were at high risk for diabetes compared to 63% of subjects without the disease. The study recommended diabetes screening for people over 45 years of age who have a body mass index (BMI measuring weight and height) of 25 or more and for people under 45 with a BMI of 25 or more and one additional risk factor. The study can be found in the Journal of Public Health Dentistry at http://www3.interscience.wiley.com/journal/123210997/abstract.

For more information about periodontal disease visit www.drterryshapiro.com/peri.html.

“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.

A prospective patient came into my East Setauket dental office recently to ask about porcelain veneers. She was unhappy with how her front teeth looked. She had old composite bonding that was stained and chipped. Her teeth had spread out, there were spaces in between the teeth, and she noticed that her teeth were loose. She thought that her problem was just cosmetic, and she was concerned that her insurance company would not cover elective cosmetic procedures.

I took some close up digital photographs of her smile, as I usually do for consultations. We then discussed her photographs which I had enlarged on the computer screen. She could see the condition of her back teeth and the condition of her gums, and she began to realize that she had other problems that contributed to her unattractive smile. We took xrays to confirm that she had decay and defective fillings in her back teeth and she had the bone loss associated with gum disease.

My point is that what may appear to be solely cosmetic is often a symptom of underlying dental disease. Her needed dental work was not only cosmetic, and she was able to collect her insurance benefits. She completed the treatment, is now in good dental health and has a beautiful smile!

Are you old enough to remember the Ipana toothpaste ads from the 1950’s?
Well, those ads highlighted Bucky Beaver advocating that “You should brush three times a day and visit your dentist two times a year!”   Thus it was a Madison Avenue advertising executive who created the 6-month checkup!  There was no scientific basis at all for this 6 month interval.

While it’s not a bad idea to have twice yearly visits to the dentist, more frequent visits may be indicated for patients with gum disease.  Laboratory research shows that the bacteria associated with periodontal disease become more active after 90 days. If these bacteria are periodically disturbed and debrided, the tissue will show a healthy response.  At 3-months, less destruction will have taken place and the tissue will be healthier than if the patient waits six months.

We’ll be happy to see you at our East Setauket dental office and evaluate your periodontal status.

When I read about Supreme Court nominee Judge Sonia Sotomayor’s finances, I noticed that she owed money to her dentist. I haven’t had a good look at her teeth, but as she does have diabetes and there is a strong link between diabetes and gum disease, there is a strong possibility that she suffers from the latter. Gum disease needs to be controlled with frequent visits to the dentist for periodontal scalings. If neglected, surgery and/or tooth loss can result. This can be costly. If you suffer from diabetes, be sure to visit the dentist regularly for a periodontal examination. Healthy gums should have a firm, stippled consistency, should not be swollen or bleed or have an odor.

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Whoopi Goldberg recently returned to the TV show The View after undergoing emergency gum surgery. She spoke candidly and emotionally about her dental health. The YouTube link can be found on my website at: http://www.drterryshapiro.com/peri.html.

Whoopi said in part: “Take care of your teeth. I am embarrassed to say this to people. I have great dental insurance and I did nothing with it. For years and years I let my mouth go and I am paying the price. I am losing teeth because I am losing bone and I brought this on myself because I could have prevented it. Your mouth is connected to your entire system, your immune system. If you do not take care of your mouth, you are not taking care of your body and it will kill you. … They finally linked mouth health to heart health. Dentistry has changed so much. I’m begging you - save your own life. Don’t do what I’ve done. I’m going to lose my teeth.”

Thank you, Whoopi. I hope the public is listening.

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A recent survey conducted by the American Dental Association, Crest, and Oral B found that the smile is more important than eyes, hair and the body as the most attractive physical feature. Nevertheless men and women treat this asset differently. 86% of women brush their teeth two or more times a day but only 66% of men do so. Women change their toothbrush every 3-4 months but men change theirs only every 5 months. The ADA recommends that toothbrushes be replaced every 3-4 months.

Floss compliance is even less. Only 49% say they floss at least once a day. Remarkably 1 out of every 3 people surveyed think that blood in the sink after brushing their teeth is normal! Believe me, bleeding is not normal but is a sign of gum disease or some other pathology. If you notice blood when you brush, please call our Long Island Dental office and we will be happy to do our best to take good care of you.

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