A dental cartoon with the caption “The last moments of Dr. Steven Puckett, D.D.S.” appears in the February 23 edition of The New Yorker Magazine. The cartoon is a picture of a dentist who while being confronted by a shark says, “Hmm .. crowding, gum recession, and a high lip line.” I laughed out loud! As a dentist practicing in Suffolk County, Long Island, I can’t help myself from evaluating people’s dentition when they dare bare their teeth. Here the dentist in the cartoon is appraising the shark’s teeth as he is about to be devoured. I love it!

Dental cartoons typically make disparaging comments about dentists and focus on the “p” word (i.e. pain). This bothers me as it reinforces people’s fears and may encourage them to avoid proper dental care. Dentists are often the butt of comedians and situation comedies. Who can forget “The Little House of Horrors” or “The Marathon Man”?

I also read this week that Nickelodeon will introduce “Glenn Martin DDS” - an animated series about the dysfunctional family of an eccentric dentist.” I kid you not. Uh, oh … can’t wait to see this one!

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The other day I received an email from an acquaintance who wrote in part, “Our insurance allows us two cleanings/check ups a year for only $5. I wouldn’t sacrifice our dental health for money however someone we know … is on our plan so I just switched to him. I haven’t seen him yet. The last dentist on the plan we went to, was awful. Before we got this plan, we had been going for years to our best friends … We only left them because even with the huge discounts they gave us, they certainly couldn’t come close to $5 a cleaning.”

I wrote back, “Unfortunately sacrificing your dental health for money is exactly what you are doing. Dentists on a plan need to sacrifice quality and cut corners (at the patient’s expense) in order to compensate for the poor reimbursement that they receive from the insurance company. You should go back to your family dentist who will look after your best interest. Going “on plan” may save you money in the short run but will cost much, much more in the long run. I have seen this time and time again - dental disasters that could have been avoided with quality care. At my Long Island dental office, quality comes first.

The moral: Don’t look for bargains on parachutes or dental care.download misfits the divxdinosaur dvd flyboys dvd download watch human traffic in divxdivx rundown the

In 1940 the author George Orwell called the British, “A nation of people with bad teeth.” Sugery tea may have been the culprit, but today tooth decay among 12 year olds in England is among the lowest in Europe. Nevertheless a survey this month of English dental patients and dentists showed that the British have a predilection for do-it-yourself dentistry. Six percent of English patients admitted to self-treatment. One took out 14 of his teeth with pliers and another used Super Glue to re-cement a crown. This self-treatment may be a result of a shortage of dentists offering dental services through the National Health Service – and the long wait time to get an appointment. I have also seen cases of self-treatment in my Long Island dental office - but this is a topic for another entry!new guy the divx download forgetting sarah marshall divx movie online

The January 1 issue of the Journal of the American Dental Association reports on a new study showing that the proportion of people taking oral osteoporosis drugs who develop a jaw condition called osteonecrosis of the jaw (ONJ) may be much higher than previously thought. ONJ is characterized by pain, soft-tissue swelling, infection, loose teeth and exposed bone.

Previous reports had indicated that the risk of developing (ONJ) from bisphosphonates in pill form were “negligible,” although there was a noted risk in people taking the higher-dose intravenous form of the drug.

The USC School of Dentistry’s database showed that nine of 208 patients taking Fosamax had active ONJ, a prevalence of about 4 percent. All were patients who had undergone some kind of dental procedure, such as having a tooth removed. The jaw complication has been seen in patients taking Fosamax for as little as one year. It seems to occur most frequently after routine tooth extraction.

Although no one is sure why bisphosphonates seem to have this effect only on jaw bones, the authors speculated that the drugs may make it easier for bacteria to adhere to bone that is exposed after a tooth extraction.

At the USC School of Dentistry patients are put on anti-microbial, anti-fungal rinse one week pre-operatively or post-operatively if they have been on bisphosphonates six months or longer. In my Long Island dental office we routinely ask patients if they are taking osteoporosis drugs and if so, we prescribe the anti-microbial, anti-fungal rinse before we begin dental procedures.

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Have you noticed those teeth whitening kiosks at the mall? These kiosks are manned by unlicensed individuals who are hired by “tooth whitening companies.” These salespeople take a weekend training session and then go out to the mall to sell white teeth. This is a big problem. Whitening teeth is a dental procedure and it requires knowledge to recognize when whitening is appropriate for a given patient. Before whitening teeth, a dental practitioner needs to recognize gum disease, decay, stained fillings, and other oral conditions. Dentists go to dental school, to dental residencies, and take long hours of continuing education in order to be proficient in their field.

The State of Tennessee has taken the lead in requiring whitening treatments to be performed only by licensed dentists, dental hygienists, or registered dental assistants supervised by a dentist. The unanimous ruling was recently handed down by the Tennessee Board of Dentistry because of complaints to the state about the kiosks. The board oversees and regulates dental safety issues in the state. For our public safety, lets hope that New York State (and that includes Long Island) will follow the standards set by Tennessee and outlaw the illegal practice of dentistry in the state’s malls!

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Oral Cancer Self-Examination

We do an oral cancer examination and screening for our Long Island dental patients at every dental examination visit. But you can also perform an oral cancer self-examination between your dental visits to check for any early signs of oral cancer. If you are concerned about any of your findings, call us immediately for an evaluation.

Oral Cancer Self-Examination Steps:

1. Press along the sides and front of your neck and feel for any tenderness or lumps. Do the same on your face. Your face and neck are symmetrical, so notice any bumps or swelling.

2. Pull your upper lip up and look for any sores and/or color changes on your lips and gums. Repeat this on your lower lip.

3. Use your fingers to pull out your cheek and look for any color changes such as red, white, or dark patches. Put your index finger on the inside and your thumb on the outside of your cheeks to feel for any lumps. Repeat on the other cheek.

4. Tilt your head back and open your mouth wide to see if there are any lumps or color changes.

5. Grab your tongue with a cotton gauze and examine for any swellings or color changes. Look at the top, back, and each side of your tongue.

6. Look at the underside of your tongue and the floor of your mouth (Touching the roof of your mouth with your tongue during this portion of the exam will allow you to see these areas better). See if there are any color changes or lumps. Using one finger inside your mouth and one finger on the outside (corresponding to the same place), feel for any unusual bumps, swelling, or tenderness.

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What a misnomer! The TMJ is the temporomandibular joint connecting the mandible, or lower jaw, to the skull. We all have it! Put your fingers in front of your ears and open and close; you will feel the TMJ. The condyle, or tip of the mandible, should rotate and slide evenly and smoothly down the maxillary slope. If the two sides are uneven, if you hear a pop or click, or feel pain, or if your jaw locks at times, you MAY have a disfunction of the joint, or TMJ disfunction. That is the proper terminology! Saying “I have TMJ” is like saying “I have knee,” or “I have shoulder.”

How to treat it? First, you need a very careful diagnosis of the problem. Second, you need to explore the many noninvasive treatment modalities that may alleviate some of the symptoms. I will be happy to see you for a TMJ consultation at my Long Island dental office.

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Have you noticed that many toothpastes now have expiration dates? This is because all toothpastes containing fluoride are regulated by the Food and Drug Administration, which now requires expiration dates. Up to that date, normally two years after manufacture, all the fluoride must be available to bind to tooth enamel, hardening it against the acid that causes cavities. Once that date is past, some of the fluoride ions may have bound with the caking agents into a salt or a crystal and thus aren’t available to bind to tooth enamel. Also, depending on the length of time and temperature of storage, the paste could separate so that an uneven amount of fluoride or flavoring agent is expressed at each squeeze. The viscosity might change and the toothpaste might not have the same consistency.

So, check the date! In our Long Island dental office we regularly check the expiration dates of all of our dental products.

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Ever since I started practicing dentistry I have included a visual oral cancer examination for my patients. This includes examining the soft tissues, the tongue and the back of the mouth for suspicious lesions. Last year over 35,000 Americans were diagnosed with oral cancer and over 7,000 died from the disease. But survival rates are very high for cases that are detected early. In recent years several screening devices have become available. Two popular systems are VELscope and ViziLite Plus. I did use each of these systems for a time but returned to the visual exam after reading several studies that showed these adjuncts to be of no value in detecting oral cancer. The patients of my Long Island dental office know that I keep abreast of medical and dental literature and do what I think is best for them!cook the thief his wife her lover the divx download

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Do you remember being taught that the tongue is a “map” divided into sections according to taste receptors? The tip of the tongue is for sweet, sides for sour and salty, and the back of the tongue for bitter. But recent studies show that the tongue map is wrong! We do know that there are at least five basic tastes: sweet, sour, salty, bitter and the recently discovered “umami”. Umami means “savory” in Japanese and can be detected in miso, soy sauce and other Asian foods, in particular those with monosodium glutamate. Scientists believe that there may be receptors for still other flavors.

In a 2006 study in the journal Nature, scientists reported that receptors for the basic tastes are found in distinct cells and that these cells are not localized but spread throughout the tongue. Still other studies show that some parts of the tongue may be more sensitive to certain flavors and that there may be differences in how men and women detect sour, salty and bitter flavors.

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