I was witness to a sad story in my East Setauket dental office today. A patient whom I had not seen for a year came in for a checkup appointment. In the time I had not seen him, he had undergone radiation treatments and several surgeries for squamous cell carcinomas of his head and neck. Unfortunately his oncologist did not advise him to seek dental care before the treatments began. Nor was he warned of the dental risks associated with radiation therapy. He now has serious dental decay and infections in several teeth.

Oncologists need to tell their patients to visit their dentist before beginning radiation therapy. The oncologist also needs to speak to the patient’s dentist in order to inform the dentist of the type of therapy, the location and dosage and number of treatments. The saliva of these patients is reduced in volume, thus losing its protection against dental decay. I thus want to see these patients on an emergency basis as soon as I learn of pending radiation treatments.

We perform a thorough oral examination, periodontal scaling and root planning and educate the patient about the risks of radiation therapy. We stress with them the importance of meticulous oral hygiene during and after the radiation treatments. I prescribe preventive oral therapies for these patients. We recommend removing any teeth that are questionable. If teeth are removed before radiation therapy, we expect that healing will be normal. But if the teeth are removed after therapy, there is a high chance of osteoradionecrosis – exposed bone and delayed healing. Hyperbaric oxygen may then be delivered to encourage healing. We also restore any decayed teeth. When radiation therapy begins, the patient needs to be fee of infection and decay. We want to see them at frequent intervals to monitor any change in their dental health.

As a Long Island family dentist I believe it is crucial for our nation’s health that dentistry be affordable. High costs must not stand in the way of the public receiving quality dental care. So I focus my attention on making my dentistry affordable. I did not raise my fees this year. I do a careful diagnosis and treatment plan for each patient which I review with the patient before restorative work is begun. I present alternative treatment plans so the patient can choose a plan that fits into their budget. We work out a manageable payment plan and arrange for financing if needed. We maximize any insurance benefits due the patient. Open communication and trust are the keys to success. No hidden fees!
What can you do? Don’t neglect your dental health. A neglected mouth is very expensive to restore to health. The regular dental visit is the best investment you can make.

As you probably know, the first line of defense against flu is to wash your hands frequently and keep them away from your face. But did you know that it was a French dentist, Arnauld Gilles, who first advocated hand washing for infection control back in 1621? His book “The Flower of Remedies Against the Toothache,” was the first French text on dentistry, and Gilles describes himself as an “Operator for the Teeth.” In his book Gilles speaks out against practitioners who treated patients without cleaning and washing their hands, thus carrying infections from one patient to the next.

Unfortunately Gilles’ recommendation to wash your hands was ignored by his medical colleagues. And it wasn’t until two centuries later, in the mid-nineteenth century, that Joseph Lister began to disinfect surgical instruments and Louis Pasteur showed the connection of bacteria to disease. But even 200 years after Gilles wrote his book, these ideas were considered revolutionary and provoked fierce opposition from the medical profession.

In my Long Island dental office I follow strict infection control procedures, including steam sterilization, surface disinfection and use of disposables whenever possible.

The first page of Sunday’s New York Times certainly grabbed my attention. The attention grabber was a photo of seven year old Ryan Massey’s wide open mouth showing stainless steel crowns on all four of his primary molars. The caption reads “Dentists near Charleston, W. Va., say pollutants in drinking water have damaged residents’ teeth.” Ryan’s teeth were capped in order to replace enamel that was eroded by chemicals in the water. The local tap water in his community contains arsenic, barium, lead, manganese and other chemicals at harmful concentrations. Nearby coal companies are contaminating the ground water in violation of the Clean Water Act, but the companies have not been fined or punished.

The September 13 article written by Chares Duhigg is an overview of pollution in our nation’s water systems. His research shows that 40 percent of our community water systems violated the Safe Drinking Water Act at least once. In New York the number of regulated polluters has almost doubled to 19,000 in the past 10 years, but inspections have not increased. While he does not mention Long Island specifically, he does say that in parts of New York the drinking water has high concentrations of tetrachloroethylene, a dry cleaning solvent that has been linked to cancer and kidney disease.

I have not seen the kind of dental decay among my Long Island patients that the Massey family experienced from their contaminated drinking water. But water quality is an issue that we all need to think about. You can contact the Environmental protection Agency at www.epa.gov/enviro/html/sdwis/sdwis_query.html to learn about your local water supply.

Lip piercing. Tongue piercing. Bad for your health? The answer is “yes.” I have seen gum recession, infection, and tooth fractures as a result of tongue piercing. Other complications include swelling, nerve damage, and bleeding. Your mouth contains millions of bacteria, so infection is a common complication of oral piercing. Your tongue could possibly swell large enough to close off your airway. Tongue jewelry also presents hazards. You can choke on studs or barbells that come loose in your mouth. Contact with oral jewelry can fracture a tooth. I explain the risks to my dental patients and let them make their own decision.

Dental erosion occurs when there is chemical removal of the enamel surface of the teeth. Erosion is often associated with acidic foods and drinks. A recent study reported in the Journal of the American Dental Association compared original-flavor candies and their sour counterparts. Both varieties are erosive but sour candies have more erosive potential than the original-flavor candies. Saliva provides some protection against the erosive effects of original-flavor candies but it affords less protection against the erosion due to sour candies.

It’s best not to consume candies at all – especially if you have decreased saliva flow – but if you must – choose the original-flavor over the sour varieties. If you do have erosion, or notches in the teeth at the gum line, we can repair the lost enamel with teeth bonding.