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.

The other day a patient asked me how long a dental crown (cap) should last. He had come into my Long Island office with two broken crowns that were about 15 years old. Well, the answer is that all crowns and patients are not alike. A crown should last 10-15 years, but I have a patient who had simply gorgeous gold crowns made some 40 years ago in California that still look as beautiful as they did the day they were inserted. And on the other hand, I have a patient who lost two crowns after only two years because they were poorly made by a dentist right here in Suffolk County.

For a crown to serve well, the dentist has to prepare the tooth properly so that all decay is removed and the tooth is the proper shape to retain a crown. He/she has to take a very accurate impression, make a well-fitting provisional crown, fit the crown properly when it comes back from the dental laboratory and cement the crown carefully. All of this takes careful attention to detail and cannot be rushed. All too often dentists skip a step or cut corners and this will affect the longevity of the crown – and ultimately the life of the tooth.

The dentist must also use the services of a superior dental laboratory that also pays attention to detail and uses finer materials. All too often, dentists who charge less for a crown, can do so because they send their work to inferior dental laboratories.

Another important factor in the life of a crown is the patient. The crown needs to be taken care of with proper brushing and flossing and regular visits to the dentist. If the patient neglects his/her dental health, this will definitely have an adverse effect on the crown. The patient’s systemic health is also a factor. Diabetes and smoking are associated with gum disease which in turn affects the crown and tooth.

For more information about dental crowns and bridges visit drterryshapiro.com.

Plaque and calculus can buildup on dentures if a patient has poor denture hygiene. This can be harmful to the oral tissues and can lead to oral Candida and other oral pathologies. Brushing the dentures removes plaque and food debris. Regular toothpaste is too abrasive for dentures so be sure to use a denture toothpaste. You should remove the dentures after eating and brush them with a denture brush and denture toothpaste over a sink filled with water or over a towel to protect the dentures from breaking if they should fall.

In addition to brushing them, dentures should be soaked daily to keep them clean. Soaking the dentures allows the denture cleaner to penetrate the denture and kill bacteria. To keep your dentures fresh-looking and odor-free be sure to brush and soak your dentures daily.

It’s a good idea to leave the dentures out of the mouth at night to rest the oral tissues and allow blood flow to return to normal. When dentures are out of the mouth, they should be soaked in a soaking solution or water to prevent them from drying out.

Denture wearers should visit the dentist for regular checkups at least once a year. Tissues under the dentures can change and the dentures can become ill-fitting and further damage the tissues.

A denture is not permanent. It will wear over time and will loosen as the ridge undergoes changes. Dentures should be replaced every 7 to 10 years. A reline might also be needed every 2 -3 years depending on the amount of ridge resorption.

Call our East Setauket dental office and we will be happy to evaluate your existing dentures for a reline or possible replacement.

Did you know that there are different kinds of partial dentures? Do you know what you are paying for when your dentist tells you that he/she is making you a partial denture? You need to ask what kind of partial denture you are getting. There are all-acrylic partial dentures, acrylic partial dentures with wrought-wire clasps, flexible partial dentures, cast metal partial dentures, semi-precision partial dentures and precision partial dentures - just to name a few! The dentist needs to do a careful diagnosis and treatment plan and discuss with the patient the pros and cons of each of the options. The dentist needs to take superior impressions and bite registrations and pour superior models.

>The acrylic partial denture is the least expensive - that is the advantage, but there are many disadvantages, such as lack of retention and lack of durability. The acrylic denture is made of plastic and often incorporates wrought-wire clasps for added retention. Acrylic dentures are often prescribed as a temporary device when an immediate denture is required - as, for example, if a front tooth is lost, the acrylic denture will serve as replacement while a more permanent solution is being fabricated. We also use it sometimes to replace a tooth while an implant is healing. It also might be used when finances are a limiting factor.

>The flexible partial denture is made entirely of acrylic and instead of incorporating wire clasps like the acrylic denture, it incorporates flexible tooth colored clasps. Valplast is one such product. The flexible partial denture is thus more aesthetic than the acrylic denture and is more durable. It is a more permanent solution when aesthetics is a concern, for example if a front tooth has to be clasped for retention. Although the flexible partial will loosen and discolor in time and is not indicted for a smoker, it can serve quite well for a number of years.

A variation is the Virginia Partial which we have used with great success. This is a tissue born, acrylic-based denture that uses a soft silicone band around any remaining teeth. The flexible band replaces metal clasps. The result is greater aesthetics and comfort for the patient.

>The cast metal partial denture is superior to the acrylic and flexible partial dentures in that it fits better and is more durable. It will serve a patient well for many years. Our cast frameworks are made by Lab One - a very fine denture laboratory in Norfolk, Virginia. They also make our fabulous dentures. The metal clasps are cast with the metal framework and fit snugly around the teeth. The metal framework also fits snugly on the residual ridge. The metal denture is comfortable and durable and can be aesthetic depending on which teeth are missing and the skill of the dentist and technician.

>The precision partial denture is the Rolls Royce of partial dentures. The precision attachment is a precision-machined male and female, or lock and key, housing to connect the removable partial denture to a fixed bridge. The female part of the attachment is connected to a fixed crown and the male part is attached to the partial denture. The two parts are machined to fit with precision. The precision partial denture is most aesthetic as there are no clasps and it is most comfortable as the connectors are precisely manufactured to fit. The disadvantage is the higher cost to accomplish this superior device and that the nearby teeth would have to have crowns.

The semi-precision partial denture is similar to the precision type but is not as precisely machined and is therefore somewhat less expensive.

>In our Long Island dental office, we always discuss with our patients the advantages and disadvantages of each option and help the patient decide which option is best for their particular situation. Regardless of the choice, it takes great skill, caring and judgment on the part of the dentist and dental technician to deliver a superior product.

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!

I’ve started traveling to NYU each Friday for the post-graduate training in teeth implants and full mouth reconstruction that I’ve been telling my dental patients about. What is full mouth reconstruction, you ask? Sounds like I am remodeling a house. Well there is some similarity. Think about how much abuse your teeth, muscles and jaw take day after day chewing, chopping, tearing, grinding. Think about teeth that have been lost and not replaced. Think about decay not addressed or gum disease not treated. Well all of this can take a toll. Repairing the damage can be very complex. Full mouth reconstruction may be required. Full mouth reconstruction is the process of restoring the teeth to their natural condition. It takes a lot of training, skill and planning for a dentist to do this kind of complex dentistry. Not for the dentist who puts on roller skates and rushes from one patient to the next.

Full mouth reconstruction usually requires a combination of crowns, bridges, implants, or overdentures. It may include periodontal treatment, orthodontic treatment, oral surgery or root canal treatment. Fundamental to this sophisticated approach is occlusion, that is, how the teeth come together. We study how to plan and sequence cases efficiently and predictably with a focus on dental aesthetics.

For more information about Full Mouth Reconstruction visit www.drterryshapiro.com/theart.html.

The family doctor may be a thing of the past, but the family dentist has not gone the way of the dial phone. So what is a family dentist? A family dentist is typically a solo practitioner whom you and your entire family can see for your dental needs. A family dentist does not work for a large practice where the dentist you saw at your last visit is no longer working or where you see a different dentist for each appointment, and there is a large and chaotic staff that only knows you as a number. A family dentist is part of the community and supports community activities. He/she is a fixture in the community and can be relied upon year after year to take good care of you and your family through good times and bad.

I’ve had the good fortune to have practiced at the same location in our beautiful Three Village area for over 20 years. I have seen my young patients grow up, marry, and become parents themselves, as other patients have aged and become grandparents. I have shared holidays, celebrations and some difficult moments with my dental family. My patients know they can always reach me, and my door is always open to take care of any dental emergency. I also act as an advocate for my patients. I may refer them to a specialist for particular procedures, such as periodontal or oral surgery, and I communicate directly with the referral doctor to be sure that my patients are well taken care of. I discuss recommended treatment with the patient and help them to make a decision that’s right for them. I call my patients after each visit to my office to see if they have any concerns. I am always available to speak to them on the phone or on email. I am responsible for the quality of the work that comes out of my office, and for the quality of the supplies and the cleanliness of the office. My office is a reflection of me. That’s why one goes to a family dentist!