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!

The columnist Jane Brody wrote a wonderful piece about implants in Tuesday’s New York Times. I couldn’t have written it better myself, and I only found one error! (She says that implants usually take about eight weeks to integrate to bone – but I would say that 3 to 6 months is more predictable.) She writes about her own tooth problems and about the first molar that she lost when she was in her 20’s and the resulting bridge that had to be replaced several times in the subsequent years. She recently elected to have implants placed in order to replace the two teeth that were now missing due to decay and gum disease. She gives the reasons that implants are superior to the conventional bridge: A bridge is not as permanent as an implant, the bridge is harder to keep clean, implants do not decay, and adjacent teeth do not have to be reduced for supporting crowns.

The implant procedure involves surgical placement by an oral surgeon or periodontist of a titanium screw, or implant, into the jawbone. The implant then has to integrate with the bone for 3 – 6 months, at which time the restorative dentist attaches an abutment, which is a connector to which a crown is then cemented. The restorative dentist needs to do the treatment plan and closely coordinate the treatment with the periodontist.

Almost 500,000 implants are placed in the United States each year! A patient’s health and quality of bone will affect their suitability for implants. A patient who is a diabetic or who smokes has a poorer blood supply and this will lessen the chance of success. Brody’s article can be found at http://www.nytimes.com/2009/11/17/health/17brod.html?_r=1

To learn more about implants visit http://www.drterryshapiro.com/implants.html.

So you don’t have any bottom teeth and are not sure what to do? Here are some options:

1. Conventional Denture: A denture needs to be comfortable and stable and aesthetic while allowing the patient to chew and speak normally. The conventionl denture is the least expensive option but it is also the least retentive option. Studies comparing conventional dentures to implant supported overdentures demonstrate a higher satisfaction with the implant retained dentures compared to conventional dentures. But if finances or health are limitations to implants, the conventional denture may well meet an individual’s needs and is not necessarily an inferior treatment.

2. Mini-Implant Retained Overdenture: If there is not enough bone for a standard size implant and grafting is not an option for health or financial considerations, the mini-implant retained denture is an option. Typically four mini-implants are placed and then fitted to the removable denture.

3. Attachment-Retained Implant Overdenture: Typically 2 – 4 implants are placed and fitted to the removable denture. These regular sized implants are more stable than the mini-implants, but grafting may be needed and the cost is higher.

4. Bar-Retained Implant Overdenture: The bar-retained implant overdenture connects 4-5 implants with a connecting bar. The connecting bar adds retention.

5. Implant-Retained Fixed Prosthesis: With the implant-retained fixed prosthesis, implants are placed so that fixed bridgework can be attached. The removable denture is entirely eliminated! This option is the most comfortable and life-like for the patient – but it is also the most expensive option. The patient needs to have adequate bone and the appropriate height for fixed bridgework – not too little and not too much space between the upper and lower ridges.

6. Which option to choose is something for you and your dentist to decide depending on your goals, your physical condition and financial considerations. The dentist needs to do a careful assessment and have considerable experience in performing complex dentistry. If you would like more information about options to replace missing bottom teeth please contact our East Setauket dental office and we’ll be happy to offer a consultation.

This week’s attention grabber in the New York Times, is an article “Don’t Forget to Floss. (But, Please, Not on the Subway)” by Lion Calandra. The accompanying cartoon features a man sitting on a crowded subway with a length of floss in his teeth. Of course, I’m excited to see anyone floss – no matter where! But I guess the article does have a point – public flossing is unsanitary. The flosser pulls up plaque and bacteria that can be infectious. And to make matters worse, the flossers often toss the used floss on the floor.

The writer lists other personal grooming activities that are better done in private: like clipping fingernails, plucking eyebrows, squeezing pimples – all of which she has witnessed on the Long Island Rail Road or New York City subways. The author blames YouTube for taking private moments and opening them up for public viewing. So what to do? Obligatory classes for adults on personal grooming and public health? A special railroad car reserved for personal grooming – like we used to have smoking cars reserved for smokers? What next? See http://cityroom.blogs.nytimes.com/2009/11/09/public-grooming-stirs-vigorous-debate/?scp=1&sq=shapiro%20floss&st=cse