People who come to my East Setauket dental office for cosmetic dentistry often ask if I also do general dentistry. The answer is, “Yes.” I believe that it is a mistake for cosmetic dentists to limit their practice to cosmetic procedures. A dentist cannot ignore a patient’s dental health, and that is what a cosmetic dentist might do if he/she just does cosmetic dentistry.

Back teeth matter! You cannot just place veneers on the front teeth without addressing the health of the back teeth. Each tooth has a function, and all of the teeth must function in harmony. When dental cosmetics fails it is often because the back teeth were not considered in the treatment plan. And I am pleased that my cosmetic patients are so pleased with my cosmetic dentistry and the care that I provide that they want to continue as my patient and send the rest of their family for their general dental needs – and yes I treat children also!

Several dental colleagues of mine recently went on a mission to Northern Kenya to perform desperately needed dental services.  They told of a local tribal custom of taking infants 1-2 weeks old to a village elder who removes the child’s primary canine toothbuds.  The villagers believe that if these teeth are not removed, the child’s head will develop abnormally and the child will be susceptible to disease.  Another custom is that of taking 10 year olds to have their lower front teeth removed so that a space is created.  No anesthesia is used.  The missing lower front teeth identify a member of the Daasanatch tribe from the village of Illeret.

Low income and low education levels are related to poor dental health.  These villagers live in temporary mud houses called manyattas.  There is an elementary school but education is sporadic because the people are nomads seeking new pastures for their livestock. There is a high incidence of hepatitis, tuberculosis and HIV/AIDS.  The average life span is 40-50 years.

I received this email from a Blog Reader in North Carolina: “I definitely agree [not to look for bargains in dentistry] –you get what you pay for with dentistry. I chose quality–I have heard horror stories and it just seemed silly to look for cheap dentistry. Yes–everyone–make sure you get excellent dentists–its your health and your life–treat yourself well. I like your blog too–I’ll spread the word!”

I couldn’t have said it better myself!

People often come to my East Setauket dental office and complain of sensitive teeth. Tooth sensitivity may be caused by erosion of the enamel outer layer of the teeth and exposure of the more sensitive dentin layer. This erosion may be caused by aggressive tooth brushing or acidic foods and drinks. Some toothpastes, mouth washes, or tooth-whitening products can also cause tooth erosion. Bulimia and acid reflux can also severely erode the teeth.

Some patients manage sensitive teeth by simply avoiding cold foods and drinks. Other patients avoid brushing the sensitive areas. I recommend that patients use a desensitizing toothpaste, such as Denquel or Sensodyne. In the office I apply a fluoride varnish to the sensitive areas and this helps to reduce sensitivity. Patients should also use a soft-bristled toothbrush. A hard toothbrush may wear away the enamel. It is important to practice good oral hygiene: floss every day and brush at least two times a day for 2-3 minutes. Hold the toothbrush at a 45 degree angle and brush gently in a circular motion. Hold the toothbrush in your fingertips instead of in the palm. Avoid very acidic foods and beverages. Visit the dentist to be sure that the sensitivity is not due to dental caries, a cracked tooth or gum disease.

In 1901 a dentist named Frederick S. McKay noticed that many of his patients had brown, mottled teeth that were resistant to decay. He collected water samples from towns where brown, mottled teeth were prevalent, and he found concentrations of fluoride as high as 12 parts per million in the water supply. Chemists then did studies and determined that it was the fluoride in the water that caused the brown teeth. But it wasn’t until 1938 that researchers confirmed McKay’s conclusion that drinking water containing fluoride resulted in a reduction of tooth decay.

In 1941 the New York Times reported that children who drank water with 1 part per million of fluoride had 1/2 to 1/3 less tooth decay than children drinking non-fluoridated water. In 1944 New York State conducted a study in which they fluoridated the Newburgh water and compared the lower decay rate to the decay rate in Kingston which did not have fluoridated water. In the early 1950’s the U.S. Department of Health officially recommended fluoridation, and many of the nation’s water supplies were then fluoridated. But fluoridation was controversial in New York City and didn’t begin in the City until 1965.

Today more than 60 percent of Americans use fluoridated water. However Suffolk County water is not fluoridated. The Suffolk County Water Authority website states: “We do not add fluoride or vitamins to the water we deliver to you. Our water delivery system has over 500 wells and over 5,000 miles of water mains (pipes) located throughout Suffolk County. Most of our system is interconnected so that your water can come from multiple wells. This makes it impossible to provide fluoride at consistent levels, and too much fluoride can be harmful.” (http://www.scwa.com/FactOrMyth.cfm) For more about fluoridation visit http://www.drterryshapiro.com/wellness.html.

I recently made a new set of dentures for a very sharp lady of 85 years.  But she had a very resorbed lower arch and consequently had a lot of trouble keeping her lower denture in place.  It would have been too much of a physical strain for her to have conventional implants placed.  So we elected to place two mini-implants.  The mini-implant or SDI (small-diameter implant) is an alternative to the conventional implant for patients who cannot tolerate surgery for conventional implants or who may have other physical or financial limitations.  This particular lady did very well with the SDI placement and is enjoying the increased stability that the implant attachments now add to her lower denture.

Conventional diameter implants received FDA clearance in the late 1970’s and are now considered a routine part of modern dentistry.  The SDI only received FDA clearance for long-term use in 1997.  This was just 12 years ago so the SDI is still somewhat controversial.  Nevertheless, research shows that the SDI’s are more than 90% successful.  If the situation is appropriate and the implant is carefully placed, I believe that it can be a great service to the patient.  In my East Setauket office the SDI is most often used to support a lower denture for people without any lower teeth.