A letter to the editor in last week’s New York Times was written by a woman who played college ice hockey in the 1970’s at Brown University, the only women’s college ice hockey team in the U.S at the time. She relates that she encouraged her brother, a varsity hockey player at Colby College, to “get some girls out onto the ice for us to play.” He did, and one of them was their friend Linda Krohn. When Linda’s mother found out she insisted that Linda stop playing hockey so she wouldn’t lose her teeth. The letter adds: “Now I smile with glee that Linda’s daughter, Lindsey Vonn, races down mountains at world-class speeds and that women’s ice hockey is in the Olympics, too.”

And Lindsey still has her teeth! After a recent accident on the ice that left blood streaming down her face she said: “I was just confused. At the bottom I didn’t know what had happened and I was hoping I hadn’t lost any teeth. I am just glad it wasn’t anything major, just a cut.” Vonn said she wears a protective mouthguard which saved her teeth and saved a huge dental bill. Read about athletic guards at: drterryshapiro.com/mouthguards.html.

After her shin injury at the Olympics she said: “My shin was still very painful, but I feel like the injury is finally progressing a bit. The pain level has gone down from a sharp debilitating pain to something that I feel I may be able to grit my teeth through. So that really puts a smile on my face!:)”. I find it intriguing that she used the term “grit my teeth through” because when I look closely at her teeth I see signs of tooth wear – likely from gritting her teeth.

So you really think you are too old for cosmetic dentistry? Well, you should know that cosmetic dentistry can brighten a smile of any age. Multiple modalities are available to the dental professional today, ranging from relatively inexpensive teeth bleaching, recontouring, and bonding to more complex procedures consisting of veneers, ceramic crowns and implants.

A simple whitening procedure can brighten teeth that are yellow or gray from age. There are several options from drugstore brighteners to custom dental trays or in-office whitening, depending on your budget and the quality of whitening desired. Tooth whitening corrects brown, yellow and mottled teeth and can brighten a dull smile.

Another simple procedure is the recontouring or reshaping of chipped or misaligned teeth. With recontouring and reshaping, crowded or chipped teeth can sometimes easily and non-invasively be corrected in one visit.

Composite bonding is another procedure that can be used to close a space between teeth or to repair chipped or cracked teeth. It is often non-invasive and anesthetic is not always needed. The composite material is chemically bonded to the tooth and polished to match the remaining tooth surface. Worn out silver fillings can also be replaced with tooth-colored bonded composite restorations.

The above are all relatively non-complex cosmetic procedures.  For a more long-lasting solution, the modern porcelain veneer offers the most esthetic result.  The porcelain veneer is a thin shell of ceramic that bonds  to the front surface of the teeth. The porcelain veneer does not stain or discolor. Veneers can close spaces, straighten crowded teeth, and cover discolored and chipped teeth. Placing custom veneers requires a high degree of technical skill as well as attention to cosmetic detail. Veneers require less tooth reduction than conventional crowns and can conservatively transform a smile.

If too much tooth is missing or damaged for a composite or porcelain veneer then an esthetic crown may be the answer. Today we have all-ceramic crowns and Zirconia crowns that are more life-like than the porcelain-to-metal crowns in use for the past 30 years. When carefully crafted by a talented cosmetic dentist and cosmetic dental laboratory, the all-ceramic crown is undetectable.

People are always embarrassed when their smile uncovers a missing tooth. Today the dental implant is a durable replacement that feels and functions like the missing tooth because the implant replaces the root as well as the tooth. The dental implant is surgically placed into the bone and fuses with the bone in a process called osseointegration. Restored dental implants are a very conservative way to replace teeth and help preserve facial structure.

Another less-costly option to replace a missing tooth is the bonded bridge for areas of light function or the conventional bridge, both of which can be fabricated of all-ceramic materials.

Some cosmetic procedures are elective, but other times the unsightly teeth are symptomatic of underlying dental disease. So a cosmetic procedure may also be an investment in your dental health and might even be covered by your dental insurance.  Teeth bleaching, recontouring, composite bonding, porcelain veneers, all-ceramic crowns and implants are all cosmetic procedures, sometimes just different ways to solve a problem. Call our East Setauket dental office, come in for a free consult, and explore what is the right solution for you!

My eldest patient is a 96 year old woman, in reasonably good health and still living at home with her son, who is retired and helps with the housework. She has most of her teeth, and she wears an upper and lower partial denture to replace several teeth that are missing. These partial dentures, over 10 years old, have served her well. She wants to keep the teeth she has: she comes into the office regularly for periodontal maintenance and dental exams. Her homecare is reasonably good. I have replaced several defective dental fillings and restored some decayed areas. We are working together to maintain her dental health - and may she live to 110.

I was at a business meeting this morning speaking to a man with a rather large gap between his two front teeth. We started talking about teeth, and he asked me if I knew that a gap between the teeth had become quite fashionable. I didn’t, so I went onto Google to check this out.

Sure enough a website on global fashion called Refinery29 features an article this month called “Gap Teeth: The Latest Must-Have Accessory?” http://www.refinery29.com/gap-teeth-the-latest-musthave.php. The article includes photos of several models and actresses who flaunt their teeth gaps, including Lauren Hutton, Lara Stone, Georgia Jagger and Anna Paquin. As the author writes, these are “all beauts who know how to work a good gap.” Maybe so, but I can’t help but think their beauty would be enhanced by some excellent cosmetic dentistry.

Unfortunately and all too often, un-cosmetic dentistry, done by dentists without the proper training and experience, gives people an unnatural look. The author adds, “More and more (blessed be!), it seems those hideously super-sized, glow-in-the-dark veneers are being replaced by normal beautifully imperfect canines.” What she may not know is that well-crafted veneers are beautiful and natural looking and undetectable. Check out our veneers and see how naturally beautiful they look.

An excellent article about teeth grinding and clenching titled ‘Dealing with the Nightly Grind’ appeared in today’s New York Times. The article links an increase in teeth grinding to the increased stress felt by middle aged men in this recession. Normal chewing places 68 pounds of pressure per square inch on the molar teeth but grinding can place 900 pounds of pressure on the teeth!  Traditionally it is predominantly women who seek treatment for bruxism, but those of us in the dental profession are struck by the recent increase of men seeking treatment.  Normally 10-15 percent of the population grinds their teeth.

I will usually ask my East Setauket dental patients if they are sleeping well. I ask if they have headaches. I will ask if they bite their tongue or if the muscles around their mouth feel sore.  Tooth grinding, also called bruxism, can break teeth or loosen them and might feel like a toothache.  Tooth grinding can often be prevented with an occlusal (night) guard that we make in our dental office. But a patient may not know that he is grinding or clenching. A dentist who has training in occlusion or esthetics can see signs of tooth wear that the patient may not be aware of. I will take photos of the teeth to point out the wear patterns on a patient’s teeth.

Sometimes a patient is not concerned and doesn’t want to wear a night guard. This presents a problem. Click on the mouth guard link in this website for a photo of severely worn teeth. This patient refused to believe that he had a problem and wouldn’t wear a nightguard – but he is silently grinding his teeth down to the gumline. Don’t let this happen to you!

An overwhelming majority of people who have periodontal (gum) disease are also at high risk for diabetes and should have screening for diabetes. A recent study showed that 93% of subjects who had gum disease were at high risk for diabetes compared to 63% of subjects without the disease. The study recommended diabetes screening for people over 45 years of age who have a body mass index (BMI measuring weight and height) of 25 or more and for people under 45 with a BMI of 25 or more and one additional risk factor. The study can be found in the Journal of Public Health Dentistry at http://www3.interscience.wiley.com/journal/123210997/abstract.

For more information about periodontal disease visit www.drterryshapiro.com/peri.html.

It’s winter and several of our East Setauket dental patients went off to warmer climates for scuba diving. I’ve never gone diving – sounds scary - but I am tempted to learn this sport so I can see the fabulously colored sea life. I read recently that pressure changes during diving can cause damage to your dental fillings. A case was reported in an article in JADA titled “Dental Restoration Dislodgment and Fracture During Scuba Diving: A Case of Barotrauma.” http://jada.ada.org/cgi/content/abstract/140/9/1118. Barotrauma is a term used to describe an injury caused by a rapid or extreme change in air pressure. Areas within the body (such as your teeth) can be especially affected by barotrauma.

The article explains that three of a patient’s fillings fractured or dislodged while he was scuba diving at a depth of 35 meters. His dentist later replaced the broken fillings with new fillings and crowns.

Inadequate fillings can predispose patients to barotrauma. To prevent barotrauma-related damage to the teeth, you need to be sure your dentist places high-quality restorations that do not trap air beneath them. People who are exposed to barometric stress should know the causes of barotrauma. They need to be aware of the importance of regular dental checkups to help avoid barotrauma-related dental problems.

“Talking Teeth” is the name of a bi-weekly radio program on 91.5 AM hosted by my good friend and colleague (and mentor) Dr. Dean Vafiadis. On this program Dr. Dean discusses issues of dental health. Tonight’s topic was implants; two weeks ago it was periodontal disease; the next topic will be “teeth in an hour.” Dr. Dean is an excellent speaker – always informative and entertaining. He calls the program “Talking Teeth” because he says that teeth talk to him. That may sound funny to the public, but I know what he means. Teeth do talk to me too! They tell me a lot about your habits and your life style. I can tell if a tooth is happy or unhappy or if it needs attention. So check out Dr. Dean’s radio program if you want to learn more about what the best dentistry can do for you.