I recently came across an excellent article on the Mayo Clinic website at: http://www.mayoclinic.com/health/dental/DE00001.  The article “Oral Health: A window to your overall health,” discusses the connection between oral health and overall health.  It explains that your mouth may harbor the first signs of disease and that diseases of the mouth, such as gum disease, can cause problems in other parts of the body.
Your mouth is loaded with bacteria which can be kept under control with brushing, flossing and regular dental visits. Saliva also defends against bacteria because it contains enzymes that destroy bacteria. But if the bacteria are not kept in control, a gum infection, or periodontitis, can result.  Gum disease may provide bacteria with a means to enter your bloodstream. Dental treatment might also be a means whereby bacteria can enter the bloodstream.
•     Research has shown that heart disease, stroke and clogged arteries may be linked to oral health and periodontal disease.
•    Gum disease has also been linked to premature births.
•    Diabetes increases your risk of gum disease and oral infections. And poor oral health can make your diabetes more difficult to control.  Oral infections can cause your blood sugar to rise, requiring more insulin for its control.
•    People who have HIV/AIDS often exhibit oral manifestations, including ulcers, dry mouth and painful fungal, viral or bacterial lesions. One of the first signs of AIDS may be severe gum infection.
•    The first stages of osteoporosis, or bone loss, may manifest in loss of supporting bone of the teeth, resulting in loose teeth.
•    Other conditions that may first exhibit in your mouth include Sjogren’s syndrome, some cancers, eating disorders, sexually transmitted diseases and substance abuse.

The relationship between your oral health and your overall health provides another good reason to take care of your teeth and gums.  An investment in your oral health is an investment in your overall health!

The singer Patti Smith was the recent commencement speaker at the Pratt Institute in New York.  She took that opportunity to speak of dental care.  No kidding!
Here is the YouTube link: http://www.theawl.com/2010/05/the-patti-smith-pratt-commencement-speech.
Here is her quote: “My greatest urge is to speak to you of dental care.  My generation had a rough go dentally.  Our dentists were the Army dentists who came back from World War II and believed that the dental office was a battleground.  You have a better chance at dental health.  And I say this because you want at night to be pacing the floor because your fuse is burning inside of you, because you want to do your work, because you want to finish that canvas, because you want to help your fellow man.  You don’t want to be pacing because you need a damn root canal.  So, floss.  Use salt and baking soda.  Take care of your damn teeth.”
Great words of wisdom! - but the audience laughed.  She was spoofing the commencement speech.  But who gets the last laugh?

Today the Port Jefferson Chamber of Commerce held its first Health & Wellness Expo at the Village Center. Over 50 exhibitors were on hand to answer questions, distribute information, provide screenings and education seminars. I also participated and answered questions about teeth whitening, missing teeth, implants, crowns and porcelain veneers. It was wonderful to meet so many new people and see some old friends. I also had the opportunity to hear Dr. Raja Jaber speak on “Lifestyle Medicine,” an approach for patients to develop wellness skills such as the adoption of wholesome nutrition, better sleep habits, appropriate exercise, stress reduction and elimination of harmful addictions. The purpose of the Expo was to “promote good health” – and I hope good oral health too! For more on dentistry and lifestyle, see my webpage on Wellness.

“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.

I was just about to place a composite filling today when my patient asked if the composite material contained bisphenol-A (BPA).  I was embarrassed to admit that I didn’t know.  I did post a blog article about BPA and sealants on my blog and I do use a sealant that does not have BPA. But composite was a different matter.    I just wasn’t sure about dental composites.

The composite that I use is Renamel by Cosmodent, and it is a very fine product.  I checked their catalog, but there was no mention of bisphenol-A, making me think that the product did contain BPA, or they would have announced that it did not.  Then my question was whether there was a composite available that did not contain BPA, and was there any health danger for the patient if composite does contain BPA.

I checked the American Dental Association website for their information on BPA at http://www.bisphenol-a.org/human/dental.html

http://www.ada.org/prof/resources/positions/statements/bisphenola.asp. They defended the use of dental composites, as I would expect, saying that there is no evidence that they are unsafe. From the ADA website: “Based on current research the Association agrees with the authoritative government agencies that the low-level of BPA exposure that may result from dental sealants and composites poses no known health threat.”

But rinse well after a composite is placed – it can’t hurt!

You realize that it’s not a good idea to neglect your dental health, but with so many other pressing expenses in this time of recession, teeth just can’t be a priority for many people. So I have been trying to help people get through the recession with minimal impact on their dental health.

To make things easier for people who might be working longer hours to make ends meet, my East Setauket dental office offers convenient hours: early morning, evening and Saturday hours. Some people are putting off their dental care until they have a pressing dental problem, so we are seeing more emergencies. We always make time for these emergencies, any time, any day. We are also seeing more children because although people may put off their own dental needs, they don’t want their children to develop dental problems. We enjoy our young visitors and make their visits affordable.

We also offer financing options and payment plans to make it easier to manage the cost of treatment. I have reviewed our fees and have reduced some fee services to make it easier for people to get the care they need without our sacrificing quality. Hopefully we’ll all get through this together – and Happy 2010!

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.

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.

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

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.