Several months ago I told Jay’s story on a blog post: His teeth had been severely eroded by acid in the air after the World Trade Center attacks. He was a supervisor on the cleanup crew for more than four years.  We fabricated upper and lower anterior porcelain bridges for him and upper and lower precision partial dentures to replace the back teeth. He looks terrific, is comfortable and can eat anything without trouble.


Severely eroded teeth.


Porcelain crowns and bridges

My patient, Ellen, went to a Hillary Clinton fundraiser at the home of a hedge fund manager in South Hampton. Don’t ask me how she got invited – along with her husband and grandson. Seems her husband knows someone who knows someone. A couple of years ago they went to a Clinton fundraiser in Manhattan.  Donations for such events probably are in the neighborhood of $1500-5,000 per person.  It is remarkable that they had this amazing opportunity to hobnob with the Democratic political elite.  Security was of course very tight.  They had to mail in photo identifications before the event. Bags were carefully checked – no guns allowed. Only photos of Hillary by the official photographer were permitted. But the event was lots of fun – even inflatable bounce toys for the kids.

So how do my teeth fit into all of this gaiety?  Well, Ellen, like everyone else at the event, had the chance to shake Hillary’s hand for a photo op.  And what do  you think Hillary said as she was shaking Ellen’s hand? “What beautiful teeth you have!” the Secretary and Presidential Candidate said to a broadly smiling Ellen.  But Ellen’s teeth have porcelain veneers, designed and prepared by me in my office. Nice that Hillary liked my teeth. And Hillary’s teeth could be just as beautiful if she came to me for her dental treatment. I asked Ellen if she gave Hillary my card but she didn’t.

Hillary at the Democratic Convention August, 2016.  She has crowns on her front teeth but they could look better.

The recent guidelines issued by the Departments of Agriculture and Health and Human Services no longer mentions flossing. Apparently officials had not done research about the effectiveness of regular flossing before they had recommended for Americans to floss. Without the requisite research, the recommendation had to be dropped.  The American Academy of Periodontology agreed that current evidence was not adequate because researchers had not included enough participants nor had they examined gum health over a long enough period of time.

There is apparently no reliable evidence that flossing prevents tooth decay or severe periodontal disease.  There is some evidence that flossing reduces bloody gums and inflammation, or gingivitis. I have certainly seen both good and poor flossers in my office. To my mind, the problem is that people don’t know how to floss properly – they really don’t understand the purpose of flossing. The goal is to remove, or reduce, plaque in between the teeth. You need to floss carefully against the root of the tooth to bring the plaque to the surface. Once periodontitis develops, the pocket may be too deep for effective flossing. An interproximal brush, such as the Go-Between, is more effective. Despite the limitations, cleaning between the teeth is crucial.  How many people remember the old saying, “You don’t have to floss all your teeth, only the ones you want to keep.” I don’t know where that saying came from, whether from an advertisement or not, but it was a popular saying some 30 years ago!

I’ve written posts about Joe Biden’s teeth, so to be fair I thought it was time for me to write about Donald Trump’s teeth. I’ve been looking closely at his abundant images on the media and observing his teeth. Definitely expensive porcelain crowns, fair esthetics but dreadful color. Too white, making the teeth too prominent, too fake. 

Ciro Scotti in an August 21, 2015 blog post in The Daily Beast wrote about his encounter some 15 years ago with Trump and his teeth.  At that time, Scotti was at the office of a dentist he called “a fancy Upper East Side dental surgeon who specialized in cosmetic work.”

The dentist showed Scotti a set of teeth molds: “Do you know what these are?” he asked.  Then answered his own question:  “Donald Trump’s teeth.” The dentist said Trump would come to the office every six months or so complaining that his veneers weren’t white enough.  “I tell him that if they are too white, they won’t look real,” the dentist said,  “but he won’t listen. So he picks a shade, and I make them about one-quarter as white as the shade he selects, and he goes away happy.”

As they walked down the hall, the door to an examining room was open and Scotti could see the back of a famous head of hair in the dentist’s chair. 

I hope this dentist informed Trump that if he continued replacing his veneers every six months, he will soon have no tooth left to veneer – crowns, root canals, extractions, implants will be in his future, if the future is not already here.

A year ago New York State passed a bill requiring that all prescriptions for controlled and non-controlled drugs that are issued by medical and dental practitioners to pharmacies be submitted electronically. Practitioners asked for a delay but now as of March 27, 2016 the New York State requirement has taken effect.  We updated our software last year to include e-prescribing so we have been on-board for a year. I love e-prescribing! It is easy to transmit a prescription electronically with our software and e-prescribing protects the patient.  We can check dosages and history for a given patient – errors are much less likely.

This electronic prescribing requirement is intended to address the misuse of controlled drugs. Electronic prescribing software provides us with a more complete picture of a patient’s prescription history, in addition to options and doses. Prescriptions are transmitted immediately to the patient’s pharmacy to be filled. This will eliminate errors resulting from poor handwriting or a misunderstanding.  Electronic prescriptions are tamper-proof and stolen prescription pads will not be accepted. E-prescribing software improves drug safety by enabling the dentist to automatically check drug dosges, adverse reactions and duplicate drugs. Access to the patient’s medication history is available to us on the spot.  Our e-prescribing software is linked to our Dentrix practice management system. It is seamless.

There are times when electronic transmission is not practical and then paper prescription pads may be used. For example a prescription that will be filled by a patient in a state other than New York will require a paper script.  Another example might be a power or Internet failure.

We are compliant. The future is here!


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I was out of the office last Friday and Saturday taking a two day course called “Incorporating Full Arch Immediate Loading into Your Practice: An Interdisciplinary Team Approach.” What a mouth full!  Translation: “Full Arch Immediate Loading” is the term dentists use to describe placement of implants for someone who has no teeth or failing teeth and attachment of a tooth bridge to the implants on the same visit. What this means is that a person may arrive in the dental surgeon’s office in the morning, have remaining failed teeth removed and leave the office several hours later with a full complement of teeth or sometimes have teeth placed the next day. This is truly amazing dentistry!

The “interdisciplinary team approach” refers to the dental team: restorative dentist, implant surgeon, and laboratory technician.  All of the players plan the procedure very carefully with models and cat scans to be sure that the patient is a candidate for this type of dentistry.   The procedure is worked out carefully beforehand so it all proceeds without a hitch.  The patient will go home with a provisional bridge – the permanent bridge is placed several months later.  We call this a “hybrid” because it is an implant bridge that is fixed for the patient but which the dentist can remove periodically to clean, repair if necessary, and to be sure that everything is solidly attached.

The course was given by a dentist and oral surgeon who came to Long Island from Westchester with their patient. We had a lecture, some hands-on exercises and a live patient demonstration. This is an excellent way to learn dental procedures. The course was given at Marotta Dental Laboratory, located in Farmingdale  – excellent dental technicians who are very experienced in doing this type of dentistry. I accompanied Dr. Edward Brant, a periodontis/implantologist from Saint James whom I work with on a regular basis. The implant system we used was from the Straumann Company which sponsored the event and donated their expertise. Straumann, a Swiss company, is the largest implant company in the world and has its American headquarters in Andover, Mass.

Truly an outstanding couple of days!

Judy slipped and fell on the ice during our January snowstorm. Today the temperature climbed to 7o degrees – a record for early March so it is hard to remember that we were knee-deep in snow just two months ago.  My daffodils and crocuses are in bloom today.  But getting back to January and Judy’s fall.  Unfortunately she fell facedown, and she fractured two front teeth.  As you can see below, the right front tooth was beginning to darken from the trauma. You can also see fracture lines in that tooth and the one to the right of it.  One of the traumatized teeth required root canal, the other did not.  She then elected to have veneers placed on all four front teeth to cover and protect the fractured and discolored teeth and to achieve the beautiful smile that she had long wanted.  We lightened her tooth color and removed the space between the two front teeth. A nice result!



Fractured Teeth Needing Restoration

X01265A2Repaired with Porcelain Tooth Veneers

Suppose you had lost all of your upper or lower teeth. What are the options?

1. The simplest, least costly but most prone to problems, is the conventional denture.

2. An improvement is the overdenture in which the denture snaps into two or more implant attachments. See my blog entry and video of  April 14, 2015.

3. Even better is the hybrid denture. For the hybrid denture, several implants, (typically six) are placed in the arch.  A prosthesis that is screwed into the implants is constructed. It is a fixed prosthesis as far as the patient is concerned, but the dentist can remove it for maintenance.  Thus we call it a hybrid, or fixed/removable.

     The hybrid is a wonderful service. The teeth function like natural teeth. However the hybrid and surrounding tissues need to be kept clean.  Calculus and plaque can lead to gingival inflammation and peri-implantitis with eventual loss of the implants. I instruct the patient to use a water pic from outside and inside, as well as running floss under the hybrid denture and use of an end tufted toothbrush.  The patient also needs to return to the office at six month intervals so we can professionally clean the hybrid and remove it as necessary.  The acrylic teeth can also chip or fracture. We supply a temporary hybrid so the patient can wear this if the denture needs to be repaired. Acrylic teeth may have to be repaired in five to seven years. If the hybrid opposes natural teeth, we may also make a night guard to protect the hybrid from breakage.

     Alan had upper and lower hybrids that were made seven years ago in another office. The teeth had chipped and they were heavily stained as well as being a vehicle for heavy calculus and plaque.  I removed the hybrids and constructed new ones.  This took several visits but look how wonderful he looks now!  He is more comfortable and can function better too. He promises to return regularly.  He went back to Florida for the winter, his spare hybrids in hand.

X0122109Old hybrids: chipped and stained teeth


New hybrids

The Pygmie people live near the equator in the African rain forest.  Teeth filing or sharpening is a painful custom of these Pygmies of the Congo Basin.  The practice began over 500 years ago in order to make the indigenous people less attractive to the slave traders, as they thought.  The sharpened teeth were also an aid in eating meat.  Some of their descendants continue the practice today as teeth sharpening has become an integral part of the Pygmy culture.  The procedure takes about 45 minutes and is performed on all six upper front teeth. The people use a knife or hammer to chisel away the tooth until they achieve the desired shape. The procedure is very painful.  At the same time, lacking sugar, these indigenous people did not have any tooth decay in the seventeenth century.

Sadly, in 1904 the American explorer Samuel Verner brought back several Pygmies to exhibit at the St. Louse World’s Fair.  One of the Pygmies, Ota Benga, was later exhibited at the Bronx Zoo.  The New York Times  reported on the exhibit with the headline “Bushman Shares Cage with Bronx Park Apes.”  Today the official website of the New York City Department of Parks & Recreation describes this human exhibit as “misguided.” Certainly a better apology is needed for this horrific chapter of our history.

Two lovely stories told to us at the office.


First story: Jaime sat down in our chair and said she had something exciting to tell us – but Linda, May and I all had to be present. What could it be? We had known Jaime for over two years and knew her to be a lovely person but she had never confided in us the story she was about to tell us now. She began: in 1963 she had a daughter out-of-wedlock. She gave the child up for adoption. She thought of the child every day for over 50 years and always wanted to know how she was and what kind of person she turned out to be. In those days the adoption records were sealed and she had no way of knowing who adopted the child.


Speed forward to 2015 when adoption records have been unsealed.  Jaime was contacted by a woman born on the same date in 1963 and at the same hospital. This was her daughter. They met each other and caught up. The daughter had been adopted by loving parents and grew up to be a wonderful, loving adult, married with two children. Jaime, who didn’t have any other children, now has a ready made family. It is a lovely story!


Second story: Michael came to the office for a new patient consult. Right away I saw that he did not have any teeth and was not wearing dentures. He had lost his teeth over the years from decay and periodontal disease. He never had dentures made because he had a dental phobia.  But he had a story he wanted to tell me. He grew up in the United States but was born in England.  Recently he received a call from an English woman who turned out to be his sister. He never knew that he had a sister living abroad.  The story is complicated about why he did not know this. He wanted to skype her but he wouldn’t do so as he was without teeth.


He wanted dentures so he could meet his long-lost sister.  He was anxious to get started so we took impressions that evening and three weeks later he had teeth. He was so happy that he could taste food again and smile broadly. This amateur artist drew my picture and wrote me a lovely note: “I wanted to thank you and your staff for improving my life – so much. I don’t have the words to articulate how grateful I am so I thought a drawing of you. Have a great holiday season with an even better New Year.”  Thanks Mike – you make my day!


Funny how both of these stories have to do with lost relatives. One story has everything to do with teeth; one has nothing to do with teeth. Both stories show how important family is! Happy New Year!