The British Royalty and their Teeth

It’s a cliche: the British have really bad teeth. A reference to British teeth always gets a laugh from the American audience. I’ve checked out the situation and maybe yes, maybe no. Are British teeth really in worse shape than other people’s? Probably not. But in 2012 the New Republic raised a ruckus when it placed a photo-shopped portrait of Kate Middleton, Duchess of Cambridge with rotting teeth. The picture is on the cover of the July 8, 2012 edition of the magazine and it is meant to be a sign of the decay of Britain, the featured story. This special issue of the magazine ran with the title ‘Something’s Rotten. The Last Days of Britain’ next to the picture. The photo really is a shocker and shows how ugly teeth can spoil a lovely face.

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The British newspaper, The Daily Mail, voiced outrage at the lack of respect for British royalty. Then other media and social media weighed in on the appropriateness of altering the royal image and whether the cover photo showed disrespect for the British royalty.
I always thought Kate had a beautiful smile and I wasn’t sure if she had had any cosmetic dentistry done. So I went on an internet hunt and searched for clues. According to the British periodical, Mail Online: “Last year the pearly white Duchess spent thousands of pounds having her teeth polished and turned to give her the perfect smile.” A French dentist used a “hidden brace to make Kate’s teeth appear a little out of line, un-American and therefore beautifully natural. ‘He did some little micro-rotations on Kate,’ the dentist Bernard Touati revealed. ‘That’s why they look so good – because they are not perfectly aligned. The problem in the United States is they have very artificial vision. But what we like is a natural healthy smile, but not artificial.'”  Yes, I do agree with him that natural is best and that is what I strive for. The dentist also whitens teeth and has an office in London’s Wimpole Street as well as in Paris and Geneva.

Here is Kate’s naturally beautiful smile, before any cosmetics were done:

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Kate’s husband, Prince William, Duke of Cambridge has his mother, Princess Diana’s teeth – incisors too large and a narrow buccal corridor. Maybe he had his premolars removed for orthodontic treatment? I think his mother, the late Princess Diana almost certainly did. His younger brother, Prince Henry of Wales, could use braces to close the spaces between his front teeth. The boys’ father, Prince Charles, has scraggly, yellow teeth.  Just look below at a cartoon of Prince Charles, complete with bad teeth, which appeared several years ago on the cartoon series The Simpsons:

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And look at how a royal fan weighs in:

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Karen and Meg are sisters. They started out with almost identical teeth.  But Meg smoked a pack of cigarettes a day for over 20 years. Karen never smoked. Guess which teeth below belong to Meg and which teeth belong to Karen? You guessed it – Meg’s teeth are at the top; Karen’s below.  Smoking is connected to periodontal (gum) disease. The bone resorbs, leaving a long tooth.  Without support of bone, the teeth loosen and move out of position. In Meg’s case, the front teeth became more crowded and became very protrusive. The teeth were so loose that she knew that it was only a matter of time before they would fall out , and she had already lost a couple of back teeth.  By the time she came to our dental office the gum disease was so advanced and the teeth so out of position that dentures were the best option for her.  She was very unhappy about the condition of her teeth, and she was excited at the prospect of having new teeth that would make her look more like her younger self. We will fashion our custom immediate denture for her.  Photos to follow!

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Dentistry and dental hygiene both were among the top ten occupations of 2014 according to the U.S. News and World Report’s “100 Best Jobs of 2014”, published on January 23, 2014. Dentists are ranked number 3, the highest ranking health care related career.  Dental hygienists rank tenth.  The two top occupations on the list are software developer and computer systems analyst.  Other professions that make the top ten are: nurse practitioner, pharmacist, registered nurse, physical therapist, physician and web developer. Certainly computing and health care are growing industries.

The U.S. News and World Report ranks occupations based on a score combining growth volume, growth percentage, salary, job prospects, employment rate, stress level and work-life balance.

Despite fluoridation and better prevention, the need for dental professionals is increasing.  According to the article, “A comfortable salary, low unemployment rate and agreeable work-life balance boost dentist to the No. 3 position on our list of Best Jobs of 2014.”

I am proud that dentistry, so dear to my heart, ranks as one of the “Best jobs,” even though I wouldn’t call dentistry a “job.” It is so much more than a “job,” but a life choice that places a person’s health in our hands and sends us on a lifetime of learning. I am also struck that the “score” doesn’t include points for career satisfaction in devoting oneself to providing a public service. Public service, helping people achieve optimum dental health, thus improving their overall health care, is why dentistry is so satisfying a profession.

Carol desperately wanted to have her teeth fixed. They were crooked and discolored and chipped.  Several were decayed. She wanted white, white teeth that were straight, straight. She came to our East Setauket dental office at 9:00 this morning and by noon she had temporary crowns that were white and straight – just like she wanted. She has to have some gum recontouring done, then impressions and cementation of the permanent crowns. We will also whiten her lower back teeth.  The permanent crowns will look even better than the temporary crowns – but for now Carol is thrilled!

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Before placing crowns

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     Temporary Crowns

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I came across an op-ed piece in The New York Times the other day with the title “Egypt in the Dentist’s Chair.” Now – that really caught my attention.  The article was written by Alaa Al Aswany, an Egyptian writer – and practicing dentist. Now that is a first!  Aswany is the only dentist I have ever heard of who was also a writer.  In my experience, dentists are not too literate as they have never focused their attention on the humanities.  Several years ago Aswany wrote “The Yacoubian Building,” a wonderful novel that I have read and found to be a fascinating account of intersecting lives in a decaying Cairo apartment building.  In this recent op-ed piece he writes about how his experiences with his dental patients give him perspectives on human nature that he incorporates into his writing.  He believes that novelists have to acquire human experience, find inspiring characters and place settings for their novels.  As he says, “I am lucky not to have had to undertake these adventures because I am both a novelist and a dentist.  The dentist’s profession enables him to see so many varied examples of humanity that his clinic can resemble the backstage of a theater, where the performers, out of costume and minus makeup, are no longer acting.”  He adds that he has treated the teeth of 1,000’s of people, from “peasant farmers to society ladies and government ministers.”  He is always learning new things about human behavior.

Yes, this is true in Suffolk County too.  I have also treated many thousands of teeth and have treated government officials, prominent professional people, laborers, and migrant workers – the tremendous range of people who live and work on Long Island.  Aswany’s experiences in this far off land of Egypt, now in political upheaval, in many ways mirror my own and in many ways, are very different.  He relates how a government minister in Egypt doesn’t go to the dentist by himself but arrives with an entourage who sniff into all corners of the clinic looking for potential hazards.  I haven’t quite seen this but have had patients who were so busy, they never made their own appointments or discussed treatment plans but directed that all communication go through their staff.  I am also party to family dynamics – of quibbling husbands and wives and of parents who are too protective of their children.  I see kindness – of people driving infirm neighbors to their appointments and sometimes things that are not so kind.

But Aswany’s experiences offer a unique window to a nuanced understanding of an authoritarian society.  He relates an incident in which a woman wearing a niqab and suffering from a toothache arrives with her husband at the clinic.  Aswany let them know that she would have to remove her niqab and the dental assistants would have to remain in the room during her treatment and the root canal specialist was a Christian. The husband grabbed his wife by the hand and started to march out of the office, but his wife refused and stood her ground. To Aswany this incident was a demonstration that women who were thought to be fundamentalists were just victims of their husbands’ dogmatic beliefs.  Aswany was also not afraid to confront a secret police officer whose tooth he had just extracted.  The person in the dental chair is in a vulnerable position and Aswany took advantage of that vulnerability in order to address political excesses.

Aswany is very brave and his writings are brave. Fortunately in Suffolk County the excesses we see are very mild in comparison.  Nevertheless I have made my opinion known when I felt that I could make a difference.  Aswany concludes his essay with his observation that after 30 years of practicing dentistry and writing, he is not convinced that they are completely separate professions. “They both treat the same subject: humanity.”

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Alaa Al Aswany in conversation (Photo credit: Jeremy Weate)

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Am I the only dentist who is overly sensitive about dental cartoons? I am always on the lookout for the nasty dental cartoon – and aren’t they always nasty? Not to mention that the genre unnecessarily frightens people and would turn anyone into a dental phobic.   The following cartoon appeared in the September 9 issue of The New Yorker – and it’s not even funny.  Yes, frightening – right up there with The Marathon Man and The Little House of Horrors.

Should I cancel my subscription? Take the magazine out of the reception area?  Or should I just add it to my collection of dental cartoons – and wait in anticipation of the next one.

 

Sheri first came into the office several months ago with broken and decayed teeth and worn out crowns (see below).  She travels to us from Sayville and even made the trip while a blizzard was on its way. She required full reconstruction due to the amount of lost tooth substance. She also needed periodontal treatment to improve the health of her gums and she needed several root canals and extractions.  She had already had two implants placed that we were able to utilize.

We talked about adding several more implants instead of a bridge and removable partial dentures  – but finances were a factor. To stay within her budget, we made her a porcelain bridge and removable partial dentures for the upper and lower arches.

The dental work is now complete and she is very happy with the result.  She will come back at three month intervals for her dental examination and teeth cleaning. We want to make sure that everything stays healthy and bright.

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Bernice’s old dentures were uncomfortable and unattractive and she could only eat soft, mushy foods.  In just four visits (three weeks total), with the help of our wonderful custom denture laboratory, we created new dentures for her.  She looks fabulous, eats everything (even steak and apples), and she is so comfortable, she says she often forgets that she is wearing dentures.  What more can you ask for?

 

Denise’s teeth were severely decayed, and we determined that they could not be saved.  We elected to remove her remaining teeth and replace them with an immediate denture.  This is a two visit procedure.  We take custom impressions. The immediate dentures are then fabricated by our fabulous denture laboratory. The teeth can then be extracted, and the immediate denture is inserted the same day – thus “immediate.”  The patient is NEVER without teeth. This takes careful planning!

The healing process then takes several months because the bone and soft tissues remodel where the teeth were extracted.  As the healing progresses, we reline the immediate denture so it fits the altered tissue.  We will see you for a reline as often as needed – sometimes once or twice, sometimes more.  Once the tissues are relatively stable, we will take custom impressions of the altered tissue and fabricate a new denture that will look great, function superbly and be very comfortable.  How good is that?

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In reading Robert Massie’s fascinating biography of Catherine the Great, I came across the following account of a toothache and high fever that persisted for months.  It got unbearable when the Princess was traveling in an open sleigh from Moscow to St. Petersburg during a brutal Russian winter.  In her diaries she describes the agony she felt.  Of course at this time there were no antibiotics and no analgesics.

When the entourage arrived at their destination, the Empress’s chief physician was finally called in to extract the offending tooth.  The chief surgeon was French – apparently there were no dentists so medical surgeons filled in as needed.  He sat on floor with another surgeon, and both held the Princess down.   He wrenched and pulled until she could feel her jaw bone breaking.  He had extracted the tooth and with it, a piece of lower jaw.  She was confined to bed and was in pain for 4 weeks, her jaw exhibiting blue and yellow bruises from the physician’s fingers.

She survived the ordeal – but aren’t we lucky to have the benefits of modern dental medicine!