From the Setauket dental trenches

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!

Remember when your teeth were bright white? Just look at some old photos – what happened to that sparkly smile? Despite your best efforts to brush and floss regularly, there are structural changes that make teeth appear more yellow as we grow older. First, the outer coating of the tooth (the enamel) gradually becomes thinner. The layer underneath (the dentin) becomes thicker. The dentin is naturally a yellow/brown color so as the enamel thins, the color of the dentin begins to show through more and more. The enamel thins out because of wear and tear and acidic foods.

In addition, once the dentin is exposed, foods that stain the teeth are more easily absorbed by dentin than by enamel.  There is also a natural laying down of secondary dentin that affects the light-transmitting property of teeth, resulting in a gradual darkening of the teeth as we age.

Some of the color change is unavoidable. But other causes, like dry mouth and acid reflux, can be treated.  Other causes to be avoided are excess sugar, acids and alcohol, bulimia and tooth grinding and clenching.  Some foods also discolor the teeth: blackberries, grapes, tea, coffee and red wine. Tobacco will also certainly stain the teeth, as well as contributing to gum disease.

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Well now I really have heard everything – this time it’s “do-it-yourself orthodontics.”  What next? Do your own fillings? Make your own crowns or dentures? Is the dentist and dental office a thing of the past? I first heard of “Straighter Teeth, by Mail” several weeks ago when I read an article in The New York Times about remote orthodontics.

By now most people have heard of Invisalign which can straighten teeth by use of successive clear plastic aligners instead of traditional metal orthodontic brackets and wires.  But Invisalign is not within everyone’s budget. So an enterprising dental entrepreneur decided that the dentist and orthodontist were superfluous. People could insert the aligners on their own, with online support. The at-home cost is considerably less than the in-office cost. The client simply purchases a kit to make the dental impressions at home. A how-to video shows the client how to mix the putty, put it in stock trays and take impressions of his teeth. The impressions get mailed to the “Do-it-Yourself” company and a series of clear aligners is made to correct crowded teeth or teeth that are too spread out. A customer representative guides the patient through the process.

This may sound easy and inexpensive – but beware of dental bargains. A thorough exam and xrays are essential before beginning tooth movement. The patient cannot self-diagnose gum disease or decay which must be treated before any tooth movement should begin. Sometimes the misalignment of the teeth is too severe for Invisalign and certainly too severe for do-it-yourself. There needs to be a careful diagnosis and treatment plan and continued supervision by a dental professional. The do-it-yourself program may seem like a bargain, but it could be nothing more than a waste of money.

The Food and Drug Administration considers aligners to be a prescription item. They have approved more than ten kinds. But the FDA does not regulate the practice of dentistry; it is up to the states and their dental boards to decide what is appropriate care.  Recently the American Association of Orthodontists warned people against tooth movement without an initial exam and continuing supervision by an orthodontist.  “Our concern is that patients who don’t see an orthodontist for regular checkups and/or for a complete diagnosis are more likely to be harmed,” said Dr. Rolf Behrents, a spokesman for the AAO.

02teeth2-tmagArticleDo no harm!

Mary did not like her smile. Her front teeth were dark and uneven. She was ready for some cosmetic dentistry to give her a smile she could be proud of. We spoke about placing veneers on several of her front teeth but she wanted to see how we could improve her smile with minimal dentistry. I felt that we could achieve what she wanted by placing porcelain veneers on her two front teeth. The veneers would lengthen and brighten her smile. She is so happy with how her teeth look that she is now considering placing veneers and crowns on her other teeth that could also use restoration.

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Before: Broken teeth, stained and decayed.

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After: Porcelain veneers to brighten her smile.

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:

kate-before

 

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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Mary came to our office from Patchogue – her daughter had recommended us to take care of her mother’s dental problems. Mary had been suffering with loose, infected teeth. She had already lost most of her upper teeth.  A front tooth had fallen out the day before she came to the office, and she arrived with tooth in hand. An upper denture with implants in the future and lower partial denture were indicated.  She was thrilled to learn that she would have teeth in a matter of weeks. She would be out of pain and would be able to smile and eat comfortably once again. Mary was anxious to get started so we took out the remaining teeth and scheduled impressions for the following week. Then the week after that we took some measurements, the week after that we had a dress rehearsal of the new teeth. One more week passed and she had her new teeth. Four weeks all told!

Her daughter flew up from Tampa to be here for the big day.  Her entire family loved Mary’s new smile and so did we. This is the start of a new life for Mary. She can go out in confidence.

 

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I received this lovely email today:

Dear Dr. Terry Shapiro,

There’s a good possibility that I might not be back to your office. I’m adjusting to my new “Custom Dentures”. I’m writing to commend you for your patience with me and how I reacted to my new dentures. I want to tell you how pleased I am with both the comfort and aesthetics. My initial reaction was based on a distorted image of my prior dentures. My new dentures are in perfect alignment & look great. I would not hesitate to recommend you to anyone who is looking to improve their appearance. I’m 71 years old and I feel rejuvinated  because of what you did for me.

Thank you, EB

Here is my reply:

Hi Ed,

Thank you so much for your very kind words. It means a great deal to me. It is people like you who make dentistry so rewarding. It is why I love what I do. Please call us if you should need an adjustment. It is good for you to come back every year so we can check the health of your gums and check the dentures.

Ray spent several years in the military. He was sent overseas, but before he left, the army surgeons removed all of his remaining teeth. His teeth were in poor condition but the military did not make dentures for him.  So for two years Ray had to function without any teeth at all. This means that he chewed on his gums.  This destroys the gums and resorbs the bone and makes it very difficult to make dentures that will stay in place.  But using my custom denture technique I made him dentures that are as good as they can be. We will add two implants on the top and two on the bottom for the dentures to snap into – giving him a more secure fit.  He is happy to be able to smile again.

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No teeth

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Teeth!

I know I talk a lot about the hazards of smoking in this blog, but that is because everyday I see how cigarette smoking contributes to gum disease and loss of teeth.  Now the latest surgeon general’s report reveals that smokers today face a higher risk of chronic obstructive pulmonary disease and lung cancer than smokers in the 1960’s. This is because the design and composition of cigarettes has been changed. Even though people on average smoke fewer cigarettes, the risk of disease is higher.  Some of the cigarettes today are more addictive than those smoked in the past.  This is because the manufacturers have designed the cigarettes so the cigarettes deliver more nicotine – thus the addiction is induced and sustained.  This re-design of cigarettes is a sneaky tactic on the part of the cigarette manufacturers.   It is a practice that demands government regulation.

The journal Nicotine and Tobacco Research published an article last week with the findings that although nicotine content of cigarettes has been more or less stable for the past 10 years, the amount of that nicotine delivered to research machines as surrogates for smokers has been rising.  The researcher concluded that changes in cigarette design have increased the efficiency of nicotine delivery to a smoker’s lungs.  The effect is that people may become addicted more easily and people already smoking may find it more difficult to stop the habit.  Techniques that cigarette manufacturers use include filter design and cigarette paper that maximizes the inhalation of nicotine.  The manufacturers also add chemicals to change the taste of cigarettes so it is not as harsh and make it easier to deeply inhale.  The surgeon general’s report concludes that nicotine increases the risk for disease and affects health of the fetus.  Although the report doesn’t address dental health, just look through my blog to see how cigarette smoking destroys teeth.

old dentures

 

Smoker’s Teeth

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In August I posted a blog entry called Laurie from Coram: New Implant Crown.  I told how she had an impacted canine which had to be extracted, orthodontic treatment undertaken and an implant placed.  She wore a temporary crown while the implant integrated to the bone.  On Friday we completed the treatment. Laurie went with me to the Dental Laboratory where the ceramist applied and adjusted the shade of the porcelain so that it matched her other teeth.  Not a small thing to match one tooth to its neighboring teeth.  Once we were satisfied with the shade of the implant tooth, we returned to my dental office where I cemented the crown. Laurie looks fabulous.  She said that the wait was certainly worth it! Can you guess which is the implant tooth? (Answer at the bottom of this post.)
Julia
It’s the second from the right!