E-Prescribing is 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!


Selfies are posted to Facebook and sent as text messages. Whether they are traveling or relaxing close to home, people want to insert themselves into their photos. And now we have the dental selfie. Recently people have been emailing me selfies of their teeth and gums. Sometimes the selfies come from patients of record and sometimes from people I don’t know.

A couple of weeks ago a young man sent me a selfie of his crooked front teeth. He wanted to know what he could do to straighten them. I suggested that he call the office and make an appointment for a consultation. It is just not possible to diagnose and treatment plan from a selfie! But I also get selfies from people who are undergoing treatment.

A woman who just had several teeth extracted and dentures placed sent me a selfie of her ulcerated gums. (Look below at her selfie.)  The photo confirmed that she was suffering from denture sores – just what I had diagnosed from our recent visits and conversations.  I reassured her, gave her some additional directions and sent an online prescription to the pharmacy. I have been reading that online medical diagnosis has also been a growing issue.

I haven’t yet asked a patient to send me a selfie – but who knows, this may be in the not too distant future.


A Dental Selfie

I launched my website drterryshapiro.com in 2006.  Since then, I have updated the content to reflect new techniques and materials, added blog posts, new before-and-after photos and reviews.  My website is my public presence on Long Island, from north shore to south shore, from home base in Setauket to Patchogue.  The website lists my credentials and tells about about my office and my staff – it shows my work and how I go about achieving beautiful, healthy smiles for my patients.  The website has valuable information about dentistry for current, as well as prospective, patients.

But I felt that after seven years, the website was outdated.  It needed an upgrade.  I wanted a modern, up-to-date website that would reflect the quality of dentistry that is so important to me.  I did a search – on the Internet, of course!  I also asked people in the web design industry to recommend someone who could create a website that would be elegant, easy to use, and technologically up-to-date.   I was introduced to Andrew Delamarter of inboundstrategiesgroup.  I was incredibly impressed by Andrew and asked him to re-do my website.  Andrew set to work to redesign and implement my updated website, and it has more than met my expectations. The process took just a matter of a few weeks.  Andrew is efficient, knowledgeable, and a pleasure to work with.  He will continue his involvement, and he will recommend updates as needed. A website is not static but is an ongoing process. I can make some changes myself or call upon Andrew for more sophisticated updates.

So check out drterryshapiro.com and tell me what you think!  Andrew Delamarter of inboundstrategiesgroup is an inbound strategies hero.



On April 2 Newsday published a lovely feature article about Marotta Dental Laboratory in Farmingdale.  The article focused on the quality of the crowns, bridges, implants and dentures fabricated at Marotta Lab.  The owner, Steve Pigliacelli, explained that his fees are higher than the industry average because his work is of a higher quality.  Instead of lowering the quality and prices to compete with less expensive products produced overseas, he has kept up his standards and relies on dentists to recognize the quality of his work.

I have been a client of Marotta Laboratory for many years and I recognize their attention to detail and pride in their workmanship.   I was surprised to read that in 2010 38% of the dental restorations in the US were made by foreign laboratories, up from 17% in 2006.  Most of the foreign work is done in China.  Some domestic laboratories send their work overseas and some dentists deal directly with overseas dental labs.  I have never considered using an inexpensive overseas laboratory.  I am glad that quality laboratories like Marotta are still in business and that there are still dentists out there who want to provide quality dentistry for their patients.

It is finally here!  The newest version of our work horse dental management system, Dentrix.  We have been Dentrix users for many years and have watched it evolve into a powerhouse management system.  Recently our computer technician installed the newest version, G4, level 8. It has all of the appointment scheduling, reminder scheduling, insurance tracking and billing that we are accustomed to.  But the charting capability is more sophisticated with better integration of xrays and photographs and Guru, our patient education videos.  We can better chart alternative treatment plans.  We can access records off-site and better utilize text messaging and input documents into patient records.  We have been more or less paperless for awhile now
and now are more so.

So come in for a demonstration and view your treatment recommendations on our office ipad!

Last week I wrote here about the questionable practice of bite analysis in criminal convictions.  This is true, but dental forensics still has a very important function in body identification.  Dental records can help identify an otherwise unidentifiable body.

Many years ago I helped confirm the identity of a young boy who tragically perished in a house fire.  I had a set of dental xrays and records of his dentition and restorations.  The medical examiner’s office called me and requested the boy’s  records.  The boy’s identity was confirmed on the basis of these records.  It was very sad for the family and community but I was glad that I could help put the family at ease that the remains were their son’s and he could have a proper burial.

Bitemark analysis is often used in criminal cases in the United States.  Bitemarks can occur during assaults, homicides and domestic abuse cases.  The perpetrator’s bite leaves a pattern of his/her teeth in the skin of the victim.  Authorities then attempt to match the suspect’s tooth pattern with the pattern on the victim’s skin.

But a recent report by the National Academy of Sciences (NAS) raised questions about the reliability and validity of bitemark analysis. Bitemark technique assumes that the arrangement of an individual’s teeth is unique to that person.  It also assumes that these dental features reliably transfer to and are recorded in the skin.  But there is little scientific backing for either assumption.  Nevertheless, bitemark analysis is accepted in all of the states and its admissibility is rarely challenged.  Its admissibility was established in the 1970’s but a number of recent cases have highlighted its unreliability.  For example, Robert Lee Stinson was convicted on the basis of bitemark evidence and served 23 years in prison before he was set free due to testing of DNA evidence.

Bitemark analysis might have some use in the courtroom but it needs to be further studied so there is some scientific basis for the approach. (Ref: JADA, Guest Editorial, Sept, 2011 (http://jada.ada.org/content/142/9/997.full).

Icon is a new treatment which removes dental white spots and incipient decay.  These white spots on the teeth are an early sign of demineralization and they may lead to decay.  White spots on the surface of the teeth may be linked to orthodontic bands and brackets, heavy plaque, a high sugar or acidic diet, trauma or heredity.

For the past century dentists have removed decay by cutting away the decayed areas of a tooth.   But today’s new technologies allow us to remove less tooth structure, emphasizing what we call “minimally invasive dentistry.”  Icon is a product that treats small lesions micro-invasively so the dentist does not have to cut the tooth.  Icon is appropriate to treat smooth surface lesions limited to the enamel.

I have successfully used the Icon treatment to remove white spots often visible after orthodontic treatment.  The Icon treatment takes just one visit; it is painless, it doesn’t involve cutting the tooth, and no anesthesia is needed.  Call our East Setauket dental office and I’ll let you know if Icon is appropriate for your needs.

I recently attended a dental lecture presented by Dr. Ed Brant, the Saint James periodontist with whom I often work with when a dental patient requires periodontal  treatment or dental implant placement.  His website is http://www.longislandreconstructiveperiodontics.com/.  The lecture was about the PerioLase for the Laser Assisted New Attachment Procedure (LANAP), which Dr. Brant has recently incorporated into his periodontal practice.

The PerioLase from Millennium Dental Technologies is a specialized Nd:YAG (Neodymium: Yttrium Aluminum Garnet) laser which performs soft tissue procedures to treat some kinds of periodontal disease  (http://www.lanap.com//).  The Periolase is an exciting laser modality.  It is minimally invasive, doesn’t require surgery, produce discomfort or a period of healing.  The laser is bacteriocidal and removes the diseased sulcular lining around the tooth.  The protocol includes antibiotic treatment, occlusal adjustment, a night guard and periodic professional cleanings at regular intervals.  The results are impressive.  I look forward to referring patients to the periodontist for laser periodontal therapy when appropriate.

An in-depth article headlined “Radiation Worries Rise With 3-D Dental Images” was featured on the front page of the New York Times on November 23.  I thought the article was well researched and largely correct. The authors maintain that most dentists are still using outmoded and slower D-speed x-ray film that requires higher levels of radiation than the faster E or F-speed xray film. The authors also question the safety of the cone-beam CT scanner which provides 3-D images of teeth, roots, and jaw bone and is used increasingly by orthodontists and other dental specialists.  Information and misinformation about the efficacy and safety of the cone beam comes from dentists who are sponsored by manufacturers to give lectures to other dentists at continuing education classes.

It is time for the dental profession to clean up its act.  The public needs to trust that we dentists are receiving information from reliable, unbiased sources and that we are weighing the safety and efficacy of new devices that reach the dental marketplace with increased frequency.

Yes, cone-beam CT scans are very helpful in diagnosing and treating complex cases.  They are the standard of care for implant placement.  But is it necessary for orthodontists to use cone-beam CT scans to screen all patients? Does the benefit justify the increased risk?  Is the Cone Beam safe? Is it effective?  The manufacturers use aggressive marketing techniques and it is difficult for dentists to find independent information.

In my dental office I  take digital xrays which produce even less radiation than the conventional E or F-speed xray film.  I take only necessary xrays with the least amount of radiation exposure.  We keep careful records when we take xrays – and send for any xrays taken at a prior dental office so we don’t have to retake any xrays.  We give the patient a lead apron with thyroid cover before taking xrays.  Our xray machine is new and inspected regularly to be sure it is working properly and at the correct settings.  We are concerned for your safety!