For the Holidays, Pull a Tooth or Save a Life

Each holiday season, Nicholas Kristof, a columnist for the New York Times, writes a guide of “gifts with meaning.” These are gifts of charitable giving, rather than gifts that will “just clog a chest of drawers.”  His title of December 2: “For the Holidays, Pull a Tooth or Save a Life” and subtitle “Pull a tooth!” caught my attention. In the article, he describes an organization called “Remote Area Medical”, an aid group that holds health fairs for people needing help.


He writes that he was in Virginia when he watched a 30-year-old man have 18 teeth pulled. And adds “for those who have suffered an agonizing toothache for months or years, a dentist makes a life-changing difference – and since the doctors, dentists and nurses donate their time, it’s very cost-effective.” Some uninsured families camped out for days for the opportunity to see a doctor or dentist and showed gratitude to Stan Brock, the founder of the organization.


Yes, dentists can make a “life-changing difference.”  Changing people’s lives is what draws me to dentistry every single day.  Look at my before and after photos and testimonials and you will see what I mean! Happy Holidays and remember charitable giving.

As the population in Suffolk County ages, we are seeing more and more older people in our practice. Many are taking medications that affect their oral health. Dry mouth, or xerostomia, is a common side effect of many commonly prescribed drugs. A recent article in the New York Times asked “What is it about so many medications that causes dryness, especially in the mouth?” Drugs that can cause dry mouth include the benzodiazepines, antidepressants, especially selective serotonin reuptake inhibitors, some blood sugar reducing oral medications, respiratory agents, quinine, drugs that treat high blood pressure, especially calcium channel blockers and diuretics, drugs that treat excess urine flow, some nonsteroidal anti-inflammatory drugs, opioids, glucosamine supplements, and the magnesium hydroxide in milk of magnesia.  The effect may be amplified if a person is taking more than one of the above medications.


The drying mechanism of the involved drugs is not fully understood. Some drugs may suppress the action of receptors on nerve cells in various glands, including the salivary glands, that produce fluids. The drying effect can also involve other mucus membranes, like around the eyes and in the digestive system.  Dryness in the mouth can lead to decay and periodontal disease. When I observe dry mouth, I discuss the importance of hydration, meticulous home care and regular dental visits.


To relieve your dry mouth:

Chew sugar-free gum or suck on sugar-free hard candies to stimulate the flow of saliva.
Limit your caffeine intake because caffeine can make your mouth drier.
Don’t use mouthwashes that contain alcohol because they can be drying.
Stop all tobacco use if you smoke or chew tobacco.
Sip water regularly.
Try over-the-counter saliva substitutes — look for products containing xylitol, such as Mouth Kote or Oasis Moisturizing Mouth Spray, or Biotene Oral Balance.
Try a mouthwash designed for dry mouth — especially one that contains xylitol, such as Biotene Dry Mouth Oral Rinse or ACT Total Care Dry Mouth Mouthwash, which also offer protection against tooth decay.
Avoid using over-the-counter antihistamines and decongestants because they can make your symptoms worse.
Breathe through your nose, not your mouth.
Add moisture to the air at night with a room humidifier
Avoid sugary or acidic foods and drinks because they increase your risk of tooth decay.
Brush with a fluoride toothpaste
Use a fluoride rinse or brush-on fluoride gel before bedtime. Occasionally a custom-fit fluoride applicator (which we can make for you) can make this more effective.
Visit our office at least twice yearly to detect and treat tooth decay or other dental problems.

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!

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.


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

After 17 years on North Country Road in Setauket, Anne Marie’s Farm stand is slated to move. The owners, Mary Ann and Joe Deriso, lost their lease and needed to find a new location for their organic fruits, vegetables and plants. They are sad to leave our neighborhood where they have become a much-loved presence, but they look forward to making new friendships at their new location at 680 Old Town Road near Jayne Boulevard in Port Jefferson Station. They also hope that many of their regular customers will make the trip across Route 347 to the new farm stand.

As many know, I am a firm advocate of local, organically grown produce. I have been a regular customer at Annne Marie’s. I always look forward to their fresh strawberries in early June (hopefully coming up next week!), corn in July, tomatoes in August. Mary Ann, Joe, Dottie Sottichio and the rest of the staff are always friendly, asking about family and work. I watched her children grow up, get married and have families of their own. Mary Ann would discuss dental issues with me and she taught me a lot about customer service. If I were hesitant about buying an uncommon vegetable, she would give it to me and say “try this, see if you like it.”  If an item, say eggplants, were looking a little worn out, she would say, “take these, no charge – I’ll have to throw them out anyway.” Or if something didn’t taste quite right, say a cantaloupe, she would replace it, again without charge. If a bill came to $20.00 and change, she would round it off to $20. She knew her customers and cared about us.

People cared about her also – so much so that Setauket Artists sponsored a benefit art sale this past weekend. And in 2011 the Village Times Herald newspaper awarded Mary Ann The Woman of the Year in Business award. Read what the Village Times Herald had to say about the relocation. Truly a business to emulate. A lost resource for Setauket – a gain for Port Jefferson Station.  Best of luck to the Derisos.

IMG_2089Anne Marie’s Farmstand in East Setauket

IMG_2088Mary Ann Deriso and Dotty Sottichio

For many years, people who had prosthetic joints were advised to take prophylactic antibiotics before undergoing dental procedures. The antibiotics were to help prevent orthopedic implant infections. It was presumed that bacteria from the mouth could infect the artificial knee or hip joint. But a recent 2014 panel formed by the American Dental Association Council on Scientific Affairs determined that there was not a demonstrated association between dental procedures and prosthetic joint infection (PJI). They voiced concern about antibiotic resistance, adverse drug reactions and costs of prescribing antibiotics for PJI prevention.  The 2014 panel recommended that prophylactic  antibiotics not be prescribed prior to dental procedures to prevent prosthetic joint infection for patients with prosthetic joint implants.

It has been my experience that orthopedic physicians do not necessarily follow the advice of the scientific panel. There may be individual circumstances for which antibiotic treatment might be advised.  As always, check with your physician if you have an artificial joint.



Fifteen month old Nicole wants to keep her teeth healthy. She is a diligent brusher, eats healthy foods and visits the dentist regularly. This wide handled toothbrush is especially made for small hands. Smart parents!


Are you among the one-third or the two-thirds?


More than a third of the American public did not visit the dentist once during the past year, says a new Gallup poll.  Two-thirds of Americans said they visited the dentist in 2013 at least once in the past 12 month. This is is the same percentage as visited the dentist in 2008. Women are more likely than men to report that they visit the dentist on an annual basis. The report was released on April 28. It gives details of findings based on interviewing over 178,000 American adults in 2013. The report is part of the Gallup-Healthways Well-Being Index.  Further findings: 55% of African-Americans and Hispanics report visiting the dentist in 2013. Whites and Asians report at 70%.  Adults of ages 18-29 are the least likely to have visited the dentist. Adults who earn $120,000 or more per year are twice as likely to say they visited the dentist in the past year as those whose income was less than $12,000.  This is 82% visiting the dentist as opposed to 43% visiting.


“Dental visit rates have held steady since 2008 for top earners,” the Gallup report indicates, “while they have declined for all other groups, particularly for low- and middle-income households with incomes between $24,000 and $60,000 per year.” Dental visits are lowest in the South at 60% and highest in the East at 69%.  Married people are more likely to visit the dentist than single adults.


The ADA website lists 15 signs to prompt people to visit the dentist:  So join the two-thirds and pay us a visit today!

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The family doctor may be a thing of the past, but the family dentist has not gone the way of the dial phone. So what is a family dentist? A family dentist is typically a solo practitioner whom you and your entire family can see for your dental needs. A family dentist does not work for a large practice where the dentist you saw at your last visit is no longer working or where you see a different dentist for each appointment, and where there is a large and chaotic staff that only knows you as a number. A family dentist is part of the community and supports community activities. He/she is a fixture in the community and can be relied upon year after year to take good care of you and your family through good times and bad.


I’ve had the good fortune to have practiced at the same location in our beautiful Three Village area (East Setauket, Setauket, Stony Brook) for over 25 years. I have seen my young patients grow up, marry, and become parents themselves, as other patients have aged and become grandparents. I have shared holidays, celebrations and some difficult moments with my dental family. My patients know they can always reach me, and my door is always open to take care of any dental emergency. My staff is equally committed to excellent patient care. We have all worked together as a team for seven years.


I also act as an advocate for my patients. I may refer them to a specialist for particular procedures, such as periodontal or oral surgery, and I communicate directly with the referral doctor to be sure that my patients are well taken care of. I discuss recommended treatment with the patient and help them to make a decision that’s right for them. I call my patients after each visit to my office to see if they have any concerns. I am always available to speak to them on the phone or on email. I am responsible for the quality of the work that comes out of my office, and for the quality of the supplies and the cleanliness of the office. My office is a reflection of me. That’s why one goes to a family dentist!


An image from 1300s (A.D.) England depicting a...

An image from 1300s (A.D.) England depicting a dentist extracting a tooth with forceps. (Photo credit: Wikipedia)

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