The importance of replacing missing teeth

Throughout the course of one's life, teeth are lost for many reasons including cavities, gum disease, cracked roots and accidents. Missing teeth compromise your eating habits, speech and appearance. The loss of a front tooth will negatively affect the appearance of your smile and your self confidence. Losing a tooth in the back of your mouth can lead to numerous problems affecting your ability to chew, your ability to properly clean your teeth and the health of your remaining teeth. Replacing a lost tooth will prevent further destruction and save your remaining teeth.

The loss of a single tooth starts a chain reaction. Let's assume that a lower molar in the back has to be extracted. The tooth directly above the lost tooth is now useless, because it no longer has a lower tooth to chew against. Losing one tooth can result in the loss of the use of two teeth. 

Back teeth have a lifetime tendency to erupt (move farther into the mouth). Only the presence of a tooth to chew against keeps a back opposite tooth from erupting too far. The tooth immediately above the missing tooth has a tendency to over-erupted which will cause some of its roots to be exposed. Exposed roots do not have an enamel covering and decay much faster than the crown of the tooth. 

Now the resulting unevenness among the upper back teeth has created areas between these teeth that trap food debris. It is very difficult to keep spaces between uneven teeth clean, despite your best efforts at brushing and flossing. The accumulation of food debris and the resulting bacteria cause inflammation of the surrounding gum tissue. The inability to easily remove the trapped food debris accelerates tooth decay.

When teeth are lost, the remaining adjacent teeth are also adversely affected. These teeth have a tendency to tilt (lean over) into the space the missing tooth once occupied. They also have the potential to drift or move. Now that a tooth has been extracted, a space is left. This allows the lower molar directly behind the space to tilt and drift forward and it will tilt farther and farther over time. The upper molar no longer makes proper contact with the adjacent, erupted molar or with the tilted lower molar. This will cause the upper molar to tilt and drift backward. The bite is no longer stable. 

A tooth tilted over will develop a gum pocket along its forward root. Gum pockets are narrow, abnormal spaces or clefts that develop between the gums and the tooth root. These pockets trap food debris and bacteria. A gum pocket is a problem, because you can almost never keep it clean. The debris and bacteria that collect in a gum pocket lead to ever-worsening inflammation of the gums. When an area of the gums is constantly inflamed, as happens in a gum pocket, the bone immediately adjacent to the gum pocket also becomes inflamed. Inflamed bone softens, and slowly begins to resorb (disappear). Chronic gum inflammation and the eventual loss of underlying bone are symptoms of advanced periodontal disease. When left untreated, this condition will negatively affect your facial appearance and damage your remaining teeth.

 If missing teeth are not replaced, a chain of damaging events may occur. Over time, one missing tooth can lead to bone loss, periodontal disease and the eventual loss of remaining teeth. Replacing a lost tooth today will avoid grief and greater expense tomorrow.

Best of Yorktown 2012

Most recently at the Yorktown fall Festival, I was honored with the Best of Yorktown 2012 Award in the Doctor/Dentist/Therapist category. It is needless to say that I am extremely proud and grateful. I was especially thrilled to share this recognition with my partner/wife Lucy and our three boys who were present at the ceremony. This award reinforces one of my ideals that treating others with respect, compassion and generally doing the right thing will eventually lead to success.

12 years ago I started practicing dentistry in Yorktown Heights and a couple of years later my wife and I moved to nearby Somers. At that time I had a dream of creating an exceptional practice that is recognized as the best in our community for providing outstanding quality of care and service. Initially my vision was met with some skepticism from the status quo but with much hard work and dedication we became established as a quality family practice. Today we are much closer to our goal and we continue to grow.

For those who are not familiar with our practice, Elite Dental Studios, our main focus is to always do the right thing by our patients and to surpass all expectations all the time. We moved into our current location approximately five years ago. We have a state-of-the-art set up with all the latest equipment and materials, a comprehensive approach which has our patients best interest at heart, a relaxing and progressive decor and an exceptionally well-trained staff and associates. We are experts in many of today's most popular restorative and cosmetic procedures.            

Please feel free to contact us with any dental concerns and/or inquiries:

Main website:  http://www.elitedentalstudiosny.com/

My blog:  http://www.elitedentalstudiosny.blogspot.com/

Facebook page:   https://www.facebook.com/elitedentalstudios

Twitter:  https://twitter.com/ashkhorramdds

Phone #: 914-245-7575

Lastly I would like to thank my amazing wife and partner Lucy who manages our whole operation and stood by my side through the years, my excellent staff who help make it all happen and most importantly all our loyal patients and friends whose support means the world to me!  

In good health- 

Dr. Ash Khorram        

Back to School Dental Tips

It is that time of year again when students of all ages are going back to school. It is important to remember that in addition to the recommended supplies, a healthy mouth is also a necessity.

According to the American Dental Association, a dental examination is as important as immunizations and booster shots and should be a regular part of back-to-school preparations. Statistics from the Centers for Disease Control and Prevention say that tooth decay affects U.S. children more than any other chronic infectious disease and 19 percent of children ages 2 to 19 years old have untreated decay. Dental pain or disease can lead to difficulty in eating, speaking, playing and learning as well as millions of hours of missed school.

Students' back-to-school checklist:

-Regular clinical and radiographic dental examinations to diagnose, treat and/or prevent dental problems are always important. In school guardians and teachers may not always realize there's a dental problem, so a regular checkup before school is especially important. Your dentist may suggest fluoride treatments or sealants to prevent decay and can diagnose and treat dental problems such as decay to save your child discomfort and lost attendance.

-A regular hygiene program including brushing with fluoride toothpaste and flossing. Visit the dental care section when you're out shopping for school supplies. If parents buy several toothbrushes they could have their child change to a new one every three months or so, or after an illness. If it's hard to remember when to change a brush, you could try to change it every time report cards come out. Ask your dentist for a recommendation on how often to change toothbrushes and other hygiene tips.

-A tooth healthy diet plan. Include portable healthy lunch items and snacks in your child's sack lunch, including grains, milk, cheese, raw vegetables, yogurt or fruit. If your child eats in the school cafeteria, review healthy, balanced food choices with him/her before the first day of school. It is always a good idea to reduce sugary foods and soft drinks as excessive sugar can not only cause dental decay, but is also unhealthy for a young person's overall health.

-Wearing a properly fitted mouth guard while participating in organized sports, PE classes or playground activities.

Good luck to all the kids who are headed back to school and remember if you take care of  your teeth now, they will return the favor for a lifetime!

Worn Teeth

Under normal circumstances a layer of enamel covers your teeth. This enamel is very hard and protects the tooth from daily wear and tear. 

However your tooth enamel may be worn away in several ways:

Attrition

Attrition is the gradual loss of enamel through "wear". A small amount of attrition may be caused by normal speaking and eating, but this typically doesn't produce excessive wear. More extreme cases of attrition are typically caused by bruxism, the grinding or clenching of teeth against each other. Bruxism typically occurs at night while the patient sleeps, so often the patient is unaware of the grinding or enamel loss. The first line of defense against bruxism is a night guard.  

Abrasion

Abrasion is the wearing away of tooth enamel by a foreign object. Common causes of abrasion are:

Brushing too hard - When using a soft bristle tooth brush, it isn't necessary to press hard. The soft bristles will bend into all desired positions with minimum pressure. 

Unnatural biting habits - Fingernail biting, chewing on pens or pencils, holding needles or pins between the teeth, etc.
Oral jewelry - Patients with pierced lips and/or tongue often wear away the enamel on adjacent teeth 

Erosion

Erosion is the chemical wear of tooth enamel. Typically this kind of wear is caused by an acid. Citric acid is one of the most common agents. Citrus fruit (lemons, limes, oranges, grapefruit) contain citric acid, as do most soft drinks and citrus juices. Some candies also contain citric acid. Many soft drinks contain additional harmful acids. Coffee and tea also contain corrosive acids. Bulimic individuals (people who intentionally and repeatedly induce vomiting) also expose their teeth to very strong stomach acids.

Occasional exposure to most dietary acids is rarely a problem, but repeated exposure to high levels of these acids can cause premature wear. Some common habits to avoid are:

 -Regularly sucking on lemons or limes

 -Regularly eating or sucking on candies, especially "sour" candies as they often contain sugar and citric acid!

 -Drinking several soft drinks daily, even "diet" soft drinks

 -Drinking several cups of coffee or glasses of tea daily

Even if you only occasionally eat or drink highly acidic foods, it's a good idea to at least rinse your mouth with fresh water when you are finished. This is to reduce the amount of time that your teeth are exposed to the acids.

Our fifth year anniversary at new location!

Recently we celebrated our fifth year anniversary at our new location. The festivities included wine-tasting and various food items with many of our patients and friends. Here is an excerpt of my speech from that night:  

Hello everyone!

12 years ago I bought an existing dental practice in Yorktown Heights. Having worked as an associate in some private practices in New York City and Westchester County, my dream of owning my own dental practice came true!

7 years later as my lease in the commerce building was coming to an end, Lucy and I looked for a property to buy and found this building. Much hard work allowed us to convert it into a state-of-the-art dental practice and we’ve been here ever since.

Here at Elite Dental Studios we are a family practice and treat the whole family with lots of emphasis on quality of care! I am a Prosthodontist, which is an ADA recognized specialty in conventional and implant supported tooth replacement and tooth restoration.We are also experts in many of today’s popular cosmetic procedures. I am proud to say that in the 12 years of practicing in Yorktown Heights, our commitment to the health of our patients has remained strong and quality of care has always been a first priority.

Over many years our practice has flourished and I’ve had the honor of meeting and serving so many good people in our community. However,  I do realize that we could not have done it alone and tonight is about appreciating all those who helped us along the way.

Firstly I would like to acknowledge my awesome staff, whose dedication and professionalism is a big part of what we do;

Lisa Piciocchi is our amazing full time hygienist! She is a superb clinician with great attention to detail.

Kim Salveggi is our part time hygienist and also an awesome clinician!

Erin Murphy is our treatment coordinator and receptionist. She is always on the ball and ready for just about anything that she encounters and always with lots of professionalism.

Debra Kane is one of our assistants and also part of the front desk crew. She is compassionate and caring and assists our part-time endodontist (root canal specialist) and periodontist (surgeon/gum specialist).

Barbara Balchunas is our other assistant and usually works with myself. She is very positive and very good at making personal connections with our patients.

Alida Palevik is the newest member of the team with much enthusiasm. She is learning the ropes quickly.

And last but not least Lucy Landolfi-Khorram is my partner and practice administrator who’s been in the dental field as long as I have. She is extremely bright and in tune with all aspects of the practice. Somehow she is able to pull it all together and always with a smile on her face!

So thank you all…..I really couldn’t do it without you!

 

I would also like to thank all of our wonderful patients who honor us by putting their trust in our hands. You all make doing what I love even more enjoyable. Thank you for your loyalty through all the years!

I am a big believer in small businesses being the back bone of our local economy. We have had the support of so many local businesses in our community and I am grateful for that.

Lastly I would like to thank the Yorktown Chamber of Commerce for their support and their dedication to furthering all small businesses in our community!

Cosmetic Dentistry Q & A

In this post I will answer some frequently asked questions regarding cosmetic dentistry:

Q. What is cosmetic dentistry?

A. Cosmetic dentistry describes any dental procedure designed to improve the overall appearance of one's teeth and smile. It can be in the form of cosmetic dental resin bonding, porcelain veneers, all-ceramic crowns or even dental implants with porcelain crowns over them. There are numerous options and the pros and cons should be discussed with your cosmetic dentist prior to treatment.

Q. How quickly will I be able to complete my cosmetic dentistry treatment?

A. Cosmetic dental procedures can usually be performed in as little as one or 2 visits. Consult with your dentist to see what procedures are right for you and determine how many visits your procedures will take.

Q. How long will my new smile last?

A. It depends on the type of procedure you have performed and how well you take care of it- including proper home care and regular dental cleanings. Resin bondings for example tend to wear and discolor with time as opposed to porcelain work which is virtually maintenance free. Again, consult with your cosmetic dentist to find out which procedures are best for you.

Q. Is cosmetic dentistry worth the time and the cost?

A. The decision to have cosmetic dentistry performed is a personal one. The benefits and costs involved should be discussed with your dentist. It is crucial to seek out a dentist that has a lot of experience with cosmetic dentistry and one that keeps up with learning the newest techniques and trends. Most people have found the benefits to be well worth their investment- They continue to enjoy it for many years to come.

Q. Who is a good candidate for cosmetic dentistry?

A. Almost anyone can benefit from cosmetic dentistry- whether it be whitening your teeth, straightening them with Invisalign or doing porcelain veneers or bonding- These procedures will improve your self esteem and give you that great smile you have always wanted!

Q. How important is your smile?

A. Your smile says a lot about you. When people see and talk with you there are two facial features they most focus on- Your eyes and your smile. A winning smile gives you confidence and self-assurance.

Apicoectomy(endodontic surgery)

Generally, a root canal is all that is needed to save a tooth with an irreversibly injured pulp(nerve) from extraction. Occasionally, this non-surgical root canal procedure will not be sufficient to heal the tooth due to a persistent and/or recurrent infection. In this type of situation your dentist will evaluate and possibly recommend endodontic surgery or an apicoectomy. 

The tip of the tooth root is called the apex; “ectomy” at the end of a word implies removing something. Therefore, an apicoectomy is the surgical removal of the tip of the root of the problem tooth which also removes the infection. A root-end filling is placed to prevent reinfection of the existing root canal and the gum is sutured. After the removal of the root tip and infection the area will heal on it's own.

This surgical procedure is usually preformed by an oral surgeon using local anesthesia . It also has an exploratory nature and can be used to locate root fractures or hidden canals that do not appear on x-rays but still manifest pain in the tooth. Damaged root surfaces or the surrounding bone may also be treated with this type of surgical procedure.

There are usually no restrictions after the procedure concerning driving or returning to work. If you have requested nitrous oxide (laughing gas) or IV sedation, you will receive special instructions at your consultation appointment about driving and recuperation after the procedure.

Following an apicoectomy, there may be some discomfort or slight swelling while the incision heals. This is normal for any surgical procedure. Application of ice on the affected side of the face off and on every 20 minutes after surgery for the first 24 hours will help minimize the swelling. To alleviate any discomfort, you will be instructed to take 2-4 ibuprofen (Advil or Motrin). Salt water or antiseptic rinses are also a good idea.

Stress and Oral Health

Recent research has shown that there is a link between stress and our physiologic health. The full extent of this connection is still being studied and more is discovered all the time. One of the ways that stressful conditions affect our bodies is through production of certain hormones. One such hormone is cortisol which is released in response to being anxious and/or depressed. It's primary functions are to increase blood sugar; suppress the immune system; and aid in fat, protein and carbohydrate metabolism. It also decreases bone formation. However  If the stress is persistent, the level of cortisol remains elevated as a compensatory mechanism and sustained elevated levels of cortisol can have a negative impact on many tissues including teeth and gums. This can lead to gum disease or periodontitis. There’s also evidence that stress and depression impair your immune system, making chronic infection throughout your body—including in your mouth—more likely. Certain sores in the mouth and bruxism(grinding or clenching of teeth) can also be a result of chronic stress.  In addition, hard times lead to bad habits which include less or no oral hygiene, smoking, drinking alcohol, and skipping necessary dental cleanings and check-ups.

The good news is that we are able to control our stress levels to some extent and in turn improve our overall health. We can change our outlook by realizing that some things are out of our control and for that reason not worth getting stressed out about. 

It is important to try and see life events as positive challenges rather than threats.

We can keep our bodies healthy by eating a nutritious, well-balanced diet, getting enough sleep and exercising on a regular basis. This will allow us to get in shape and also feel better by producing mood-boosting brain chemicals.

There are also many relaxation techniques including meditation, stretching and progressive muscle relaxation which involves a two-step process in which you systematically tense and relax different muscle groups in the body.

Procrastination

If there is one thing I am certain of from all my studies and twenty years of clinical private practice experience, it is the fact that avoiding the dentist and proper treatment will ALWAYS work against you! I have also learned through thousands of patient interviews that the two main reasons for avoiding the dentist are fear and finances. Now these may seem like fairly legitimate reasons, but in actuality they are not! 

The reason that some folks are fearful or "phobic" is usually because of an unpleasant experience that can be traced back to childhood or a long time ago. These experiences create a phobia that is completely irrational and baseless as seen in today's professional philosophies and technologically advanced practices. there have been many significant advances in the art and science of dentistry which make the vast majority of treatment modalities comfortable, safe and effective. I often hear "....if I knew it was that easy, I would have done it earlier."

On the other hand those who are concerned with finances should realize that the alternative is much more costly and unpleasant. Whether you have insurance or not, there are still financing options available that will allow you to get healthy. Often times those who come in regularly for check ups and cleanings have far fewer problems. Pathologies are a lot easier and less expensive to treat in their initial phases. By ignoring small problems you will most certainly inherit bigger ones! So in the long run procrastination will cost more and require more invasive and complex treatment.   

In general, the dental profession is more in tune with the individual needs of the patient and treatments are less uncomfortable and more affordable. You need to be honest with yourself and ask, are you putting off going to the dentist or are you finally going to start to become invested in your health?

Chemotherapy and Oral Care

You may be surprised that your dentist plays an important role in your cancer treatment. If you consult with your dentist before chemotherapy begins, you can help prevent serious mouth problems.
Chemotherapy is the use of specific drugs to treat cancer. These drugs kill cancer cells, but they may also harm normal cells, including cells in the mouth. Side effects include problems with your teeth and gums; the soft, moist lining of your mouth; and the glands that make saliva.
These drugs will basically diminish the immune response and therefor the patient becomes more susceptible to inflammation and/or infections. It is important to recognize and treat any oral pathology that may lead to an infection before the chemotherapy starts.
Also a loss in saliva will make the patient more vulnerable to tooth decay and gum disease. Saliva is a natural guard against plaque build up and bacteria. In it's absence oral bacteria tend to flourish which is why immaculate oral hygiene is essential during chemotherapy. A dentist can recommend ways to keep the oral environment moist. 
If the oral side effects are severe, the patient may not be able to keep up with their cancer treatment which is why it is important to consult with a dentist before any chemotherapy.

Dental Resolutions

Here are some dental resolutions for the new year that will keep you healthy and problem free:

1- Brush twice a day for about 2 minutes at a time. Not 1 minute, 30 seconds or once a day. It really does take that long to clean the majority of all surfaces of the teeth in your mouth decently.
2- Floss once a day. Approximately 40% of your teeth are not being cleaned if you don't do it and a substantial percentage of cavities start in those areas.
3- Clean your tongue. I would say 95% of patients don't do this. A couple of quick swipes on the tongue is usually enough.
4- Reduce your intake of sugary foods. it will decrease the incidence of cavities, improve your blood sugar and health.
5- Drink more water, especially after staining drinks like coffee, tea and wine.
6- Regular maintenance appointments at least every 6 months. Seeing your Dentist/Hygienist for a checkup and cleaning is truly the dental version of the oil change. Prevention is always the best option.
7- Get things taken care of while they are small and don't procrastinate. Fairly minor issues easily become more severe if neglected. Dentistry operates on an exponential cost scale as things get more involved and complex. Getting a restoration that costs a few hundred dollars (and is usually covered by insurance) is much better for you and your finances than letting it turn into a multi-thousand dollar root canal/post&core/crown or implant.

I hope this is helpful and happy 2012!