Word Of Mouth – A Dental Blog

I attended a most interesting lecture in conjunction with my monthly staff meeting at New York Presbyterian Hospital last week.  Dr Greg Chotkowski, an oral surgeon who trained at New York Presbyterian, presented information on harvesting stem cells from teeth.  Yes, from teeth!  Greg is the founder and president of StemSave , an innovative organization that has developed the capability of storing stem cells from children’s teeth.  I’ve taken the liberty to share information from the National Institute of Health and some of Dr. Chotkowski’s thoughts from an article he has recently published. 

What are stem cells?

According to the National Institute of Health:

“Stem cells are distinguished from other cell types by two important characteristics. First, they are unspecialized cells capable of renewing themselves through cell division, sometimes after long periods of inactivity. Second, under certain physiologic or experimental conditions, they can be induced to become tissue- or organ-specific cells with special functions. In some organs, such as the gut and bone marrow, stem cells regularly divide to repair and replace worn out or damaged tissues. In other organs, however, such as the pancreas and the heart, stem cells only divide under special conditions.”

“Stem cells have the remarkable potential to develop into many different cell types in the body during early life and growth. In addition, in many tissues they serve as a sort of internal repair system, dividing essentially without limit to replenish other cells as long as the person or animal is still alive. When a stem cell divides, each new cell has the potential either to remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a red blood cell, or a brain cell.”

Stem cells are unique in that they are the only cells in our body that can regenerate. They are the repair and maintenance cells of the body and are the key to unlocking the promise of regenerative medicine.  Another unique feature of certain types of stem cells is their ability to differentiate. They can turn into a broad range of specialized cells. This enables stem cells to regenerate organs, tissues, bones, specialized cells, and much more.  There is hope that stem cell therapies may treat diseases and conditions such as Parkinson’s, Alzheimer’s, diabetes, MS, arthritis, heart disease, spinal cord injuries, joint replacement, and other genetic diseases.

Recently, scientists have discovered stem cells in the baby teeth of children and in the developing wisdom teeth of young adults.  The stem cells that exist in teeth are very compelling for a number of reasons. Most notabel is their “plasticity”, or ability to differentiate into other types of tissue such as muscle, neurons, bone, organs, insulin-producing pancreatic beta cells, skin and cartilage to name a few. This means they could potentially be used to treat a wide range of diseases and injuries. 

The second  interesting thing about saving the stem cells from your teeth is they are your own- this is referred to as autologous tissue. Once they are reintroduced into the body during a treatment, they will not be rejected as foreign tissue.  Recovering stem cells from baby teeth also ensures the stem cells are young, strong, and vital.

In the StemSave program, patients enroll directly with StemSave and provide the name of their preferred dentist. The dentist is contacted and provided with the necessary tools and instructions so the tooth can be returned to the StemSave lab. In the StemSave lab the stem cells are processed, tested for viability and cryo-preserved.  All registered StemSave dental practices are provided with materials that are both informative and visually compelling. StemSave works closely with the dentist to offer training so that patients can be made aware of the option to save the stem cells from a tooth that is scheduled for extraction.

According to Dr. Chotkowski, growing new tissue and organs from stem cells is no longer science fiction. It’s happening now!   Recently, a new windpipe was grown with tissues developed from a patient’s own stem cells. The new windpipe was transplanted into the patient without the need to take any rejection drugs.

It’s both exciting and gratifying to know that dentists are now on the frontlines of this emerging medical technology. We are now at a point where a trip to the dentist could potentially change a life.

As always, thanks for listening.

RMS

What a world we are all living in- just trying to make it through the day!  One might think that considering the changing economic climate businesses would be interested in providing customer service that would keep customers happy, satisfied and loyal.  But in the case of Nissan Motor Corporation, that would not be the case.

In January of this year I leased a new Infinity when the lease on my old one was up.  Drove the old one to the dealer, picked up the new one and drove away.  Simple.  Or so I thought.  Seems like the dealer arm didn’t communicate well with the financial support arm.  Now the financial arm of Nissan thinks I still have the old automobile and keeps calling me every evening, telling me I am 60 days in arrears on the old lease.  Countless phone calls and faxes have possibly resolved the problem but what a waste of my time.  What wasn’t really my problem became my problem.  The point of all this is that nobody on the other end listened; no one cared enough about a loyal customer to try to solve my problem.  Didn’t leave a good taste in my mouth.

In a healthcare world that has become, at times, very depersonalized, I still believe that patients want to feel cared for and cared about.  It’s the personal connection between doctor and patient that is so important.    My team and I believe in a very individualized, personal approach to patient care.  It’s important for us to understand our patients concerns, listen to their stories, and help them meet their treatment goals.  And while we think we are providing great customer service we are now about to initiate an in- office project to see if this is truly the case.  We are going to begin looking at how our patients are treated, and what their perception of treatment is, starting with the first phone call and proceeding through each phase of the patient experience.  We are going to ask our patients to provide us with feedback about how they feel they are being treated; are they comfortable, are their expectations being met, and are we creating a quality care experience that makes them feel comfortable returning for care and referring other who may need similar kinds of care.   Are we listening and responding appropriately?

 So if you are reading this, and you are a patient in our practice, feel free to respond in kind.  Send us an e-mail or call us in the office.  We’re anxious to include you and hear what you have to say.  It’s the only way we can get better!

As always, thanks for listening.

RMS

Historically, patients requiring certain types of dental treatment were required to take antibiotics prior to dental care in order to prevent a heart infection caused by certain bacteria that were prevalent in the mouth. 

Recently, after reviewing studies about infectious endocarditis, the American Heart Association has suggested a change in the need for antibiotics prior to dental treatment.

The December 2008 issue of The Johns Hopkins Medical Letter addresses the new suggestions for antibiotic prophylaxis and reviews the reasons given for the new thinking. 

Previously it was thought that procedures such as routine dental cleanings introduced beta hemolytic streptococci into the blood stream where the bacteria could grow on heart valves of patients who had abnormal blood flow through the heart valves (heart murmur).  In order to prevent a serious heart infection, The American Heart Association and the American Dental Association suggested that these patients be pre-medicated with antibiotics prior to receiving certain types of dental treatment.

As reported in the Johns Hopkins Medical Letter, the American Heart Association(AHA) recently reviewed infectious endocarditis (IE) studies between 1950 and 2006 and concluded that only patients at high risk for serious complications from IE should continue taking preventive antibiotics.  High risk patients included those who had previous episodes of IE, those with artificial heart valve replacements and repairs, or who had valve problems after a heart transplant, and those patients who had congenital heart defects.  Patients with heart murmurs were no longer considered high risk.  The AHA panel found little incidence that preventive antibiotics stop IE from developing or that dental procedures cause IE.  They concluded that, in fact, millions of IE causing bacteria enter the bloodstream every day as a result of common activities like brushing, flossing and chewing.  Yet IE remains rare.

One study of 299 healthy adults found that 33% of blood samples from patients who took antibiotics before dental treatment tested positive for IE causing bacteria after their procedure.  Another study evaluated the death rate of high risk patient with artificial heart valves who did not premedicate and found the chance of developing IE was very low, one in  54,000.
The new regime of limiting antibiotics before dental treatment to only high risk individuals will decrease the incidence of allergic reactions to the antibiotics, help prevent antibiotic resistance, reduce the number of medications some patients have to take and will save patients money. 

For most people, proper brushing and flossing will go a long way to controlling the bacteria in the mouth.

By Trish Rubin                                                                                              

 My journey to a new smile started with a story, and I now have become sensitive to the stories around me that people carry, the story behind their smile. In the perfect world of advertising in print, in media, and now in internet technology, those people who have the smile that dazzle seem to have it all. It’s the Hollywood Smile.

But, there is a story behind getting to a smile, one that I’m sharing. The story is about making choices, being able to risk, being able to trust, and being able to dream. Not just putting on a surface show.  It means making an investment in that belief by seeking the best treatment offered in this city. And that’s not Hollywood…it’s in a New York Smile. That’s what my hygienist, Elvie told me I could have!
When first thinking of treatment, Dr. Sorin asked me to find smiles that looked like the one I dreamed of having. After weeks of looking, I arrived at Hillary Swank…the Hollywood smile. Her smile has been crafted for her, and she wears it naturally. She has a story behind her smile and her look that was made for her, but it is pure Hollywood.

If you look at my picture, you’ll see the digital version of the smile my photographer helped me to get for my book. It’s part of the wonder of airbrushing and brightening via the laptop that presents this smile. I guess that’s the smile I want, but I want even more. It’s the smile I was born with, not Hillary Swanks. I guess I want the smile I have, yet healthier and brighter and more confident, so I can throw my head back and laugh and not be afraid of showing the less than perfect story of my years of dental mistreatment.

I want my smile to tell my unique story; one of happiness and health, one of care and confidence. I know Dr. Sorin is going to craft that with me.

In the New York Times (February 3, 2009) Science section Larie Tarkan writes about new tests for oral cancer.  You may find the following synopsis informative.
Although oral cancer is relatively rare in the adult population, researchers have been finding increased incidence in people traditionally at low risk for oral cancer.  Some attribute this to the rise in Human Papiloma Virus (HPV) which can be transmitted to the oral cavity. Traditionally, the dental office has been the first line of defense, with many dentists and hygienists checking visually for oral cancer during routine examinations.  Several new tests have been developed that may detect oral cancer at an earlier stage possibly leading to better treatment outcomes.
According to Ms. Tarkan, at this time, there is some controversy as to whether these new tests are cost effective and can lead to better treatment outcomes.  The American Cancer Society and the American Dental Association recommend a regular visual examination but no one knows for sure if a visual examination saves lives although most experts believe that it does.
Two new screening tests are being marketed by medical companies who claim their advancements will significantly improve early detection of oral cancer.  Yet according to the New York Times article, “no extensive studies of the general population show that these devices are any better than the naked eye for screening.”  One system uses the VELscope to evaluate the tissues of the oral cavity and in one small study was effective in detecting oral cancer lesions that experienced specialists missed with the naked eye.  A second system (ViziLite Plus) uses a special dye to help aid in early diagnosis but some researchers say the findings are still open to questioning as to the effectiveness in the hands of less experienced clinicians and a lower risk patient population.
While there seems to be advances on the way for oral cancer screening and early detection, most experts agree that everyone should have a thorough, visual examination for oral cancer on a regular basis.  Be sure to ask at your visit if your dentist or hygienist has conducted a thorough oral examination for you.

Robert M. Sorin, DMD

Maybe someone finally gets it.   For years I’ve been getting questions from patients about “Usual and Customary” fees.  Patients sometimes had difficulty understanding why my fees were different from the usual and customary fees set by the insurance companies.   I explained my belief  that “Usual and Customary” fees were arbitrarily set by the insurance company and were not related to fees set by private care practitioners.  I always believed they were set up to assure profitably for the insurance companies and not to maximize coverage or benefits for the insured.

Evidently the Attorney General of the State of New York agrees.  Below are excerpts from an editorial that appeared in The New York Times on Saturday, January 17, 2009 addressing the above issues.

NOT SO REASONABLE AND CUSTOMARY

“Patients who feel ripped off whenever they use a doctor outside their insurance company’s network should benefit from two important new agreements.

UnitedHealth also has agreed to pay $350 million to settle class-action lawsuits brought by the American Medical Association and other groups on behalf of patients and doctors who claimed to be shortchanged for services provided out of network. New York State’s attorney general, Andrew Cuomo, and UnitedHealth Group, one of the nation’s largest health insurers, have agreed to set up a new system for calculating out-of-network payments.

Typically, when patients use non-network doctors, their insurance company agrees to pay 70 percent to 80 percent of the “reasonable and customary” charges for a given medical service in the same geographic area. If the doctor’s bill is higher than that rate, the patient must make up the difference or the doctor must settle for less.

The rub comes in defining what is reasonable and customary.

That calculation for most of the industry is made by a company called Ingenix, which conveniently is owned by UnitedHealth. The whole system is rendered suspect by an obvious conflict of interest: If Ingenix pegs the customary rates low, it keeps insurance reimbursements low and shifts more of the cost to the patient.

Investigators for Mr. Cuomo contend that UnitedHealth and Ingenix have been manipulating the data through a variety of stratagems to keep the customary rate calculation low — and the insurance payments low.

As a result of the agreement, future reimbursements should be less subject to manipulation and a lot more transparent. UnitedHealth is planning to close its Ingenix databases and shift responsibility to an independent nonprofit organization

New York’s attorney general deserves thanks for forcing the industry to adopt a fairer and more transparent system for determining out-of-network reimbursements. It has been a long time coming.”

Thnaks for listenting.

Lisa Mandelbaum-Brown, MS,RD,CDN
As a practicing dietitian, I have seen and heard it all when it comes to what people eat, when they eat it, what they thought about before they ate it and how they felt after they ate it.  Something so necessary, so pleasurable can be made into such a complicated experience. 

In a world where we have so much opportunity and so much we all want to accomplish in life, I truly get why so many of us look to our health as the determinant.  Some of us on the way there take a pit stop at vanity and get stuck while others are in hot pursuit of the ultimate elixir.  No matter what the impetus, one thing is for sure, more of a good thing or rather less of a seemingly bad thing doesn’t always add up to making it great.  Less sugar, less white flour, no carbs, low sodium and the list goes on.  We really do not need to ‘treat’ what we don’t have.  Too low of a sodium content can lead to electrolyte imbalances especially for the avid exerciser, too low of blood cholesterol is an indication of poor nutrition, avoidance of carbohydrates leads to a plethora of issues…

This is where I say let’s go back to basics.  Science, which is what we base medicine on, is forever redirecting us. It is exciting and dynamic and at times predictable.  In my experience as a dietitian I have aided and abetted in the chase for the next best thing and then boom, sound the alarms. NO MORE folic acid, NO MORE vitamin E, Trans fatty acids are THE DEVIL…we have all danced that dance.  Not anymore…this is where the KISS acronym has its debut. 

The basics:
Food is a necessity and it is also a source of GREAT pleasure. Let’s maintain that.
Eat real food—food in its or close to its original format.
Eat a wide variety of food—this is your best bet to get all of your nutritional needs met.
Avoid all the additives and processed food as a general rule of thumb.
Eat the real deal — if you want dessert, eat a real dessert.   Eat all throughout the day—don’t skip meals and snacks
Take supplements but K.I.S.S.  If you are a healthy eater all you need is a good multi vitamin, maybe some fish oils for those super Omega 3’s and calcium for us women of age.  Go back to listening to your body. It is the greatest predictor of necessary calorie intake.

AND love the body you are in. Take care of it, exercise it, put wholesome food in it but don’t stress it out with too much exercise, too little food, too much food, too much processed food and too many rules.

We have other complicated matters to attend to, keep this simple and peaceful

 Lisa Mandelbaum-Brown MS, RD, CDN is an associate of Joy Bauer Nutrition, a private nutrition practice in New York City.  She provides counseling to individuals of all ages addressing various nutritionally related concerns. Lisa has worked with some of the leading professionals in her field and has been interviewed and featured in national publications.

She received her M.S. in Clinical Nutrition from Hunter College School of Health Sciences and maintains affiliations with multiple professional organizations.

Robert M. Sorin, DMD

I’m angry and sad today.  I’m angry that blatantly false and inaccurate information is being disseminated to the public in the name of beauty.  And I’m sad to see some in my profession “hawking” cosmetic procedures, to an increasingly susceptible public, that have no scientific basis for success.

But let me digress.  Several days ago my attention was directed to an episode of a nationally syndicated TV show, “The Doctors”.  A guest on this panel of doctors was a cosmetic dentist who has received prior national exposure as the result of his appearances on other cosmetically related television shows.  Now let me say that I accept the fact that reality makeover shows are now part of our culture.  Ever since December 2002 when the first episode of “Extreme Makeover” aired on television, cosmetically related procedures have become a regular feature on numerous TV shows.  And I accept the statement by sociologist  Victoria Pitts-Taylor in her book “Surgery Junkies” when she states “in postmodern cultures our bodies have been positioned as signs of personal, individual identities”. 

It’s been said that we live in a fifteen second culture.  That’s how long it takes someone to look at someone else and decide if they’re interested.  We live in a society in which more of us than ever before are concerned about how we look, because how we feel about how we look significantly impacts on our self image and how we feel about ourselves.  Ms. Alex Kuczynski, a well know writer for  The Style section of The New York Times, in her book “Beauty Junkies”, describes “a world in which images hold more power than words, and language has been replaced with symbols and sound bites”. 

So the potential influence on the public perception of cosmetic improvement by shows such as “The Doctors” is huge and as such, shouldn’t we expect that the truth will be told? Don’t they have the responsibility to tell it like it truly is?

 In the show I saw, the participant from the audience shared with the studio and television audiences her concern about her “gummy” smile.  When she smiled she felt that too much gum showed.  From a cosmetic point of view, her concerns seemed to be well founded.  But the procedure that was demonstrated was not one that could address the patient’s concerns and correct her problem in a professionally accepted manner.  In fact, to correct the patient’s problem, a much more extensive procedure(s) was needed, one that fully took into account the anatomy and histology of the structures involved.  The solution was not one that could be accomplished in just a few minutes!

At the conclusion of the segment the hosting MD showed before and after photographs; this was a sham.  Photographs before the demonstrated procedure showed lots of excess gum tissue.  Photographs after the procedure showed less exposed gum tissue.  But this was only because in the photographs taken after the procedure was completed on camera, the patient’s upper lip didn’t move as much because she had received an injection of local anesthetic!  So while the procedure did remove the barest minimum of gum tissue, the procedure shown was not one that is clinically accepted to achieve the results purportedly demonstrated. The result shown on camera was highly misleading if not an outright lie. 

 So I’m curious.  I’ve got some questions.  Why can’t we expect some truthful “reality” here?  Are these TV shows just pandering to a viewing audience drinking the Kool Aid of looking better? Should the public accept all that is shown as factual?  Who and where are the professionals who are fact checking to evaluate risks, benefits, accuracy and truthfulness?  And is my colleague appearing just for the exposure that drives his entrepreneurial empire? 

There is nothing wrong with wanting to look better.  That’s the world in which we live.  It’s an essential part of what I do every day. But the real problem for all of those concerned about looking better is who are the good guys and who are the bad guys and how do you tell the difference?

Thanks for listening.

by: Trish Rubin
That’s me now that I am on TRAY two, brace 2. I have graduated and, boy
am I ever full of myself! I’m getting a bit scatterbrained too, but, I think
it’s because this process is so easy…much easier than I imagined. So when
I take my braces out briefly, I sometimes wind up scouring the apt for
them…don’t tell my dentist they weren’t in the handy case I use at
fancy restaurants, ok! And the funny thing is I have to put on my contacts to
find my braces. Thank God my kids are grown and they aren’t using them for
costume shows in the backyard! Although my 20 year old son has threatened to hide
them. ( No worries now..I’m on tray 2, that means if I lose that tray, I
still have tray in a pinch!)

I like them, really. OK I like that they are not permanent, too…and that I
feel progress real or imagined, I do.

And I’m in a club. I’ve had two social incidents this week alone where
I compared Invisalign notes as I networked. And I’m confident enough to BIG
SMILE it now, sort of proud that I am wearing them! When I saw an Invisalign
commercial last night I almost applauded…that’s me! That’s where I am
going!

It’s funny though, some people have tried to convince me I don’t need
them??!! yes…I can see myself in the mirror and in photos and on video and I
KNOW I do! But for some people it seems silly that a middle aged woman would
wear braces….DON’T LISTEN TO PEOPLE LIKE THIS! Make yourself as healthy and
comfortable and as beautiful as you want to be…and with the excellent
resources of Dr. Sorin’s practice, you can. I even wore my braces proudly
into another dentist’s office when I picked up a friend for a meeting…and
guess what…I smiled and they didn’t even see them!!! Invisable!!
Now the trick will be wearing them to speak in front of 100 people on cable TV
next week! I CAN DO IT! My support team at Health Comfort and Beauty will be
standing by me when I do… literally!

Tooth whitening or “bleaching” one’s teeth has become very common today and we have some wonderful techniques in dentistry for getting great results with our patients’ smiles. However, we still get a lot of questions regarding “the truth” about all of those products you see at the grocery and drugstores, along with questions and doubts about their effectiveness compared to in office options. We would like to take this opportunity to dispel some common myths that we hear, answer some questions, and hopefully address some of the most common problems we see in our office with regard to tooth whitening.

First of all, let’s discuss how tooth whitening works. Basically, no matter which product you choose, the bleaching chemicals penetrate into the tooth enamel and set off a chemical reaction known as oxidation. To do this, most tooth whiteners use one of two chemical agents: carbamide peroxide or hydrogen peroxide. When used in the mouth, carbamide peroxide breaks down into hydrogen peroxide and urea, with hydrogen peroxide being the active whitening ingredient. The key to how effective any product is depends on two factors: how strong the solution is, and how long the agent remains against the teeth in order to allow the oxidation process to take place. Typically, the longer you can hold it on the tooth, the closer you can keep it to the tooth and the stronger the agent, the better the results.

For the most part, the products that you can purchase at your local supermarket do exactly what they claim. The strips cover 6 to 8 teeth, and the effects will last anywhere from 6 to 12 months, with monthly touch-ups, depending upon your own personal habits. They seem very affordable, given that your short-term investment is anywhere from $20 to $50, but the concentration is not always listed on the container. So if cost is an issue, try to compare apples to apples. The problem with these systems is not so much in the products themselves.  The problem we see in our office, is that patients’ expectations can be unrealistic. Whether you’re using strips or have decided to pay a little extra for the trays, the product is not custom designed for your mouth. What does that mean? It means that unless your teeth are perfectly straight, you’re going to get spotty results. Some of the strips can be especially problematic in that they cover only 6-8 teeth, leaving you with a two-tone mouth!  When we smile, most of us show 10 to 14 teeth. This is especially true when you laugh. Most patients want that younger-looking, beautifully-white, natural-looking smile, with no stain or discoloration showing at all. The more crowded your teeth are, the more you need the custom trays that only a dentist can provide.

Also, you are probably already aware that most over-the-counter medications are weaker, by law, than prescription medications. The same is true for whitening agents. What they are allowed to sell in the grocery store is not the same strength that your dentist can provide. Why does that matter? A stronger agent will give you longer-lasting results. The whitening systems used by dentists today can get very satisfying results that last for a long time.

Another problem we see occurs when a patient decides to use an over-the-counter method before they come in for a cleaning. If you have tartar buildup on your teeth when you whiten, the agent cannot get through to the enamel, so when the tartar comes off those portions of your teeth are the same color as before you whitened. Very disappointing!  So if you are going to use an over-the-counter product, at least get your teeth cleaned immediately before-hand so that you get the best results possible. Even though the over-the-counter whitening solution is weaker than our professional brands, if you have cavities, you will increase the risk of some uncomfortable sensitivity if you don’t get them evaluated and cared for prior to bleaching. Likewise, if you have any issues with your gums, you’ll want to get that evaluated prior to whitening as well.

More and more patients these days are asking about “the light.” Some whitening systems have been developed that utilize a high-intensity light to expedite the oxidation process. In our office, we utilize the BriteSmile Whitening System , the most advanced in-office whitening system.  BriteSmile whitening gel is carefully applied to your teeth. The gel is then activated by BriteSmile’s patented gentle blue light for 20 minutes while you relax and watch TV or listen to music. This process is repeated twice more before you go home with a naturally brilliant new smile. Take-home whitening systems can be just as effective, but usually require wearing your custom trays with the bleaching solution for about 30-60 minutes per day, for 14 days. If you are looking for the most expediant method, the BriteSmile process is for you.

Finally, we offer another whitening choice for those teeth that are badly discolored or are very gray; Power Bleaching consists of an in-office application of whitening agent, use of the tray system at home for 14 days, and a final in-office whitening application. We have found this combination to work very effectively on teeth that are very dark and have tetracycline staining.

With regard to safety, most studies show that tooth whitening is both safe and effective. If tooth sensitivity or gum irritation occur, it is best to stop using the whitening product for a few days, and then start again, but less frequently — say, every other day instead of every day — and reduce the amount of time spent with the whitening agent against your teeth.

These are the most common questions and concerns raised by our patients, but we’d love to hear from you! If you have a question or comment about specific whitening options for your teeth, please call us at 212.355.3533, or e-mail us at info@nycdmd.com.