My Blog

By Dr. Edward Portnoy and Dr. Grace D'oria
December 04, 2019
Category: Oral Health
Tags: fluoride  
FluoridatedDrinkingWaterHelpsCurbToothDecaySafely

The U.S. Centers for Disease Control and Prevention calls it “one of the ten most important public health measures of the 20th Century.” A new vaccine? A cure for a major disease? No—the CDC is referring to the addition of fluoride to drinking water to prevent tooth decay.

Fluoride is a chemical compound found in foods, soil and water. Its presence in the latter, in fact, was key to the discovery of its dental benefits in the early 20th Century. A dentist in Colorado Springs, Colorado, whose natural water sources were abundant with fluoride, noticed his patients' teeth had unusual staining but no tooth decay. Curious, he did some detective work and found fluoride in drinking water to be the common denominator.

By mid-century, fluoride was generally recognized as a cavity fighter. But it also had its critics (still lively today) that believed it might also cause serious health problems. Ongoing studies, however, found that fluoride in tiny amounts—as small as a grain of sand in a gallon of water—had an immense effect strengthening enamel with scant risk to health.

The only condition found caused by excess fluoride is a form of tooth staining called fluorosis (like those in Colorado Springs). Fluorosis doesn't harm the teeth and is at worst a cosmetic problem. And it can be avoided by regulating the amount of ingested fluoride to just enough for effectively preventing tooth decay.

As researchers have continued to learn more about fluoride, we've fine-tuned what that amount should be. The U.S. Public Health Service (PHS), which sets standards for fluoride in drinking water, now recommends to utilities that fluoridate water to do so at a ratio of 0.7 mg of fluoride to 1 liter of water. This miniscule amount is even lower than previous recommendations.

The bottom line: Fluoride can have an immense impact on your family's dental health—and it doesn't take much. Excessive amounts, though, can lead to dental staining, so it's prudent to monitor your intake. That means speaking with your dentist about the prevalence of fluoride in your area (including your drinking water) and whether you need to take measures to reduce (or expand) your use of it.

If you would like more information on how best fluoride benefits your family's dental health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Fluoride & Fluoridation in Dentistry.”

By Dr. Edward Portnoy and Dr. Grace D'oria
November 24, 2019
Category: Dental Procedures
Tags: dental implant  
GettingaNewToothinOneDayWillDependonYourBoneHealth

If you've thought the ads for a “new tooth in one day” seemed too good to be true, we have…sort of good news. You can get a new “tooth” in one visit, but only if your dental situation allows it.

The restoration in question is a dental implant, a metal post (usually titanium) surgically imbedded into the jawbone. They're especially durable because bone cells naturally grow and adhere to an implant's titanium surface, a process called osseointegration. Over time this process creates a strong bond between implant and bone.

Usually, we allow a few weeks for the implant to fully integrate with the bone before attaching the visible crown. With “tooth in one day,” though, we attach a crown at the same time as we install the implant, albeit a temporary crown. It's more aesthetic than functional, designed to avoid biting forces that could damage the implant while it integrates with the bone. When that process finishes, we'll install a permanent porcelain crown.

The health of your supporting bone and other structures will largely determine whether or not you're a candidate for this “tooth in one day” procedure. Your bone must be sufficiently healthy, as well as the gums surrounding the implant and the tooth's bony socket.

If, on the other hand, you have significant bone loss, gum recession or socket damage, we may first need to deal with these, usually by grafting tissue to the affected areas to stimulate new growth. Your implant, much less a temporary crown, will likely have to wait until the affected tissues have healed.

The bone can also be healthy enough for implant placement, but might still need time to integrate with the implant before attaching any crown. Instead, we would suture the gums over the implant to protect it, then expose and attach a permanent crown to the implant a few weeks later.

Obtaining even a temporary crown the same day as your implant can do wonders for your appearance. A more important goal, though, is a new tooth that you can enjoy for many, many years. To achieve that may mean waiting a little longer for your new beautiful smile.

If you would like more information on restoring missing teeth with dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Implant Timelines for Replacing Missing Teeth.”

By Dr. Edward Portnoy and Dr. Grace D'oria
November 14, 2019
Category: Oral Health
WearingaRetainerWillProtectYourNewSmileAfterBraces

After living with braces for a couple of years, the “big reveal” finally happens and you see your new smile for the first time. But then you’re told you have to wear another mouth appliance—around the clock to start and then just at night. After all the new smile excitement, wearing a retainer can be a little anticlimactic.

But this part of your orthodontic treatment is as important as the earlier tooth movement phase. That’s because your new “forever smile” doesn’t necessarily come with a “forever” guaranty. In fact, your teeth could quickly begin moving back to where they were before braces if you don’t wear a retainer.

The reason why is because of a tough but elastic gum tissue called the periodontal ligament. This ligament lies between the teeth and the jawbone, attaching to both through tiny extending fibers. The periodontal ligament actually does most of the anchoring work to hold your teeth in place.

The ligament is also why we’re able to move your teeth to different positions: As braces apply pressure to the teeth and jaw in the direction of desired movement, the ligament remodels itself to allow the teeth to take up these new positions.

The tissues involved, though, still retain a kind of “memory” of where the teeth used to be. This creates an immediate tendency for the teeth to revert to these old positions. To prevent this, we use a retainer that when worn keeps or “retains” the teeth in their new positions until they’ve stabilized and the old tissue “memory” fades.

There are different types of retainers, some removable and some fixed in place. Choosing the best one for a particular patient will depend on the complexity of the bite treatment, the patient’s age and level of self-responsibility and the preferences of the orthodontist. Whichever type of retainer you eventually use, it’s important you wear it to preserve all of the time and effort that went into transforming your smile.

Wearing a retainer might not be high on your “exciting things to do” list. But it’s the best way to guarantee you’ll enjoy your new smile for years to come.

If you would like more information on keeping your new smile after braces, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “The Importance of Orthodontic Retainers.”

By Dr. Edward Portnoy and Dr. Grace D'oria
November 04, 2019
Category: Dental Procedures
MileyCyrussLittleSecretStraighteningHerSmileWithLingualBraces

Miley Cyrus's rise to fame began when she was cast in the Disney series Hannah Montana. She played the title character, Hannah Montana, a famous singing star hiding her true identity, ordinary girl, Miley Stewart. In her real life at the time, Miley Cyrus had her own little secret—she was undergoing orthodontic treatment to straighten her smile.

Like many teenagers (as well as many adults), Cyrus's dental bite wasn't in proper alignment. She could have gone the traditional way by straightening her smile with braces fixed to the front of her teeth. It's an effective treatment, but the metallic hardware can overwhelm a person's appearance.

With her various roles in the public spotlight, Cyrus and her family wanted an effective but out-of-sight method for moving her teeth. They chose a relatively new one called lingual braces. Unlike traditional braces, the hardware for lingual braces is fixed on the back of the teeth (or the tongue side, hence the term “lingual”).

Lingual braces can correct any bite problem labial (“lip”) braces can, just through different mechanics of movement. Its main appeal is that the hardware is hidden behind the teeth, so only you and your orthodontist need know you're wearing braces.

There is also less risk of damage to the mouth or the braces themselves if you're in a sport or profession where you're at high risk for facial blows. And unlike patients with traditional braces, you'll have an unobstructed view of your progress over the course of treatment.

Lingual braces do tend to cost more than traditional braces. Some patients also have difficulty at first with speaking and tongue comfort, though most grow accustomed to the braces within a couple of weeks. Because lingual braces are relatively new, there's been a limited number of orthodontists offering it.

But lingual braces are just one of the ways to straighten teeth. Modern dentistry offers several ways to give you your dream smile. If you have dental problems or would like to improve the look of your smile, please contact us or schedule a consultation, and we can discuss your options. To learn more, read the Dear Doctor magazine articles “Lingual Braces” and “The Magic of Orthodontics.”

By Dr. Edward Portnoy and Dr. Grace D'oria
October 25, 2019
Category: Oral Health
Tags: oral health  
CelebrateWorldSmileDayWithMoreAttractiveTeeth

The smiley face: It’s been around forever. Except it hasn’t—someone created it. No, not Forrest Gump (but good guess!), but graphic artist Harvey Ball in 1963 to help boost employee morale at an insurance company. Do you know what else Harvey Ball came up with? World Smile Day: Beginning in 1999, Ball began promoting the first Friday in October as a day to encourage smiles and acts of kindness. But there’s no need to limit smiles to one day. We hope you treat every day as World Smile Day—to make your corner of the world a little brighter.

What can you do to show your support? Well to begin with, smile—a lot. And also do things to make other people smile. We don’t want you to hold back because you’re not completely satisfied with your smile. If you’d like to get that wonderful smile of yours in better shape, here are some ideas:

Have your teeth professionally cleaned. Having your teeth cleaned at the dental office is one of the best things you can do to prevent dental disease. Dental plaque makes your teeth look dull and dingy and can lead to gum disease and cavities. A professional cleaning to rid your teeth of any built-up plaque and tartar (hardened plaque) with a follow-up polish can help your teeth look great!

Brighten up your smile. You can turn up the brightness volume on your teeth with a tooth whitening application. There are whitening products you can buy over the counter, but for best results see your dentist for a professional whitening. Dentists can better control the degree of brightness and their professional-grade solutions often last longer.

Upgrade your teeth’s appearance. You may have a great looking smile—except for that chip, discoloration or slight gap between a couple of teeth. There are a number of ways, many quite affordable, to improve your teeth’s appearance. Your dentist can bond color-matched composite resin to your teeth to “fill in” chips or other blemishes. And a veneer, a thin layer of porcelain bonded to the face of a tooth, can mask mild to moderate dental blemishes.

There are other “smile changers” like orthodontics, crowns or dental implants that are a bit more extensive. Depending on your needs and expectations, these can give you a “smile makeover” that will get you ready for future World Smile Days.

In the meantime, talk to us about how you can perk up your smile. An attractive smile is much easier to share with the world.

If you would like more information about smile enhancements, please contact us to schedule a consultation.





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