My Blog

Posts for: June, 2020

By Dr. Edward Portnoy and Dr. Grace D'oria
June 21, 2020
Category: Dental Procedures
RemovableorBondedRetainersHelpProtectYourNewStraighterSmile

The straightening process for a crooked smile doesn't end when the braces come off. There's one more crucial phase to undergo to make sure we don't lose the progress you've achieved: wearing an orthodontic retainer.

Although often viewed as a nuisance, retainers are important because they prevent realigned teeth from reverting to their old positions. This is possible because the periodontal ligament, the gum attachment that allows us to move teeth in the first place, can contain “muscle memory” that naturally tries to draw teeth back to where they once were.

A retainer prevents this from happening: During wear the subtle pressure they exert keeps or “retains” the teeth in their new positions until they're firmly established, usually after several months. While most patients initially wear a retainer around the clock, this will gradually taper off until they're worn primarily during sleep hours.

While retainers come in many different styles and sizes, most fall into one of two categories: removable or non-removable (bonded). The first type, a custom-made appliance a patient can easily take in and out of the mouth, has its advantages. Removing it makes it easier to clean the teeth. They're also adaptable to reduced wear schedules for eating, brushing and flossing, or for special occasions.

But a removable retainer may be noticeable to others. Its removability can also lead to problems. Out of the mouth they're prone to be lost, resulting in additional replacement costs. And immature patients may be easily tempted to take them out too often—or not wear them at all.

A bonded retainer solves many of these potential problems. Because the retainer wire is securely bonded to the back of the teeth, it's not visible to others. And because it can't be removed except by an orthodontist, there's virtually no chance of losing it or haphazard wear.

On the other hand, bonded retainers can occasionally break, requiring repair or replacement. And flossing is more difficult than with a removable retainer, although a little training from a dental hygienist can make that easier.

The choice of retainer depends on the individual and their priorities. But whether removable or bonded, a retainer is absolutely essential for protecting your new, hard-earned smile.

If you would like more information on bonded retainers, 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 “Bonded Retainers.”


By Dr. Edward Portnoy and Dr. Grace D'oria
June 11, 2020
Category: Oral Health
Tags: antibiotics  
ExcitingNewDiscoveryCouldHelpintheFightAgainstAntibioticResistance

Like the rest of healthcare, antibiotics have transformed dentistry. Advanced oral infections that once eluded successful treatment are routinely stopped with the use of these “wonder drugs.” But their overuse over the years has given rise to dangerous “superbugs” resistant to many antibiotics.

Antibiotics are one of the 20th Century's most significant healthcare achievements. Drugs like penicillin played a major role ending the global threat of tuberculosis, cholera and bacterial meningitis. Over the last few decades, more antibiotics have been developed to defend against an even wider array of bacterial dangers.

But along the way doctors and dentists began prescribing antibiotics for all manner of illnesses including viral infections like colds or flu for which they're less effective. They've also been increasingly used as a preventive measure, including inclusion in animal feed to fight disease.

But our tiny biological nemeses are adaptable. As bacterial strains come in contact with greater amounts of antibiotics, individual bacterium that survive transmit their resistance to subsequent generations. This can produce new strains like Staphylococcus aureus (MRSA) that are resistant to methicillin and other common antibiotics that once contained them.

There's deep concern that these new resistant strains, often recent incarnations of old diseases once thought defeated, will lead to higher rates of sickness and death. Increasing resistance could also make common procedures like those performed by dentists and oral surgeons, much riskier to undertake.

To combat this, pharmaceutical companies are racing to create new drugs to compensate. Recently, they've received an encouraging sign of hope in this battle from an unlikely source: viruses. Researchers in Tel Aviv, Israel have discovered an antagonistic protein to bacteria among a group of viruses called bacteriophages. The protein, injected into a bacterium, commandeers the cell's DNA function to aid virus reproduction, which kills the host.

In the words of one researcher, this makes these particular “enemy of our enemy” viruses our “friend.” Although the discovery is still a long way from practical use in antibiotics, harnessing it in future drug versions could help pack a greater punch against resistant bacteria.

In the meantime, providers and patients alike must practice and advocate for stricter protocols regarding the use of antibiotics. The viability of tomorrow's healthcare is on the line.

If you would like more information on the use of antibiotics in dentistry, please contact us or schedule an appointment for a consultation.


By Dr. Edward Portnoy and Dr. Grace D'oria
June 01, 2020
Category: Oral Health
Tags: sedation dentistry  
SedationTherapyCanHelpAnxiousPatientsGettheDentalCareTheyNeed

Dental visit anxiety is a serious problem: Half of all Americans admit to some level of dental fear, while 15% avoid dental care altogether due to acute anxiety. The harm this can cause to dental health is incalculable.

But dentists have a number of sedation techniques that can relax anxious patients and allow them to receive the care they need. Although often used together, sedation is slightly different from anesthesia, which aims to deaden pain sensation. The aim of sedation is to calm the emotions and state of mind.

Sedation isn't a new approach: Physicians have used substances like root herbs or alcohol to relieve anxiety since ancient times. Modern dentistry also has a long history with sedation, dating from the early 1800s with the first use of nitrous oxide gas.

Modern dental sedation has expanded into an array of drugs and techniques to match varying levels of anxiety intensity. At the milder end of the scale are oral sedatives, taken an hour or so before a dental appointment to produce a calmer state. This may be enough for some patients, or it can be used in conjunction with nitrous oxide.

For those with more intense anxiety, dentists can turn to intravenous (IV) sedation. In this case, the sedative is delivered directly into the bloodstream through a small needle or catheter inserted in a vein. This causes a quicker and deeper reaction than oral sedatives.

Although similar to general anesthesia, IV sedation does differ in significant ways. Rather than unconsciousness, IV sedation places a patient in a “semi-awake” state that may still allow them respond to verbal commands. And although the patient's vital signs (heart rate, breathing, blood pressure, etc.) must be monitored, the patient doesn't need breathing assistance as with anesthesia.

There's one other benefit: The drugs used often have an amnesic effect, meaning the patient won't remember the treatment experience after recovery. This can be helpful in creating more pleasant memories of their dental experience, which could have its own sedative effect in the future.

Whether oral, gas or IV, sedatives are a safe and effective way to calm dental fears during treatment. That could help someone with anxiety maintain their oral health.

If you would like more information on reducing dental anxiety, 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 “IV Sedation in Dentistry.”