Currently, our world and society are in a pandemic of epic proportion. This global pandemic has changed the way we live our lives and staying home has been the primary message to help minimize the spread of disease. Many people are concerned about their overall health and the strong correlation between systemic and dental health can’t be ignored. So the question becomes, how do we maintain our dental health and can we see our dental healthcare provider? The American Dental Association (ADA) has recognized its members and patients who have questions about whether dentists should continue to provide care during the COVID19 pandemic. Our Midtown team at New York General Dentistry is working hard to provide care to our patients while complying with the guidelines set by the CDC and the state of New York.

How to Prevent Transmission of COVID19?

The primary steps to follow in any pandemic is prevention. What steps can you take to protect yourself and those around you from contracting this novel virus? It is important to follow the 5 steps set by the World Health Organization to prevent contracting coronavirus.

  • Wash your hands often for at least 20 seconds.
  • Cough and sneeze into your elbow.
  • Don’t touch your face with dirty hands.
  • Keep a safe distance from others (6 feet) and avoid group gatherings.
  • Stay home at all costs unless unavoidable.

COVID19 and Receiving Dental Care

One of the main questions that we have been receiving during this time is: can patients still receive proper dental care during this pandemic. It is important during this time to adhere to the ADA policy of emergency treatment only. Any elective care can be postponed till the pandemic lessens in magnitude. This restriction protects the patients, staff and doctor. The ADA has listed different dental procedures that can be rescheduled or need to be taken care of right away:

Non-essential Dental Care

  • Regular visits for exams, cleanings, and x-rays
  • Regular visits for braces
  • Removal of teeth that aren’t painful
  • TMJ treatments
  • Treatment of cavities that aren’t painful
  • Elective cosmetic procedures such as veneers, botox, bonding and tooth whitening

Essential Dental Care

  • Bleeding that doesn’t stop
  • Pain in a tooth, teeth, or jawbone
  • Gum infection with pain or swelling
  • After surgery treatment (dressing change, stitch removal)
  • Broken or knocked-out tooth
  • Biopsy of abnormal tissue
  • Snipping or adjusting orthodontics that are causing pain
  • Denture adjustment for people receiving radiation or other treatment for cancer

This pandemic has led to major disruptions in everyday life and medical treatments. We are implementing these measures to ensure that we keep our staff, patients, and our society safe and healthy. If you need emergency dental care, feel free to contact us for the next steps.

How to Maintain Your Oral and General Health While Quarantined?

When quarantined at home, make sure to follow your regular routine of hygiene. If you have extra time, try to set the goal of improving your oral hygiene so when you do see your dentist, there is less of a chance of issues (cavities or gum disease). Some tips to maintain oral health are:

  • Eat healthy and nutritious foods. Think of vegetables and fruit.
  • Floss or use a water flosser at least once a day
  • Brush at least twice a day for 2 minutes
  • Have vitamin-c on hand to increase general health.
  • Rinse with mouthwash to reduce gingivitis.
  • Try to stay active.
  • Meditate to keep calm, stress can lower your immune system and increase inflammation.

What to Do in Case of a Medical or Dental Issue?

If you have a medical or dental issue during this stressful time, reach out to your healthcare provider as soon as possible to be screened for the level of emergency and proper next steps. It is crucial to avoid the emergency room in every way. Our office has implemented Teledentistry and FaceTime consults to aid in diagnosis and treatment. If you have any questions at all, feel free to contact our Manhattan team. We are working together to help stop the spread of this novel virus to keep everyone safe and healthy.

Final Note From Dr. Chern:

I have been involved in dentistry for almost 30 years from roles as a dental assistant to dentist. There was never a time in my life where I could not practice the profession that I love, so this has been a very humbling experience for me. Everyday that goes by, I miss my staff and patients, who have become my family over the years. Helping people with their oral health was my purpose for so long! I am hopeful this will all resolve soon and meditate every day on what the lesson for all of us as a society is? I truly believe that only after a disaster, can we be resurrected. I am hoping that as a whole our society is resurrected for the better!!!

The evolution of oral health as a function of systemic health has bought dentistry into the forefront of integrative medicine. Issues with tooth alignment and oral cavity size/shape and oral inflammation have links to sleep apnea, diabetes, cardiovascular issues, and a slew of other health issues.

I’m happy that dentistry has become a huge part of systemic health. I want to believe I’m helping people past the mere counting of teeth and filling cavities.

This being said, many people are afraid to come in for care. Often when a lot of time has gone by, they worry about being judged. Patients also harbor different expectations of pain and discomfort based on their previous experiences.

Overcoming anxiety

I recently had lunch with a friend who happens to be a patient of mine. We went for lunch prior to his appointment and he shared with me the slew of anxieties he usually faces prior to his medical and dental appointments. I asked him what he does to overcome them. Interestingly enough, he brought up CBD (cannabidiol) oils and tablets.

This prompted me to start reading a bit more literature on CBD products and how they pertain to dentistry and anxiety. What I found was truly amazing and prompted me to try the tablets for myself.

I make a habit of trying new products, dental or otherwise, before speaking to patients about them.

Finding the right CBD product

First of all, CBD products are not regulated by the FDA and are legal. Still, it was crucial to me to find a brand that had a great reputation for quality. Most CBD products can be purchased in stores or online and come in tablet or oil form in varying concentrations.

My experience with CBD

I decided to try a very small dose prior to going to bed when I was having a hard time falling asleep due to stress.

I felt very relaxed upon waking, but wasn’t convinced if this was a placebo effect or the merits of trying the CBD. I shared my experiences with a few colleagues and friends and found that many other dentists have tried the various products with similar success.

So, what is CBD???

The compound CBD (cannabidiol) is one of 113 identified cannabinoids found in cannabis sativa. It works directly on Serotonin and GABA receptors in the brain.

CBD research has mostly been conducted in animal studies and a few human studies, but is growing in popularity for several key systemic benefits. It has been shown to help with anxiety, sleep issues, seizures, acne-control, and inflammation. There is even some discussion as to whether CBD can cure cavities — although far more research is needed.

Dentistry and CBD

Insofar as dentistry is concerned, the anti-anxiety and inflammatory benefits of CBD are truly remarkable.

Many of my patients suffer from anxiety related to their healthcare appointments and most people suffer from differing levels of periodontal issues caused by inflammation (gingivitis). I can definitely see benefits in further research into those two categories.

A natural pill or oil that eases anxiety, yet leaves a patient fully functional while also lowering systemic inflammation and gingivitis sounds like a dream to me!

My conclusion

I am not yet fully ready to start recommending CBD products to patients as a form of treatment, but am definitely willing to have a conversation urging more research be done in that arena.

I also think it’s important to ask patients if they are using any medications (prescribed and herbal). When patients ask me about my thoughts on CBD, I urge them to make their own decisions and recommend they find a reputable company to purchase the products.

Personally, I like to take them occasionally before bed when I find it hard to fall asleep and would love to see more evidence-based research to support the benefits so I can start recommending them for anxiety and as an anti-inflammatory.

Natural products are a staple of my work and personal philosophy!

In the past year, I have embarked on an amazing journey to expand my dental knowledge in the direction of preventive and educational dentistry. Two years ago, I left my part-time position in academics to focus on private practice. But I missed the teaching aspect of my career and so decided to dive in to Spear Education. I have subsequently been doing online work for the past year and have gone to Arizona to their facility to train twice.

Sleep apnea prevention with airway prosthodontics

The most fascinating part of this experience is their new focus on airway prosthodontics. This is not to be mistaken with sleep apnea dentistry. Sleep apnea dentistry is the final result of a problem that the Spear Education system says can be predicted and even prevented with early intervention.

Evaluating (and improving) how you breathe

Airway prosthodontics is the evaluation and treatment of the breathing systems of an individual which may cause a multitude of problems including:

  • Bruxism (tooth grinding)
  • Poor sleep quality
  • Sleep apnea
  • Irritability
  • Cardiovascular problem

Don’t ignore tooth grinding and clenching

In my practice, as many as 80% of my adult patients grind or clench their teeth. Research shows that 50% of these individuals are likely to have airway issues. This number jumps to almost 100% in children under the age of 12.

Traditional treatments

The traditional approach to treatment is to make a night guard for adults and wait for children to “outgrow” this problem.

Recent airway theories maintain that the para-function of the jaw is to help the body get more air. With the traditional approach, the problem is already there and we are merely putting a bandage on it and not curing it.

In the realm of sleep apnea, the treatment involves appliances which move the lower jaw forward to open the airway, or CPAP appliances which push air into the airway with a mask worn during sleep. Unfortunately, research shows most patients are noncompliant with these forms of treatment due to discomfort. The average time spent wearing them is about 1-3 years.

Is there a better way?

These facts were very disheartening for me and I was eager to see if there was a better way to treat and identify these problems. At Spear Education, I began to learn how to identify people with potential problems.

The premise of what I learned was that a dentist can be the first person to identify possible airway issues. I started to ask people with bruxism and clenching about their sleep and if they had any issues breathing. I also started to look for people with septal issues in the nose and scalloped tongues which appeared big in the mouth and placed more emphasis on the alignment of people’s teeth.

Here’s what I found…

With this newfound information, I discovered a lot of people have some kind of issue involving their breathing and have never been approached by their healthcare provider — let alone a dentist.

I felt like I opened a door to helping people not only with their teeth but also with their systemic health.

The Seattle Protocol: Prevention, Treatment & Resolution

The Spear philosophy uses a format they have called the Seattle Protocol. It is a 6-step program that focuses on prevention, treatment, and resolution of the problem. The most interesting part of the protocol is the first step of nasal breathing training. Some people have a hard time breathing from their noses and can be trained in as little as 14 days to breath through their noses.

I have subsequently tried this method based on the Buteyko breathing clinic manual with great results. Watch the video below to learn more:

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The remaining 5 steps of the protocol have to do with appliance therapy of different forms, which act to open airways. Once a patient is comfortable and breathing better, a resolution step to get them out of an appliance is formulated using a multi-disciplinary model. The resolution step involves multiple disciplines, such as otolaryngologists, orthodontists, and oral surgeons.

The key is that a patient will be given the steps to final resolution and not be forced to live with “bandages” forever.

Continuing my journey and helping my patients

I am still learning more about the role I can play in airway health, but this new addition to my dental knowledge has added a layer to my profession that can really impact people‘s systemic health. This is very rewarding!

By the time most people are diagnosed with sleep apnea, they often have several other problems including cardiovascular disease, diabetes, depression, anxiety, and oral issues such as bruxism.

I look forward to educating patients both young and old about not only their oral health but the signs of possible long-term problems related to their breathing.

If you’d like to learn more about your airway health, schedule your appointment at New York General Dentistry today.

Recently, I’ve noticed something at my practice. There’s a growing number of patients who come in for routine care and complain of TMJ related problems like tooth grinding (bruxism) and clenching. Even more surprising is that patients of all ages are suffering these problems. At New York General Dentistry, my patients range in age from 3 to 92 years old and anyone can suffer from TMJ pain.

After a thorough comprehensive exam of the TMJ and evaluation of a patient’s medical and dental history, I’ve found nearly 60% of my patients report some form of TMJ pain starting at as young as 7 years old.

The dangers of teeth grinding

The biggest problems associated with grinding and clenching are TMJ damage, wearing away of healthy tooth structure, and head/neck pain, which includes migraines and tension headaches.

TMJ pain

The temporomandibular joint, or TMJ for short, is the joint which contributes to the movement of the jaw and connects the lower jaw to the head. It has a thin disc which separates the two components. When a person grinds their teeth, they are exerting up to 5 times the normal force on the disc. The disc can thin out or skirt up leading to clicking and popping sounds and chronic pain. The deterioration of the joint can happen abruptly or over the course of several years.

Enamel loss

The wearing away of enamel from the teeth is an equally concerning matter.

The forces from grinding and clenching can be up to 800 pounds per square inch. This extreme force can cause enamel to break or wear away over time. People with fillings and dental work often come in with broken restorations caused by grinding and clenching. In many cases, their restorations are fairly new and would normally last longer.

Another consequence of lost enamel is that the facial structure begins to collapse. If you’ve ever seen a person with no teeth, they often look sunken and sallow. This same effect can occur over years of grinding and clenching.

Head and neck pain

The final issue of head and neck pain is often overlooked by medical doctors. When a person is grinding their teeth, the muscles in the face and neck area are in spasm. If you were going to the gym for a workout and overdid it…you’d be sore …RIGHT?

The same happens to the muscles of the face and neck, which can manifest as neck pain and migraines.

What causes tooth grinding?

The direct cause of tooth grinding is not fully known. However, a huge contributing factor is stress. Anything you can do to alleviate your stress will definitely help.

Stop grinding your teeth at New York General Dentistry

For patients who grind their teeth or who suffer from TMJ pain, I start by taking an extensive history of the symptoms and performing a thorough TMJ evaluation.

I may recommend occlusal splints, nightguards, and acupuncture. Now there is even evidence that Botox can work wonders in relaxing the muscles that cause the grinding.

The most important step is to see your dentist and start the process of diagnosis and treatment. Want to learn more? Schedule your consultation today.

As a whole, our society is focusing on being more environmentally conscious. For the first time in decades the ozone layer is shrinking and to me that’s proof , that we are slowly but surely doing something right.

As a dentist, I always like to find ways our profession can contribute to preserving the environment. Toothbrushes are a key goody bag product in our office and we order hundreds every few months for the office. The plastic they are made of fills landfills and takes years to degrade. I was curious to find and alternative material to help solve the problem with these plastic toothbrushes.

I stumbled upon a company out of Australia, which started mass producing bamboo toothbrushes. Invented by a Brisbane dentist, The Environmental Toothbrush is made from bamboo, a natural cellulose fibre, the handles are biodegradable, environmentally sustainable, and do not pollute the environment. The amazing growth and self-renewing ability of bamboo means that deforestation is not necessary either and their packaging is bio-degradable.

I have ordered a few for myself and the office and am pleased with the results. My teeth are happy and I feel good about my contribution to helping the environment. Similar brushes can be found in Whole Foods and natural markets as well!!!