If you have diabetes, you already know that the disease affects the body in numerous ways. The gums and teeth are no different. For some patients, your dentist may even be the first to notice diabetes symptoms. Here are a few things you should know about the connection between diabetes and your dental health.

What is Diabetes?

Diabetes is a disease in which the blood sugar, or blood glucose, is too high. This is because the body does not produce sufficient insulin or because the body is unable to utilize insulin properly.

Patients with type 1 diabetes are typically diagnosed as children or young adults. For these patients, the immune system attacks the cells within the pancreas that produce insulin, so the body is not able to produce sufficient insulin.

Type 2 diabetes can occur in patients of any age and is caused by the body failing to produce or use insulin well.

How Does Diabetes Affect Dental Health?

There are a few ways that diabetes can affect the teeth and gums. Diabetes is associated with gum disease, which is also known as periodontal disease. This is an inflammatory process of the gums which causes the gums and jawbone to pull away from the teeth and lose attachment. Those with diabetes are at a higher risk because of a decreased ability to fight infection and heal properly.

Diabetic patients are also at a higher risk for tooth decay, or cavities. Due to high blood sugar levels, increased acids can erode the surfaces of the teeth, including enamel and dentin. This issue also causes gingivitis, a precursor to periodontal disease.

Thrush is also a concern for patients with diabetes. Thrush is a fungal infection that is caused by the yeast Candida albicans. Symptoms of thrush include white or red patches within the mouth which are painful. Diabetic patients should be especially careful with their dental hygiene routines to avoid thrush.

Finally, patients with diabetes often experience dry mouth due to a lack of sufficient saliva. Also known as xerostomia, dry mouth can lead to other dental problems including tooth decay, gum disease, or thrush, as the lack of saliva decreases your natural ability to cleanse the teeth throughout the day.

Symptoms to Look Out For

Symptoms of diabetes include excessive thirst, frequent urination, weight loss, and fatigue. In terms of dental symptoms, you may also experience dry mouth, inflammation or bleeding of the gums, difficulty tasting food, or poor wound healing within the mouth. Children with diabetes may also have teeth that erupt at an earlier age than average.

Dental Treatment Options for Diabetes

It’s key for patients to carefully manage their blood sugar levels to best avoid dental complications related to diabetes. Dr. Chern will also recommend that you have regular dental check-ups and cleanings. Maintaining good oral hygiene is an important way for diabetic patients to avoid issues including gum disease, cavities, and thrush, which they are at a higher risk for. Dr. Chern can also advise the best ways for you to maintain your oral hygiene through your regular, at-home routine. These include brushing your teeth at least twice a day, flossing at least once a day, and avoiding smoking.

How Often Should Diabetic Patients Visit the Dentist?

Patients with diabetes should visit the dentist at least twice a year for professional cleanings and check-ups. If you notice any symptoms such as inflammation of the gums, bleeding, or teeth becoming loose, schedule an appointment as soon as possible.

Schedule an Appointment

To schedule an appointment with Dr. Chern in Manhattan, New York, call (212) 838-0842 or request your appointment online.

Tooth damage and decay can not only affect your oral health, but they can be a source of self-consciousness if not treated. Fortunately, porcelain crowns are a great long-term solution. It can seem daunting to wonder what to expect, so talking with your dentist about your options is a great place to start. Here’s what to know about the process and how porcelain crowns can help transform your smile.

What is a Porcelain Crown?

A porcelain crown is a fixed prosthetic that is attached to the tooth. Crowns replace the entire outside of the tooth down to the gum level, and are designed to look and feel the same as your natural, healthy teeth. This sets porcelain crowns apart from crowns made from other materials (like gold or other metals) which are more noticeable. Metal crowns vary from porcelain crowns in terms of their durability and biocompatibility, so each type will come with some benefits.

Why Do I Need Porcelain Crowns?

Most patients who opt for crowns are trying to preserve their teeth after damage or decay. If a portion of the tooth is visibly damaged, your dentist might recommend porcelain crowns to repair the tooth and improve your smile. In some cases, porcelain crowns can be placed on either side of missing teeth in order to support a dental bridge.

Porcelain Crown

What is the Porcelain Crown Procedure Like?

During your initial visit, Dr. Chern will take a look at the damaged or decayed tooth and prepare it to receive a crown. This involves reshaping the tooth by filing the top and sides so that the crown can properly fit around it. During this step, Dr. Chern will also treat any decay. An impression of the tooth is then made so the crown can be custom-made. Our porcelain crowns are always custom-made and sculpted to suit the size, shape, and color of your teeth so your results aren’t noticeable. Porcelain crowns are made in a dental lab, so you’ll need a second appointment to have the crown fitted.

Once the porcelain crown is made, it can be placed over the tooth. Dr. Chern will first make sure it properly fits and make any adjustments before permanently cementing the crown in place. After placement, Dr. Chern will schedule a follow-up appointment to check up on your crown and make sure it’s functioning properly.

How to Care for Porcelain Crowns

Getting the most out of your porcelain crowns is largely dependent on a good oral hygiene routine. Make sure to brush your teeth, including the crown, twice daily using an electric toothbrush or a manual toothbrush with soft bristles. You should also floss daily or use a Waterpik. Make sure to cut back on soft drinks and sugary foods to minimize further decay, and schedule regular dental checkups every 4-6 months with Dr. Chern. This can help you maintain your results and keep a healthy mouth for the long term.

Schedule an Appointment

Porcelain crowns are an excellent option for restoring your smile and keeping your teeth healthy. To meet with Dr. Chern and learn more about your options, we invite you to contact our New York City office by calling or filling out our online form.

If you’ve ever had concerns about your oral health, you know it can be stressful to wonder if it’s time to call your dentist or not. There are times when it’s appropriate to call your dentist and even necessary. At other times, you can simply manage the issue at home. Here’s a cheat sheet for the most common symptoms and what to do to alleviate them. 

Tooth Pain

Tooth pain and toothaches are usually caused by cavities, infected nerves, and fractured teeth. NSAIDs such as ibuprofen or naproxen can help relieve pain. If medications are needed to alleviate the pain, it’s important to contact your dentist as soon as possible to schedule an appointment. If you need to wait to see your dentist because it’s nighttime (and pain is often worse at night), it can be helpful to sleep propped up on a few pillows and to take an NSAID before bed. This can often help with throbbing. If you’re traveling and the pain is severe, contact your dentist and their office can prescribe antibiotics, which can ease an irreversibly damaged nerve until you can come in for an appointment.

Jaw Pain

Jaw pain can be caused by increased tension in your head and neck muscles or damage to the TMJ rather than your teeth. Occasional jaw pain can be managed with medications and compresses. The key is to mention occasional discomfort at your next check-up appointment so that your dentist can find the source of your pain. Jaw pain can be an indicator of a clenching or grinding problem. If the pain in your jaw is constant, it’s important to contact your dentist as soon as possible to get a diagnosis and start working on a treatment plan so permanent damage to your joint and teeth doesn’t occur. Patients with jaw pain should generally avoid chewing gum, hard foods, and opening their mouth too wide. Treatments for jaw pain include NSAIDs, muscle relaxer therapy, oral appliance fabrication, Botox therapy, dental restorative therapy, and sometimes surgery.

Sensitivity

Sensitivity while eating or drinking things that have extreme temperatures can be an indication of gum (periodontal) issues or cavities. In this case, it’s important to see your dentist to find the source of the sensitivity. If the issue is cavities, restorative dentistry can alleviate the problem. If the sensitivity is gum-related, then there are some options like special toothpastes, cleanings, and grafting surgery. If you can’t see your dentist right away, stick to milder foods and start on a toothpaste such as Tom’s of Maine Rapid Relief (specially formulated to help sensitivity in 60 seconds) or Sensodyne. 

Swelling

Swelling (with or without pain) is a major concern and can lead to hospitalization and death. If you have any head or neck swelling, call your dentist as soon as possible. Swelling can grow quickly and cause issues with breathing. If you have issues with swallowing or breathing, bypass your dentist and go straight to your emergency room or call 911. Dental swellings can be treated with antibiotics, root canal therapy, extraction, and drainage procedures. Dental swelling is one of the more serious issues in dentistry and should not be taken lightly. This will not resolve on its own so contact your dentist as soon as you notice a change in the symmetry of your head and neck!

Schedule a Consultation

Maintaining optimal oral health is important and will contribute to your overall health! Our integrative approach will provide you everything you need to know to stay healthy and symptom-free for the long term. Make an appointment today with Dr. Chern and her team to get started on a better smile! You can get started by calling or filling out our online form.

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:

[et_pb_video src=”https://youtu.be/ClQqi87UAoQ” image_src=”//i.ytimg.com/vi/ClQqi87UAoQ/hqdefault.jpg” 

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!!!