Ring Out the Old

Brighter, Whiter Smiles.

If you’ve purchased or even just admired any hand-painted porcelain plate, vase or figurine over the past 20 or 30 years, it may have been the work of 83-year-old Wilma Manhardt that attracted you to the piece.

Wilma Manhardt and Janice Valmera chose Dr. Farag to treat their dental issues and they’re very glad they did.

Wilma Manhardt

Wilma has been hand-painting everything from stylish home accent pieces to bric-a-brac since she was a young girl growing up in Dusseldorf, Germany, where her son now runs the porcelain art business she opened there before moving to Florida in 1989.

“It took me two years, but I trained all the employees there how to paint porcelain, then turned the business over to my son,” Wilma explains. “I’m retired now, but I love my painting and teaching others how to paint so much that I still stay busy with it.”

Wilma’s appreciation for detailed craftsmanship extends beyond that used to ornament knickknacks. It is, in fact, one of the reasons she recently began looking for a new dentist after some of her old dental work began to show signs of aging.

“Some of the work I’ve had done over the years was not done very well,” Wilma confides. “And some of it was just starting to look old, so, I started looking for a new dentist. And I found one, but the employees there were always changing, and I didn’t like that.

“I never knew who I was going to see when I went there, and then one day about two years ago I received a copy of Florida Health Care News in the mail. I read an article in there about a dentist nearby and I thought, I should go see him.”

The dentist Wilma read about in the article is Joseph H. Farag, DMD, of Port Charlotte Dental Care. Dr. Farag practices a full scope of general, cosmetic and implant dentistry, and upon first examining Wilma, he confirmed her belief that she was in need of some updated dentistry.

The Can-Do Dentist

“I could see right away that she had not had anything updated in a number of years because she had a lot of old metal crowns, and the gum line was receding around many of them because you could see the metal margins,” Dr. Farag explains.

“The good thing was that she had gotten a lot of good years out of that old dental work she had done. She just felt that now was the time to update it and make it look and feel better and she picked a very good time to do it.

Wilma Manhardt and Janice Valmera chose Dr. Farag to treat their dental issues and they’re very glad they did.

Updated dentistry gave Wilma a more appealing smile.

“The reason is that some of the crowns, for example, had aged to the point where they were beginning to trap food and plaque around those margins. That makes the teeth harder to clean and leads to decay.

“And the x-rays showed that there definitely was some decay in some of her teeth. There was also a little bit of decay surrounding some of the old patch fillings that had been done over the years.

“It was just aged dentistry, and on the lower right side she had a broken tooth. Also, particularly throughout the lower teeth, I could see that she had been getting some periodontal treatment for gum disease.”

The most pressing issues existed in Wilma’s back teeth, but she agreed to have a complete restoration done that included restoring some of her worn out front teeth, the benefits of which would leave her with a much healthier, better looking smile.

Dr. Farag began his restoration of Wilma’s smile by doing a full-mouth disinfection, which is a deep cleaning of the gums, the results of which create a foundation for stronger, healthier teeth. He then pulled the broken tooth on the lower right side.

After pulling that tooth, Dr. Farag did a bone graft to prepare Wilma for an implant, which is a titanium root-shaped body that is surgically placed into the jaw bone. The implant supports an abutment and a crown, which is attached to the implant, creating a new tooth.

Dr. Farag then tackled the task of changing out all of Wilma’s old porcelain-fused-to-metal crowns – 18 in all, including 12 on the top and six on the bottom – and replacing them with new zirconium crowns.

“I don’t have any lines around any of my teeth anymore, and all my teeth look the same – very bright and white, just the way they should be.”- Wilma

Fashioned through a digital imaging machine used by his lab technician Bob at All Smiles Dental lab, zirconia crowns have become the gold standard of dental crowns. The advantages of the zirconia crowns, Dr. Farag says, far outweigh those made of other materials.

“With the old crowns, the porcelain was baked over a metal cover, so there were two layers,” Dr. Farag explains. “But now, we mill these zirconia crowns out of a single solid block of zirconia, which is a much stronger material.

“Zirconia is at least five times stronger than porcelain, and that allows these crowns to be very thin. For example, a 0.5-millimeter thick zirconia crown is actually stronger than a 1.5-millimeter thick porcelain-fused-to-metal crown.

“The advantage that gives us is that we don’t have to cut off as much of the natural tooth as we used to in order to fit the crown over it. We can get a very strong and very natural looking tooth and keep more of the original tooth.

“Zirconia is also very hard and very impact and wear resistant, so it won’t chip. With the old crowns, when the porcelain would chip it would leave little potholes where the metal would show through on the tops of the molars and at the margins around the gum line of the tooth.

“That was part of the problem that Wilma was having. But you don’t have that problem with zirconia crowns, because they’re made of one monolithic uniform material that allows us to end up with a very strong natural looking tooth.”

Zirconia is naturally white, but its appearance can be altered – or in the case of creating crowns, shaded – to match the color of a patient’s existing natural teeth. That leaves patients with a much more appealing and confident smile.

“A lot of times we’re just matching something,” Dr. Farag says. “But if we’re doing a completely cosmetic case where we’re working on the teeth you see when a person smiles, we’ll ask the patient what shade they’d like to have and give them that.”

Dr. Farag also used a zirconia crown to cap off the implant that was put in place of the broken molar he pulled from the lower right side of Wilma’s jaw. The results, Wilma says, are as beautiful as some of the plates, vases and figurines she paints.

“I don’t have any lines around any of my teeth anymore, and all my teeth look the same – very bright and white, just the way they should be,” Wilma reports. “I can’t imagine my teeth looking any better than they do now.”

Dr. Farag says he’s not surprised with Wilma’s response.

“I was always confident this would prove to be a good experience for her,” he says. “I knew that the dramatic change from the old metal crowns to the zirconia would make a tremendous difference in her smile and it really has brightened it up a lot.

Right on Time

Janice Valmera has always had a rather high tolerance for pain. It’s a trait that has served the Punta Gorda resident and local restaurant manager well over her 47 years. That trait met its match, however, this past February when one of Janice’s teeth became abscessed.

Wilma Manhardt and Janice Valmera chose Dr. Farag to treat their dental issues and they’re very glad they did.

Janice Valmera

“The abscess developed on the upper right side in the back, around one of the molars,” Janice relates. “I usually deal with pain pretty well, but this pain was really bad. I mean, it was crazy bad. Some of the worst I’ve ever experienced.”

Being the trooper that she is, Janice attempted at first to fight through this pain as well. For several days she took TYLENOL® or Aleve®, particularly before she went to bed, in the hopes that it would at least allow her to sleep through the night.

That attack plan worked for a day or two, but when the pain refused to subside Janice’s husband told her to pick a dentist associated with his health care plan and make an appointment. The dentist she chose was Dr. Farag.

“I probably should have gone to see him a lot sooner than I did,” Janice relates. “I’d been dealing with some gum issues and some toothaches for about seven years, but I was always too busy to really do anything about it and kept putting it off.

“Then I got this abscess. When I finally decided to take my husband up on his advice and go have something done about it, it was more out of convenience sake that I picked Dr. Farag. He was close by and I just figured I’d try him.”

During his initial examination of Janice, Dr. Farag found a couple of issues outside of the abscess that needed to be treated as well, but the abscess and the severe gum
disease that had caused it were by far the most pressing.

Laser Tag

Dr. Farag began his treatment of Janice by first prescribing Amoxicillin to help rid her of the abscess. He then suggested Janice undergo advanced laser assisted periodontal therapy using the LANAP® protocol to rid her of her gum disease.

LANAP, which stands for laser-assisted new attachment procedure, is the only FDA-approved two- to three-hour-long periodontal treatment in which the entire gum line is treated by making three passes across the gums with a special dental laser and sonic equipment.

During the first laser pass, the energy from the laser kills any bacteria in the gums, vaporizes the diseased gum tissue and dehydrates the tartar on the tooth, making it brittle and easy to remove. This is also the step during which the diseased lining of the tissue is removed.

During the second phase, the tartar is removed with a vibrating fine-tipped ultrasonic instrument, while the pockets are flushed with an antimicrobial substance that stops the growth of new bacteria.

Finally, during the third pass, an antimicrobial seal is created that prevents re-infection and releases growth factors from blood cells that help regenerate the  attachment between the gums and the teeth.

The entire procedure, Dr. Farag emphasizes, is painless. So is its aftermath.

“The great thing about the LANAP procedure is the speed of recovery and the tissue response,” Dr. Farage educates. “It doesn’t take weeks or months. It literally takes just a couple of days, which is truly amazing.

“When the bacteria or the tartar or the insult that is causing the inflammation and infection is removed from the tissue to the point where it’s sanitary, which is what the laser does, the tissue heals ever so quickly.

“The analogy I use with patients is, say you cut yourself while working in the garden or just because you work with your hands a lot. You get that cut and if you don’t clean it and don’t put Neosporin on it, you’ll go for days and it will burn and get irritated.

“It will eventually heal but it will take a lot longer and you’ll feel it. But if you get a cut and you clean it, sanitize it, disinfect it and routinely put an antimicrobial on it and keep it clean, it will heal very quickly without pain and without scarring.

“That’s what LANAP does. It cleans, disinfects and sanitizes, and the body just heals up really quickly afterwards, which is something that is very hard to do in the mouth because our mouths are not a clean environment. They’re filled with bacteria.

“And when there’s that constant flow of bacteria in the mouth, it just makes it harder for the gums to heal. But when you remove the bacteria and the tartar and the plaque in the entire mouth at once, they heal quickly.”

“Dr. Farag is a very compassionate, caring dentist. I actually look forward to going to see him now, because the work he does is so good.” – Janice

Janice says she was initially a bit apprehensive about having the LANAP procedure done, her fear being that it would be a long and painful process. She was pleased to discover that it was in fact quick and painless.

“It was very easy,” Janice relates. “They numb up your gums, so you don’t feel anything once they’ve given you the Novocaine, and most of the Novocaine shots were painless as well.

“As far as how long the treatment took, I’d say I was probably out of there in a little under two hours. And that included Dr. Farag removing two teeth. I had all of that done in one day, which I thought was incredible.”

The only thing more incredible, Janice notes, was the result of the LANAP therapy. She says her abscess began to clear up within a few days and she felt an immediate sense of relief from the laser procedure that has continued for months.

“My gums used to bleed a lot whenever I would brush my teeth and they were painful. I used to ignore the pain,” Janice reveals. “But now, there’s no more bleeding and no more pain. My mouth is a lot healthier and I’m working to keep it that way.

“Dr. Faraghas taught me a lot about how to properly take care of my teeth, and I’m following his orders. He’s really a very compassionate, caring dentist. I actually look forward to going to see him now, because the work he does is so good.

“I remember the day I first showed up for the LANAP surgery, another patient was in the waiting room and she was telling me how good Dr. Farag and his entire staff are and how nice they are, and she was absolutely right. They take great care of you.”

Wilma says she came to realize the very same thing after making Dr. Farag her dentist.

“He’s very nice and he makes you feel really comfortable,” she says. “I remember after he first started to tell me about all the work he was going to do and why he was going to do it and what the benefits would be, I developed a very strong sense of confidence in him.

“I could tell he knew what he was doing and that there weren’t going to be any problems. And I really like the fact that whenever I go there, the same nurses and hygienists are there and that they’re always so welcoming and friendly.

“When I see the same people working there it tells me they really like working there. It’s like a family working together to help you feel better. That was a big thing for me.

“I read a lot of articles about Dr. Farag before I went to see him and now that he’s been taking care of me, I know I made the right choice. I thought from all that I read that he stood out from all the others and I was right. He’s the best.”

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    • Port Charlotte Dental Care

      Dr. Farag provides a full range of quality, caring dental services to the Port Charlotte community. He looks forward to hearing from the viewers of the Florida Health Care News website. For more information or to schedule an appointment, pl... Read More

    • Joseph H. Farag, DMD

      Joseph H. Farag, DMD, earned his Doctor of Dental Medicine degree from the University of Florida College of Dentistry, Gainesville, FL after completing his undergraduate degree at Florida Atlantic University, Boca Raton, FL. Dr. Farag served an... Read More