Word of Mouth

Patient recommendations pave way for dental restorations.

Photo courtesy of Sue Chaplin.

Sue Chaplin

With more than ten billion tons of raw materials, finished goods and foodstuffs being moved across the US by truck each year, the trucking industry is considered the lifeblood of the US economy.

Without those trucks, economists fear the economy would come to a virtual standstill. That’s why the service company Sue Chaplin took over after her husband passed away a few years ago is so important.

“The company is like AAA for trucks,” Sue explains. “When a truck breaks down anywhere in the United States, the driver calls into a call center, and we have vendors that will go out and find the driver and their truck and get them moving again.”

With the help of her son, Sue runs her family’s company from the home in Punta Gorda she moved to after spending the previous 38 years in Green Bay, Wisconsin, where she raised her family and helped her husband create and run the company.

“Green Bay is a great place to raise a family,” Sue says. “The people are all very nice and friendly, but it’s very cold there. So, we built a home in Florida and moved here in 2013. My husband died a few years after we moved, in 2016.”

Before passing, Sue’s husband became a patient of Joseph H. Farag, DMD, of Advanced Dentistry of Fort Myers. Sue, 71, says her husband used to rave about Dr. Farag’s work. She remembered that recently when a dental problem of her own arose.

“It wasn’t long after we first moved to Florida that I was eating an olive that I didn’t know had a seed in it,” Sue explains. “When I bit down on that seed, it cracked a tooth, and I went back to Green Bay to get it fixed.

“They wound up doing a root canal, but it must not have been done correctly because it was always very tender and had kind of a zing to it. About the time my husband died, it was really bothering me, so I decided to see if Dr. Farag could do something about it.”

Though it was the problem stemming from the root canal that prompted Sue to visit Dr. Farag, that was not the only issue she voiced a concern about during her first visit to Advanced Dentistry of Fort Myers.

“The other problem was one I’d had for a number of years,” Sue confesses. “At first, I didn’t think it was a dental problem because it started out as me getting earaches and having some slight neck and jaw pain. But over time, it just got progressively worse.

“I went to a few medical doctors for it, but none of them ever put together what the problem was. One of them actually told me, No, you don’t have an earache. I knew that I did, of course, and knew that I had this constant neck and jaw pain, too.

“I think it was probably due to the stress of my husband passing, but about three years ago, it got really bad. So while I was visiting with Dr. Farag, I mentioned this pain I was having to him and asked him if he had any idea what may be causing it.”

More Than Meets the Eye

It didn’t take long for Dr. Farag to solve the mystery behind Sue’s discomfort. During his initial examination, he found she had previously undergone an extensive dental restoration, the finishing touches of which were proving problematic for her.

“She had received a number of crowns,” Dr. Farag reports. “In fact, most of her teeth had been given crowns. The problem was that the crowns as they were weren’t allowing her teeth to meet properly when she closed her mouth.

“Bottom line, she had a bite problem. Because the crowns weren’t meeting properly when her mouth was in the closed position, her jaw was not resting properly. That’s what was causing the earaches and the neck and jaw pain.”

Dr. Farag’s discovery came with a bit of bad news. Though he had clearly found the cause of Sue’s pain, it became immediately clear to him that the only way to resolve the issue and rid Sue of her discomfort was to re-crown all of her teeth.

“I really thought I might have to live with this problem forever. But Dr. Farag took care of it, and I’d recommend him to anyone because he’s very thorough, very patient and he obviously does great work.” – Sue

Knowing it was the best thing for her, Sue agreed to what amounted to another full dental reconstruction. This one, however, proved to be a bit more extensive, in part because of the cracked tooth she created when she bit into the olive pit.

The repair of that tooth, a lower molar, required more than just a crown. Because the crack ran so deep, it required the tooth to be pulled and the root to be replaced with a dental implant.

Dental implants are screw-like posts that are made of a titanium alloy that are surgically implanted within the bone of the patient’s jaw. Once the implants are in the jaw, they fuse over time with the bone and become a solid unit.

It typically takes three to six months to complete the fusion process, but once that solid unit is formed, it provides stability for an abutment, which is then capped off with a crown for a single tooth or a partial or full denture for patients replacing multiple teeth.

Dr. Farag also provided Sue with an implant for a tooth that was missing. In that case, he first had to perform a bone graft, where bone particulate is injected into the empty socket to ensure the jawbone will support the implant.

“The bone graft does a number of things,” Dr. Farag explains. “One of those things is, it helps to maintain the volume of bone that is already present in the jaw so that we don’t have any atrophy in the height, width and depth of the bone.”

Bone grafts are not always necessary. When they are, it takes about three months for the bone to heal to a point where it can receive and support an implant, which is put in place with the aid of a computer-assisted, 3-D guidance system.

A Comfortable Fit

Photo courtesy of Advanced Dentistry of Fort Myers. The crown itself looks like a real tooth and is fashioned out of ceramic using a machine that allows the dentist to make it on the spot on the day it is screwed onto the implant. In Sue’s case, this crown was one of more than 20 that Dr. Farag created for her.

“We did all of her lower teeth first and got her into temporary crowns, which I kept her in for about three months,” Dr. Farag says. “We did that so that she was sure she was going to be comfortable with the fit.

“We eventually had to make some adjustments, but we finalized both the lower teeth and the upper teeth, including another implant where the crown wasn’t fitting right. She now has the comfortable bite she was missing and is out pain.”

The entire reconstruction of Sue’s mouth took about two years to complete, but Sue says the outcome was well worth the investment in time. She says her teeth now look and feel better than they ever have.

“The best thing is that the earaches are gone,” she exudes. “So is the neck stiffness and jaw pain. Everything fits the way it’s supposed to now. I’m so glad I went to see Dr. Farag, because he solved this longstanding pain problem I had when no one else could.

“I really thought I might have to live with this problem forever. But Dr. Farag took care of it, and I’d recommend him to anyone because he’s very thorough, very patient and he obviously does great work.”

Arrested Development

Syracuse, New York native John Eastman decided at a relatively early age that the cold, snowy Northeastern winters weren’t for him, so about eight years ago, he and his wife packed up their lives and moved to Florida.

Now an inventory specialist for Charlotte County Fire and EMS, John currently spends not only his winters but every other season making sure the fire trucks, ambulances and animal control trucks used across Charlotte County stay in tip-top shape.

“Whenever one of those emergency vehicles needs a part, I order it, and I keep a stock count of everything we have and what we use the most so that we have everything we need to keep those vehicles on the road and running,” John relates.

“What I do now is a bit of a combination of what I used to do in New York, where I worked in the parts department for J.B. Hunt Transportation and spent about fifteen years serving as a volunteer firefighter.”

John’s New York-based firefighter training did not transfer to Florida, so his days as a volunteer firefighter have been put on hold. He recently wound up fighting a three-alarm fire all his own nevertheless.

“I was not one of those guys who went to the dentist all the time, and it eventually caught up with me, because I got to a point recently where I could not brush my teeth without my gums bleeding and bleeding badly,” John explains.

“Every day, my gums would bleed when I brushed my teeth, and I also had what I later found out was tartar build-up on the back of my bottom front teeth that was breaking off. At the time, though, I thought it was parts of my teeth that were chipping off.”

Those two issues sparked an earnest search for a dentist that began with John asking some of his co-workers for recommendations. One co-worker recommended he visit Dr. Farag at Advanced Dentistry of Fort Myers.

“This guy could not say enough good things about Dr. Farag, so I decided to see if he could take me on as a new patient,” John relates “When I called the office, they said to come on in, so I went ahead and gave Dr. Farag a try.”

John first saw Dr. Farag the first week of January 2018. During that visit, Dr. Farag learned that John was a heavy smoker who had neglected his teeth for years. A full examination revealed the result of those habits was a severe case of periodontal disease.

“We noticed he had a lot of deep pockets in the gums around his teeth,” Dr. Farag explains. “Most of those pockets were five millimeters deep, but in some cases, they were up to ten millimeters deep, whereas healthy pockets are between one and three millimeters.

“In addition, the x-rays we took showed he had a lot of bone loss around the teeth and that there was a great deal of tartar build-up on his teeth. Both of those were signs of a chronic condition that was ongoing.”

Regenerative Procedure

Photo by Fred Bellet.

John Eastman

Based on his findings, Dr. Farag recommended John undergo a specific minimally invasive laser treatment that he’s been performing for more than a decade called LANAP®, which stands for laser-assisted new attachment procedure.

LANAP is not the only treatment option for patients suffering from periodontal disease, but Dr. Farag considers it best because it improves the attachment between the gums and teeth, does not result in a gross loss of tissue or gum recession and is pain free.

“If you use another laser with a different methodology, you’ll end up with tissue harm, necrosis or a recession of the gums around the tooth bridge,” Dr. Farag educates. “We do not want the gums to recede because that can make the teeth appear longer. The goal is healthy gums that reattach naturally to the teeth, and LANAP does this without harming the healthy tissue.”

Another reason Dr. Farag recommended the LANAP procedure for John is because of the significant loss of bone he had suffered around his teeth. In addition to healing gum tissue, Dr. Farag explains, LANAP can also improve bone quality and density.

“The LANAP procedure does improve the quality of the existing bone, and in some cases, we can re-grow bone,” Dr. Farag confirms. “But in cases involving a smoker such as John, we’re often happy if we can stop the bone loss.

“Smoking amplifies the periodontal disease. It makes it worse because nicotine in the cigarette constricts the capillaries, which are the blood vessels in the tissue, stalls healing and creates an environment where bacteria thrive.

“Those bacteria thrive because they’re not getting attacked by the immune system. Blood supply to the tissue is reduced. There’s some, but the tissue is not healthy, and that’s why heavy smokers usually have worse cases, including more bone loss.”

In John’s case, the bone loss was, in some areas, significant. Though the loss was 20 percent in most areas, there were areas where the loss was nearly 40 percent and some others where it was greater than 70 percent.

Because of the bone loss and the advanced nature of his periodontal disease, John was on a track that would have resulted in him eventually losing several teeth. That bottom line made him an ideal candidate for the LANAP procedure, which John agreed to.

“No Discomfort at All”

“My only hesitation was that I have a problem holding my mouth open for long periods of time because I always begin to gag,” John says. “That’s one of the reasons why I’ve never really gone to the dentist a lot.

“But Dr. Farag assured me everything would be fine and gave me a very light relaxant of some kind, something I took about an hour before the surgery and that helped to settle me down, which made the procedure even easier on me.

“And just like Dr. Farag said, it really was pain free. I was surprised by that, because the thought of a laser cleaning between my gums and teeth scared me. I was thinking, How can this not hurt? But it didn’t. There was no discomfort at all.”

Despite the advanced nature of his periodontal disease, John’s LANAP procedure took only about two hours to complete, which is typical. During those two hours, the entire mouth was treated through three steps.

“The treatment worked great, so if you need it, don’t hesitate to get it. And if you need to get it, get it done by Dr. Farag. My experience with Dr. Farag was by far the best dental experience I’ve ever had.” – John

Dr. Farag explains that 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 teeth, making it brittle and easy to remove.

During the second step, the tartar is removed with a fine-tipped, vibrating, ultrasonic instrument. The teeth are then rinsed with an antimicrobial substance that halts the growth of new bacteria. During this step, the diseased lining of the tissue is removed and the bone surrounding the teeth is debride of infected tissue.

Finally, during a third pass of the laser at a different setting than the first two, 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 patient doesn’t have any sensation of what we’re doing during the procedure because we use a local dental anesthetic, just as we do if we’re doing a filling,” Dr. Farag says. “That’s how patients stay comfortable during the process.

“And there is no post-op discomfort because we’re not traumatizing anything. The gums are not inflamed, so they’re not painful. Afterward, however, we do ask patients to briefly stay on a soft-food diet to prevent any tearing of the new tissue that’s forming.”

That soft-food directive wasn’t the only post-procedure instruction John received. He was also ordered not to smoke during the healing process. For a man with a nearly two-pack-a-day habit, that figured to be a difficult order to follow. John managed, however.

“Dr. Farag told me that if I smoked at all during the healing process, it would do more damage than what I had in the first place,” John notes. “So, I didn’t. From that day on, I literally did not smoke one cigarette for four months.”

John recently resumed his smoking habit, but he says he is smoking only about ten cigarettes a day now and is on a “quit plan” that he is confident will rid him of the habit for good. Meanwhile, his gums have healed nicely, and his overall oral health has improved markedly.

“My teeth feel much, much better, and there’s no more bleeding when I brush anymore,” John exudes. “I’m forty-five years old, and for the first time in my life, really, I’m taking care of my teeth the right way because Dr. Farag and his staff showed me how to brush and floss properly. Now, I know why my buddy couldn’t stop talking so highly of Dr. Farag.

“The treatment worked great, so if you need it, don’t hesitate to get it. And if you need to get it, get it done by Dr. Farag. My experience with Dr. Farag was by far the best dental experience I’ve ever had.”

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    • Advanced Dentistry of Fort Myers

      Dr. Farag looks forward to hearing from readers of Florida Health Care News. Their office is conveniently located  at 16601 San Carlos Blvd. in Fort Myers. For more information or to schedule an appointment, please call (239) 466-3131.... Read More

    • Katrine A. Farag, DMD

      Katrine A. Farag, DMD, earned her Doctor of Dental Medicine degree from Nova Southeastern University after completing her undergraduate studies in neuroscience at Vanderbilt University. She is a member of the Florida Academy of Cosmetic D... 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