Out With the Old

New-generation technology delivers better results.

Photos by Jordan Pysz.

Shirley Ladd

Like a bird in winter, Shirley Ladd has slowly migrated south across her lifetime. A native of the Canadian providence of Newfoundland, Shirley first moved to Montreal during early adulthood and then to New York.

From New York, the one-time nurse moved to Athens, Georgia, and from Athens, she moved to Port Charlotte following retirement. Oddly, her migration was not a prolonged quest to find warmer weather.

“I like the warmer weather, but it can be a bit much sometimes,” says Shirley, who has been living in Florida for the past 12 years. “I actually enjoy cool weather. But I don’t miss shoveling snow. I’m really glad I don’t have to do that anymore.”

With plenty of family members and friends still residing in Newfoundland, Shirley occasionally travels back home for extended visits. It was during one such visit recently that a dental problem arose that needed immediate attention.

“I was having breakfast one morning when the stud inside one of my crowns broke,” Shirley says. “I ended up going to a dentist there, and he put a temporary on, and when I came back to Florida, I went looking for a dentist.

“Prior to my crown breaking, I’d only had about three dentists in my life, and I’d been looking for a new one for a while because I just had this feeling that I needed to get things checked out and make sure everything was okay.

“In doing that, I’d been to two dentists. One told me I had decay underneath these six crowns I have on my top front teeth, but the other told me everything was fine and that I didn’t have any problems. Then I had the one tooth break in Newfoundland.

“When I came back, I did what I should have done in the first place, which was go see this dentist that I read about in Florida Health Care News. I wanted to go to that dentist, but for some reason I don’t remember anymore, I didn’t. But this time, I did.”

The dentist Shirley had read about and finally went to see is Joseph H. Farag, DMD, of Port Charlotte Dental Care. During his initial examination of Shirley, Dr. Farag found issues with several of the crowns she had on her front upper teeth.

Signs of Aging

“All six of her anterior teeth, which are essentially the upper teeth in her smile line, had been crowned previously,” Dr. Farag reports. “That work had been done years ago, and the thing about these restorations is that they only last a finite amount of time.

“Eventually, and this is especially true with older restorations, the gums recede and the old materials, which have metal in them, start to show. For someone like Shirley, who has those crowns in her smile line, that can become a problem.

“She wasn’t happy that the old material was starting to show and that her gums were receding around them. She wasn’t happy with the way those old crowns felt and the fact that they had become a little discolored and yellow.

“What I also discovered was that, in addition to the aesthetic issues she had with them, those crowns were not really sitting down all the way on her teeth. The margins were not sealed around them, giving her a bit of a problem with the feel of them as well.

“I also found that her gums were quite irritated, which is a sign of the margins between the teeth and gums being opened, allowing bacteria to accumulate in that space. When I explained all this to her and suggested we clean everything up and refresh the crowns, she agreed.”

Dr. Farag’s treatment plan for Shirley called for him to remove her old crowns, treat her gums to rid them of any bacteria and disease, and seat new crowns that would provide Shirley with improved function and aesthetics.

“Her old crowns were made of an older generation of dental ceramic,” Dr. Farag explains. “It’s a very brittle porcelain, and the shade she was given was much more yellow than her other teeth, and as I said, the fit wasn’t really good.

“The material we use to make crowns now is zirconia, and the crowns are actually made of that one material throughout. There’s no layering anymore, and it’s a much stronger material, so there’s no chance of fracture or chipping.

“You can literally hit this material with a hammer, and it can withstand the impact of the hammer. Racecars now use something called ceramic brakes, and that hard, ceramic brake, that’s that kind of utility you get from the material in these zirconia crowns.”

Airtight Fit

Dr. Farag creates some crowns – mostly those used for posterior teeth – in his office. But in a cosmetic case such as Shirley’s, he typically employs a lab technician to build the permanent crowns so that the patient is guaranteed the best look possible.

In creating Shirley’s permanent crowns, Dr. Farag and Shirley settled on a whiter shade of material than she had before. Her new crowns also fit better than the old ones, giving her vastly improved function and aesthetics – “airtight, like a glove,” Dr. Farag brags.

“They’re really nice,” Shirley says of her crowns. “I really like them a lot, and so do my family and friends. They all tell me, Oh, your teeth look really good, so I’m thrilled with the outcome and glad that I chose to see Dr. Farag.

“I like him. He’s very professional and very knowledgeable. I like that he has a lot of high-tech equipment he uses in his work. I was very impressed with him, his work and with everyone in his office.

“Everybody there is so professional, and they all treated me so very kindly. They were helpful in explaining everything that was being done for me. They were all great, and I highly recommend them to anyone.”

Periodontal Do-Over

Of all the positions she filled during her long career in the health care industry, the one that 69-year-old Pam Bicking found to be the most rewarding was the position she held while working for a nonprofit organization called Healthy Start.

“Healthy Start is a program that helps women with their pregnancies,” Pam explains. “It especially helps women who are on Medicaid, and what we try to do is improve pregnancy outcomes. I was what they call a Mom Care Advisor.

“I loved the job because it made me feel like a mom myself. A lot of the women I dealt with were younger, had never been through a pregnancy and didn’t know which way was up. I helped them get through it all.”

The mother of two grown children of her own, Pam had to get through a medical issue herself a couple years ago when a toothache prompted a trip to the dentist while visiting a daughter in Atlanta. During that visit, Pam learned her toothache wasn’t her only dental issue.

In addition to that bothersome tooth, one that the dentist said would likely need to be extracted because it was on the brink of failing, Pam learned she was also suffering from a severe case of periodontal disease, or gum disease.

“I wasn’t surprised to hear about the gum disease,” Pam admits. “My mother had problems with her gums and so did my sister. And when I brushed, my gums would bleed. Not a lot but enough that I knew there was probably a problem.”

Pam soon learned that her gum disease was bad enough that in addition to affecting her fast-failing tooth, it was also endangering her other teeth. Resolving the problem long-term, the dentist said, would require periodontal flap surgery.

Armed with that information, Pam returned to Florida, where she soon visited a dentist who confirmed the original diagnosis and agreed that a periodontal flap procedure, in which the gums would be repaired surgically, was indeed her best option.

Despite being a bit apprehensive, Pam agreed to have the surgery. She changed her mind just a day or two before the scheduled surgery, though, after reading an article in Florida Health Care News about a more modern fix for severe gum disease.

“The dentist in Atlanta had mentioned this procedure, but I thought there was no way it was available in Port Charlotte,” Pam reveals. “Then I read this article about a dentist who did the procedure here, so I went out and called him right away.”

Regenerative Procedure

Photos by Jordan Pysz.

Pam Bicking

The dentist Pam called is Dr. Farag, and the procedure she read about in the paper is a revolutionary gum treatment called LANAP®, which stands for laser-assisted new attachment procedure.

“Pam first came to me primarily because she wanted to learn about LANAP, so I told her all about it; then, I examined her,”
Dr. Farag remembers. “It was after the examination that I told her I thought LANAP would work very well for her.

“One reason for that conclusion was because she told me she was going to have a tooth extracted during her visit with the other dentist. I could see why someone might want to extract that tooth, but I also thought that, with LANAP, we might be able to save it.

“It wasn’t a dead tooth. She just had a periodontal infection and not necessarily an abscess. If we do the LANAP, we can wait and see how that tooth looks after the procedure and decide whether it really needs to come out or not.”

Encouraged by what she learned of LANAP, which would not only rid her of her periodontal disease but offer her a chance to salvage her failing tooth, Pam agreed to undergo the LANAP procedure.

Dr. Farag considered it a wise choice, largely because he strongly believes that LANAP provides far better results than the traditional flap procedure, during which a dentist uses a scalpel to remove the diseased tissue.

“With the flap procedure, you cut the gums open and then you scrape the diseased tissue out, clean the roots, scrape the bone, and when you’re done with all that, you sew it back together,” Dr. Farag explains.

“It works, but the result is usually a very high gumline, a lot of recession, gum loss and sensitive teeth. With LANAP, we get even better results without that gingival recession because we’re not cutting the tissue.

“What we do instead is use the laser to make small troughs that are three hairs thick between the gum and bone. We then put our instruments into that gap and debride, disinfect and sanitize all the way to the bone and flush all the bad stuff out of there.

“The gums actually stay where they are, so it’s a nice way of getting up in there and cleaning things out and disinfecting and sanitizing the periodontal pockets without cutting everything open.”

In addition to healing gum tissue, LANAP can also improve bone quality and density. In some cases, it can even spark the regeneration of bone, according to Dr. Farag, who treats a patient’s entire mouth in three phases during a visit that lasts about two hours.

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

More Brushing

Pam says that sticking to a soft-food diet for a few days following the procedure was a small sacrifice that she was more than willing to make to avoid the invasive nature of the periodontal flap procedure.

“What I really liked about the LANAP procedure was that it didn’t involve any cutting or stitches and all that recuperative time afterward,” Pam says. “And this procedure takes care of your whole mouth in one visit.

“It wasn’t painful at all, and now, when I brush my teeth, there’s no bleeding. I brush my teeth and floss more than ever now because it doesn’t hurt to brush, and I really want to take care of my teeth.”

One of those teeth that Pam is now taking better care of is the molar she was in danger of losing. Just as Dr. Farag suggested, the LANAP procedure allowed her to save that tooth while improving the status of several others.

“That tooth was such a bother because the pockets were so big around it that food would get stuck in it sometimes,” Pam says. “But I haven’t had a problem of any kind with that tooth since the LANAP procedure.

“I am very pleased with the results of the procedure. And I couldn’t be happier with Dr. Farag and his staff. I get regular cleanings from them every three months now, and they take such good care of me.

“I really appreciate everything they’ve done for me. And if it weren’t for Florida Health Care News, I wouldn’t have found them. I don’t know how my teeth and gums would be had I not read that article, but I doubt they’d be as healthy as they are now.”

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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