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Dr. Shah:
We have an awesome podcast for us today. Um, we’re going to be talking about beauty and beauty from kind of a dental perspective. Um, I’m pleased to be joined by, uh, not just any guests, but an expert in all things, uh, dental and oral aesthetics. Um, he actually is a kind of a, uh, a neighbor of sorts, uh, down the hallway. Well, I’m in the water tower building and, uh, um, down, which is downtown Chicago. And, uh, basically we’re about what, 20 feet apart, 30, 40 feet apart, right next door. Um, however, uh, due to COVID we are speaking from our respective offices. So you could be all the way in the other side of the world. I wouldn’t, I wouldn’t no idea. I see a rainbow where that, I assume that’s not a window. That’s a picture. Yeah.
Dr. Daniel Aneszko:
Yup. Okay.
Dr. Shah:
Chicago. And, um, so, uh, so this is Dr. Daniel and Nesco, and, uh, he graduated from the university of Detroit in 1999, pursued a general practice residency at Layola, uh, in, uh, oral and dental health in Chicago. Um, and his desire was to deepen his understanding for biomechanics of the jaw, um, related to TMJ and bite related issues. So further training you did, uh, at the Hornbrook center for dentistry, uh, the COI center in a Las Vegas Institute for neuromuscular dentistry, uh, by our research associates. And he uses a lot of CAD and cam technology using Sarah and Invisalign. Um, which for those of you don’t know, Invisalign is probably one of the leading ways of reshaping teeth. Um, in every year he spends more than a hundred hours, uh, staying current with the con continue education with the ever-changing dental industry. Um, I know him because, um, I’ve seen some of his, uh, amazing work, not just with patients I’ve sent over, but some of my staff actually, uh, goes over there as well.
Dr. Shah:
And it is the, um, probably in Chicago. I know it is the highest end, uh, and best cosmetic full mouth reconstructive practice in Chicago. Uh, he’s got a fully digital workflow and, uh, I’m really, really excited to kind of pick his mind about all things, uh, oral beauty, beauty, smile, beauty. Um, and so we’re going to kind of hit a couple of topics over here. Um, and so, uh, and we’ll just kind of vibe back and forth. So first question we have for you is, you know, there’s general dentists and cosmetic dentists. What’s kind of the main difference between the, of them
Speaker 4:
Hold out your shot. I think the most important thing, and as you know, is post-graduate training. Um, so, you know, after dental school, you, you know enough to be dangerous, but it’s not until you actually go. And you further your education by taking postgraduate courses. And then you kind of dive into those kind of the deeper understanding of, you know, understanding the bites, um, understanding how to prepare a tooth for a veneer, um, and just all the postgraduate training that comes with that. So there’s a lot of dentists that, you know, everyone that places a white filling says, they’re a cosmetic dentist. So when we got away from amalgam and then everyone’s placing white fillings, they’re like, oh, I’m a cosmetic dentist. Cause I placed white fillings. Um, and there’s no board certification for a cosmetic dentist. So I think the most important thing is just doing your research. When you do look for, um, improving your smile that you do look for that you look for someone that has more education in specifically cosmetics.
Dr. Shah:
Let’s talk about cosmetic dentist because some people might not know the difference between a regular dentist and a cosmetic dentist. So somewhere one of the things, uh, w what would, if a patient comes, say, I’m looking to see a cosmetic dentist, where are some of the main reasons they come for a cosmetic dentist as opposed to a general dentist?
Speaker 4:
Well, when you’re restoring someone’s smile and you’re actually placing porcelain or glass on their teeth, the biggest thing is you want that to last, and it’s easy to, to prepare a tooth and, and bond of veneer to it. But if you don’t understand the bite in the way the teeth come together, most likely that that porcelain or that glass is going to shear or break. So, um, we’re all about longevity. We want things to last. And when you do someone’s smile, you’re not just doing one teeth, you’re doing multiple teeth. So you’re doing anywhere from two to 12 or more teeth, and function is really important when you’re restoring a smile. So, um, it’s just understanding though, kind of the biomechanics on how teeth work. So your personal veneer is last for 10, 20, 30 years.
Dr. Shah:
Veneers are one of the big things for cosmetic dentistry. How about, uh, someone who comes in and says, I just want my teeth wider. Would they be a good client for cosmetic dentists as opposed to continents?
Speaker 4:
Absolutely. If someone comes in with nice teeth, we are not pushing veneers, we are doing the most conservative thing. So even just getting someone’s gums, like if their gums are red and inflamed, to me, cosmetic dentistry is just getting those gums pink and healthy, or if their teeth are yellow, just doing some, even if it’s crest whitening, strips over the counter or in office zoom whitening, or custom trays. So we always want to start with the most conservative thing, especially someone has a good starting place.
Dr. Shah:
Okay. So, um, let’s just dive into a couple of different topics. So maybe we’ll start with the, um, teeth whitening. Everyone wants white tea by self. I want more tea than it’s always one of the things. So if I go to Amazon and say, Hey, let me just buy, you know, some, some random thing on Amazon and, you know, some teeth whitening thing versus, you know, when you go to a cosmetic dentist and say, Hey, let’s do, um, zoom whitening. Uh, tell me kind of the main difference between doing the crest whitening strips and the let’s say doing or
Speaker 4:
So great question, actually. So if, if you’re buying your bleaching supplies off of E-bay, I would be a little concerned of where that’s coming from, but if you’re getting a reputable, like crest whitening strips from like Colgate or crest, you’re really honestly going to end up in the same place as if you came into my office and you got your teeth white. And if you’re, if your teeth are clean and you don’t have plaque on your teeth, and you’re, you, you just had a cleaning done and you went home and you put a crest whitening strip on your tooth or teeth, and you did that as prescribed for 14 days, you’re going to get pretty bright and white. Um, it wouldn’t really be any different than what you would get from our office. Uh, we would, we just use a higher concentration. That’s going to get you there quicker.
Dr. Shah:
That’s the main thing, because I’ve done press whitening strips, and I’ve done them like maybe like six, seven times, and maybe it’s marginally brighter. How many zoom treatments do you need to do? Like how many, is there a sort of a ratio of crest whitening strips to zoom treatments? Um, so if I said, Hey, I want to get my teeth as white as it, as fast as I can. How many zoom treatments would I need? And then find a press planning trip. There might be like 30 days, great, or 60 days straight, or I might have
Speaker 4:
In one important thing that differentiates zoom is before we do a zoom, we actually Polish the teeth with like a pumice material. So it actually opens the porosities of the enamel. Uh, so the, the, the whitening agent can actually penetrate into the tooth better. So if, if you do have anything, that’s like coding, biofilm, that’s coating your teeth, that crest whitening strip just can’t get in there. So, um, to answer your question, yeah, it’s really hard to say that the, the equivalent, like 30 home sessions equal to zoom treatments, but I think just the zoom treatment with like a promising of the teeth beforehand is a big differentiator.
Dr. Shah:
Yeah. I mean, I think to me that might be that game changer to, you know, when I see patients, um, even my own, uh, uh, you know, staff that have gone there, um, if your office, um, um, my teeth are not as bright white, and I’m not, definitely not that person, um, that, um, it seems like your teeth look amazingly early white right now. Um, so, so I think that, uh, that there has to, that’s the secret sauce. It sounds like it’s, it’s a combination of expertise and opening things up. Um, and so with one to two Zim treatments, you could get your most people’s teeth, um, the degree of what they would
Speaker 4:
Need. Yeah. And then you end up plateauing, your, your teeth will only get so white and then you end up plateauing and then you’re on maintenance at that point. So my recommendation is anytime you have a cleaning right after your cleaning, that’s the best time to either wear your bleaching trays or get another resume, or just do the crest whitening strips.
Dr. Shah:
Now kind of, uh, beyond that, is there anything you recommend for people from a lifestyle choice? Are there things they can do at home or their toothpaste you recommend? Are there habits that you recommend to say, Hey, if you really want to do this, and then kind of as a follow-up to that is how often should they come back for zoom? So let’s say someone has their teeth whitened. Maybe they’re trying to maintain it. Should they go backwards? Zoom? Like every year, every two years,
Speaker 4:
I would say every one to two years is a good recall. Um, and then one thing to pre, to kind of prolong that is something as simple as drinking through a straw. If you love your, if you love your dark coffee, if you drink your coffee black, if you don’t mind drinking through a straw to bypass the teeth, that’s going to prolong the whiteness of your teeth. Um, and same with like, if you like tea and you like green tea and versus a black tea, then maybe stick with green tea. You’re not going to get so much Stayner or discoloration with darker cheese. So I sometimes it’s food choices.
Dr. Shah:
So one thing where the straw, sometimes you can get those little, uh, uh, broker’s lines and run your mouth. So it’s almost a double-edged sword. Right,
Speaker 4:
Right. Then you need filler Botox.
Dr. Shah:
Um, okay. So, um, and with the teeth whitening, so, um, sensitivity with teeth whitening, um, a lot of people complained about a sensitivity with teeth whitening with over the counter products. Uh, how has that with zoom? Is that less of an issue, more of an issue, or kind of,
Speaker 4:
It’s a lesser of an issue because what we’re doing, we’re putting like a liquid dam or like a liquid barrier over the exposed roots, because the reason people have sensitivity when that crest whitening strips wraps on like any exposed root surfaces or like exposed dentin, it’s almost intolerable. I mean, you can’t even keep that on there for more than a few minutes without it hurting. So with zoom, we’re covering all those sensitive areas and just putting a higher concentration gel just on the enamel.
Dr. Shah:
Um, okay, awesome. Yeah, that’s probably why I never get past date two or three with Creswell, and he’s just like, it’s done, it hurts too much. I’m like, okay, it’s not working for me. Okay. Um, kind of a step beyond that. Uh, so someone comes in and, um, uh, you know, they, they want something, uh, you know, with the veneer, who’s your classic veneer patient. Who’s the person coming in for veneers is that, uh, a 20 year old, a 30 year old, a 40 year old. Is it, um, an Instagram star? Is it a,
Speaker 4:
You know, I’ve got to say it’s a lot of baby boomers. Okay. People, uh, that have their kids are off to college and they’ve got discretionary income and they want to feel younger, look younger. So I say to the baby boomers, I would say it’s, uh, the, the 40 year old single female. Um, it is the, you know, th th they come all, all ages to be perfectly honest. Um, because sometimes someone could have nice teeth, but they have spacing and they just don’t want to go through Invisalign. Uh, and they give you the 20 year old something too. So, um, but I would say the majority is at the baby boomer, take the, the 60 plus,
Dr. Shah:
Is there an age that’s too young? You think if someone comes in like a, is a teenager to young bourbon near is a 20, 21 year old, is there not really a, it’s not really.
Speaker 4:
Yeah. I, you, I mean, if, if they’re 18 or younger, if they, if they have like spacing issues or they want to do something cosmetic, we usually just go with composite bonding where we don’t remove an animal. And we just add to it cause to do a veneer typically. Um, I mean, there’s something called a no prep veneer where you don’t have to remove any enamel and you just bond to the enamel. Um, but that’s, if the teeth are undersized, but if someone has teeth that are flared or too big, you have to remove an animal. If they’re under the age of 20, 25, I just kind of cringe when I have to remove kind of healthy enamel. Um, so,
Dr. Shah:
So what’s your take your sweet spot. Like, for example, for me, if someone comes in at, uh, and there’s really no way to lift, but usually for me, for a facelift, it’s going to be at least 45 years old is typically where we’re sort of like, okay, that’s where I want to kind of really, um, you know, for twenty-five year old comes and says, I want an echo facelift. I’m like, you’re not going to, and you need something else. It’s not really that that’s the procedure. What’s your kind of your sweet spot for aids when someone’s coming in. Should you be thinking about veneers?
Speaker 4:
Well, Dr. [inaudible] sometimes we do some, even as like someone has pegged laterals, like their lateral incisors are just undersized and they’re 20, we just do two veneers, done completes their smile. But I agree with you, like come 40 years old if the teeth are worn, um, before these colored.
Dr. Shah:
So, so promotion, if you’re taking a full, full mouth of veneers, but it depends on the mouth. If someone has horrible teeth, they might be an earlier candidate. Sounds like, but if someone had nice teeth when they’re 20 and then with time and age, just kind of starting to shell, um, and what are some of the parameters you can change with veneers? So it sounds like you can, can you make your teeth longer, uh, shorter, uh, angle? Like, what are some of the things when you’re adjusting veneers, what are some of the dementia people can to contain?
Speaker 4:
So that’s the nice thing about vineyards is you have the option to change shape, color. Uh, you can change pretty much everything w with, with your teeth, with vineyards. Um, so the sky’s the limit. Now, if you’re only talking about doing two veneers, then you’re kind of limited to the adjacent teeth and those teeth have to compliment the adjacent teeth. Uh, but if you’re doing a full arch, then you literally can change the size. However you want the shape. However you want the color, however you want. And you’re not limited by, uh, adjacent teeth.
Dr. Shah:
Um, and then, uh, how long does it take to do like a full arch? So it’s so much I want to come in. Do you have to do temporary spurs? Do you have to do like, what’s this whole process? So if I said, I want to get my mouth, uh, throw in some veneers, um, cause obviously there’s more thought than now, but, uh, um, how long does that whole process take?
Speaker 4:
That’s like the number one internet internet question when we get, so it’s typically three appointments. The first appointment is a diagnostic appointment where we do a diagnostic wax up. We sit down with the patient and find out what their chief complaints are. And then we do some cosmetic imaging with a photo, but off of that photo, we can say, okay, we’re going to do eight veneers. And we do that in wax, on a 3d model first. So the patient can appreciate what it looks like in their hand. And then, yeah, it’s really cool to really have like a blueprint before you start. The second appointment is where we numb the patient. Uh, we do any adjustments to the teeth to be able to shrink wrap that, that 3d model onto their teeth, uh, to give them like a trial, like a trial smile. Um, and then they live in that for about four weeks.
Speaker 4:
Uh, and then they can assess a phonetics and see how their speeches make sure nothing’s changed there. Uh, take some profile pictures, make sure their profile is good and I slip support. Um, and then we assess the, the shape of the teeth, how it fits into the smile line with their lips. And then we can make any changes at that point. I always tell patients, you’re not going to hurt my feelings. If you come back, if there’s anything you want to change, this is the time we make those, those, those changes. And then if they are perfectly happy, then we move forward with the final, uh, fabrication of the porcelain veneers. And then that’s when we use like a dental lab where they make everything out of porcelain. Third appointment is to wiggle off the temporaries and to bond in each individual veneer and how
Dr. Shah:
To do, uh, to put all the new in. Is that a full day? Is that,
Speaker 4:
Uh, maybe 90 minutes? Well, that’s not true
Dr. Shah:
At all. And that’s truly the, um, the artistry, right, is when you’re taking someone smile, transforming it into a whole nother level. That’s, you know, obviously the crest whitening strips can only take someone so far. And, um, so you’re really building a brand new mouth for them, a new smile. Um, how important for you when you’re assessing them, is the resting phase versus the smile phase? Do you use a full smile because there’s so many differences in that? What are you looking at when you’re assessing them and giving people guidance?
Speaker 4:
Well, exactly that actually we take a complete series of photos. We take a repose position that arrest, uh, we have them, um, say like Emma and Emma and this relaxed, their upper lip. So we want an incisal display of a couple of millimeters of tooth. And that kind of varies on age. Um, the younger you are, the more incisal display you’re going to have at rest, uh, versus someone that’s going to be, you know, in their sixties or seventies where they show more, more lower teeth. Um, so we take a repose, we take a smile, we take an angled shot from the lateral view. Um, so all those are, all those photos are crucially important for us and the lab in terms of designing the smile.
Dr. Shah:
Now let’s talk about, that’s such an important thing, smile and smile, and design a youthful smile versus an older smell. And you kind of hinted on that a little bit. So equal smile has a little bit more incisors, uh, uh, kind of, uh, an older smell is going to have a little bit lower teeth. Um, do people request to have a more useful smile or do you adjust it based on that? Or is it kinda more important is it’s not just the teeth there’s other factors at play?
Speaker 4:
Well, I would say everyone wants more of a youthful smile, so we always want more incisal display on the upper teeth, but sometimes you just can’t help to show those bottom teeth unless I send them to you. And then you can do your magic in terms of, you know, the lips and enhancing the lips. But, um, we always try to go longer with the incisal edges of the upper T just for that incisal display, it’s just more youthful. And then we, we consider the face and the structure of the face in terms of the design of the teeth.
Dr. Shah:
Wow. Um, and to me, it seems like there’s so many dimensions to adjust to. I mean, you’re looking at the little, I know, I guess not my ear. I know nothing really about, uh, you know, veneers. Uh, but the little I know it seems like there’s, there’s overjet and under Jack and there’s like the ankle and taping that. So it seems like it’s, there’s a lot of, um, and you have to not do it just for one tooth. You have to do this in three dimensions with the whole mouth, which is like, um, wow. Um,
Speaker 4:
And it affects lip support too. You know, if someone has reclined incisors, they lose that lip support. And that’s where maybe Invisalign is a great option because it’s not all about veneers. Trust me. If I don’t have to do veneers, I would rather do Invisalign to move their own teeth kind of where they need to be. So if I can, procline that tooth to add some lip support, uh, that’s the best case scenario. If the Namel is nice, the color is nice. The shape is nice.
Dr. Shah:
Uh, so when you’re doing Invisalign, um, one more time on veneers is how long do they last? So if, uh, what, which is the question, people ask all the time, right.
Speaker 4:
And kind of that, that’s why the whole biomechanics, I think so important because as a young dentist, I had fractured veneers and I’m like, what is going on? You know, two, three years, I’m getting this, this crack in this veneer, why is this happening? And that’s why I pursued kind of further education to find that out. And then once I wrapped my head around kind of what was going on and what was happening with the envelope of function of function with their lower jaw. Um, and if you can plan that out where you consider all those variables, veneers can last for decades. I mean, now that I’ve been practicing 20 years, I have patients that I’ve, you know, after my training, I see patients veneers are in there for 15 years and they look great. Nothing’s cracking, um, things are holding up and, you know, they’re happy and we don’t have to replace a vineyard unless they neglect the flossing and they get a cavity around it or they bite into something or they eat something, they really shouldn’t be eating like ice or, you know, use their teeth, their teeth as a tool to open up a rapper or something.
Speaker 4:
But yeah, veneers can last 10, 20, 30 years,
Dr. Shah:
Do they stay wider than regular teeth, like with live in the air or is it sort of don’t have the same sort of issues that regularly we have
Speaker 4:
The color stability on a veneer, which does not change the tooth underlying, the veneer can change, but the, but the shade of the veneer will not change. Right.
Dr. Shah:
Um, wow. Okay. And then, um, is there any special care besides the, um, mechanical issues? Is there a special, uh, toothpaste, special things that avoid, or is it just sort of like, you just kind of go on living your life?
Speaker 4:
Yep. They’re your teeth, just, uh, floss brush, you know, I just don’t eat things. You shouldn’t be eating like, you know, don’t jump into a lifesaver or again, use your ear to open up a, you name it a bottle, not tools.
Dr. Shah:
That’s not exactly for Invisalign. Um, let’s talk about Invisalign and let’s kind of compare Invisalign to some of these, uh, DIY orthodontic options that are available. Um, some of these options you’ll see, like, um, I’m not super familiar with them. I’ve seen some of the commercials for them, uh, like smile direct and candid. Um, what’s kind of the main difference if you’re going with Invisalign versus one of those, uh, do it yourself, types of options.
Speaker 4:
Well, the most important thing is there’s we take a 3d x-ray to see where the roots are in the bone, uh, which is very important because when you remove teeth, you’re moving roots through bone. So we want to make sure there’s sufficient bone around the teeth, and there’s no periodontal disease. There’s no plaque or tartar on the teeth. So, um, that’s really the most important thing. Uh, now if you’re doing a single little movement and you have a little overlapping and you want to try candid or smile direct club, you know, you can take your chance, but again, going back to the bite issue, if you’re doing a lot of movement and that your bite’s not, you know, a consideration, you’re going to end up with a TMD issue, like a TMJ joint issue, migraines, job pain, because the bite is, is critically important in terms of having muscle harmony with chewing. And
Dr. Shah:
Yeah, and I would say for sure, because, you know, uh, way back in the day I used to do, you know, more trauma and mandible fractures, and essentially it’s not the mandible fracture, that’s the problem. It’s the teeth alignment. And I would imagine if someone’s trying to align their teeth, which is so complex, it’s such a, you have all these different dimensions, three dimensions across, or trying to get the grooves and the facets and everything, all kind of aligned. I think that person’s going to be asking for trouble. I mean, it’s, um, uh, uh, it’s, it’s hard enough to, um, you know, kind of put a bandaid on yourself, but someone to try to line up, it seems kind of borderline, uh, irresponsible, but, um, what are your thoughts?
Speaker 4:
Well in Dr. Shad, there’s a reason there’s a class action lawsuit against a smile direct club right now, too. I’ve had a number of patients, uh, come. And the, the, what I understand is patients going into smile direct, have to sign a waiver saying that they don’t hold smile, direct club, you know, accountable or responsible. Um, but there still as a class action lawsuit is so many patients that I’ve even seen that have come in with jaw issues. And they’re like, my bite is off and now they’re getting recession and bone loss around the tooth, uh, or they move the bone outside of the Ridge. And now there’s a huge bony defect. And these things are hard to fix because you either have to go back into ortho or like orthodontics, or you’re looking at gum grafting. And so it’s a kind of a big deal. I’m actually surprised that they’re still around to be perfectly Frank. Um, we’ll see how much longer they’re around for, but I dunno the do it yourself, orthodontics, I don’t think is a smart move for, for, for patients. I really don’t.
Dr. Shah:
Yeah. I mean, crest whitening strips might be the limit most people should do, but even then, um, you know, if you’re me, you’re going to have some issues with gum, so I can’t do that. So to me, I think it’s, if you’re dealing with something as important as your teeth, um, again, the little I know is, um, you know, when you see people get older, uh, they, most of the time they’re lucky to have teeth. So it’s, it’s a really precious resource. And to try to put that in your own hands, it seems like you’re playing fire.
Speaker 4:
Yeah. I can’t agree more.
Dr. Shah:
Um, okay. So, uh, talking about that, who is your, um, who’s the Invisalign versus what the Dominick’s, so someone comes in, um, and, um, can you do, how much can you do with Invisalign? Um,
Speaker 4:
So Invisalign, I’ve been an Invisalign provider for 13 years now. And initially, you know, it was kind of limited. It was just more spacing, my mild crowding, but Invisalign has advanced a lot in, in the type of patents they have on plastics and the elasticity and the smart forces that that’s within this plastic. And one big difference going back to candid and smile direct club is there’s no attachments, which are like little bumps on your teeth, which once the aligners in place, it allows that aligner to kind of grip that tooth in a special way and make a, make a specific movement on that tooth. So the, the do do it yourself, um, options don’t have that. So now with the attachments on the teeth, in this special plastics there, there’s, I think you can do about 75% of orthodontic cases with Invisalign alone. Now, if you’re dealing with a lot of post cheerier or back teeth crossbites, uh, or you’re doing a lot of translation of teeth, meaning that you’re like moving bodily, the two through bone, um, you know, three, four millimeters, you still, there’s still a place for, you know, hardware where there’s brackets and wires, and you just need that constant force on the tooth.
Speaker 4:
Um, but I would say 75% of malocclusions are like bad bites or crooked teeth or spacing issues can be dealt with with clear liners. Oh, wow.
Dr. Shah:
And so how does it work when you have Invisalign on, is that something you have to wear all day and all night? And then when do you, when are you done with Invisalign? Is this a six month process, a year process, or is it vary from patient to patient?
Speaker 4:
So it’s all case dependent. Uh, if someone has a mild crowding case or a mild space in case it can be as short as three to six months. Uh, and you know, I’ve had cases that were a year and a half, or even up to two years with like open bites where their front teeth don’t even touch and you’re bringing those teeth together so that they’re touching again. Um, but compliance is, is huge with patients and I stress to patients like you have to want Invisalign, you have to come and ask for it, uh, because it’s a commitment. Um, it’s like going to the gym. If you want to transform your body, you, you can’t just go when you want, you have to go regularly. You have to wear these things between 20 to 22 hours a day, uh, for the whole course of treatment in order to kind of transform your smile, improve your bite because in order for it to, to move, you need a constant force.
Speaker 4:
And if they’re in and out and in and out too much, the two Swan God wants to go back where it was because that’s where the socket of the tooth was. And that ligaments that’s pulling the tooth back to where it wants to. So that aligner needs to win that tug of war. It needs to be in there longer, uh, meaning 20 to 22 hours a day, uh, for the whole course of treatment. Once you’re done with treatment, let’s say your treatments nine months then, you know, and then we usually have the patients hold there until the bone remodels around that new tooth position. And then you’re just wearing retainers. And our motto around here has nighttime for a lifetime. As long as you want your teeth straight, you just have to wear your retainers. Cause I would say more than half of our Invisalign cases we do in the office are relapsed cases. You know, patients that have had ortho as kids, as teenagers, quit, quit wearing the retainers years, go by slowly, you know, the teeth shifted around and now they’re, self-conscious because you know, their, their teeth are crooked again. And then we’re back to braces or clear aligners. So,
Dr. Shah:
And to me, that’s such a fascinating change and, um, talks about the, uh, um, you know, how important it is that you can actually shift your bone, your bone around. I mean, that’s just, uh, and you’re not having to like take your teeth out. You’re not having to like where the uncomfortable, so, I mean, that’s just an amazing breakthrough. I mean, it’s probably understanding how important that is
Speaker 4:
In the, the, the guys that invented in V align technology or Invisalign. They weren’t even dentists, they were engineers. So it, it, it really blows my mind still that like, you can do this with a piece of plastic. You can move roots through bone with a piece of plastic.
Dr. Shah:
Um, wow. And how comfortable is it to talk with like Invisalign and having these places, or is it going to impair your lifestyle? I know that, uh, uh, Tom cruise was that a couple of boxers with them. They seem like he was doing okay with that and when he had him on. But, um, is it going to affect someone day-to-day or is it one of those things you just kind of forget about it once it’s in your mouth?
Speaker 4:
I preface it by the first week, it’s going to be strange. You’re going to fumble a little bit on, on certain words. And, um, but after a week, the, the lips and the tongue, they, they adapt, they kind of get used to that, you know, millimeter thickness of plastic on the teeth. And, uh, you power through that first week after that you’re, you’re talking normal.
Dr. Shah:
And then how often do you have to adjust the plastic in there? Is that something, once you put it in you’re there and you’re set, or do you have to kind of keep adjusting that as you kind of go along?
Speaker 4:
So once a week, you, you get a new aligner. So, uh, we give all the aligners kind of upfront. So let’s say if your treatment is 12 weeks, you get 12 aligners each week, you change out your aligner and each aligner slowly puts different pressures on, on the teeth and kind of ends up in that input, the endpoint. Cool.
Dr. Shah:
Um, let’s talk about, uh, um, gums. You mentioned gums earlier. I’m not sure if that’s what we have time to talk about that, but, um, what kind of gun missions do you see from an aesthetic standpoint and, and, and how do you handle these issues when they come in?
Speaker 4:
Well, from like a medical perspective, that’s like truly the most important thing, because there’s a oral systemic link there just with inflammed inflammatory issues, inflammation, bacteria in our mouth. So, um, you know, that’s where we always start in our practice is getting the gums healthy and plus causes halitosis too. I mean, if you’re, if you have any Croesus, if you have inflammation, you’re going to have bad breath. So we get everyone’s gums perfectly healthy before we do any type of treatment. Uh, and that just starts with a good assessment of like probing the gum pockets, making sure that that look gum pocket is healthy. Um, and then it could be something as simple as just a regular cleaning, or it’s going to require some anesthetic in a deeper cleaning where you go down to the root surface and remove any buildup that’s causing kind of a foreign body response.
Speaker 4:
So that hardened plaque or tartar is causing like, almost like a splinter. You know, if you don’t remove that splinter, you’re going to have that inflammation. So once you remove that splinter or that buildup, the gums, just tighten up like a cuff on the sleeve. You know, it prevents food from getting underneath the gum line again, and the gums are pink. They’re tight, they’re healthy. Um, no bleeding, healthy gums should not bleed. Um, and then that’s when we kind of take that next step to whitening composite bonding, Invisalign, veneers, you know, that’s the fun stuff and find out exactly,
Dr. Shah:
Um, with halitosis, um, you know, do do those things work like tongue scrapers, proper tongue scrapers, all list. What’s your list. If someone comes with bad breath and you said, I have to transform their breath, not just their mouth, um, what would be your kind of your, uh, your tips?
Speaker 4:
Gosh, I’m so glad you brought up the tongue scraper is like the underutilized tool that we talk about it with every patient and like, no, I’ve never heard of that. Show it to me, the tongue Harbor, so much plaque and bacteria. Um, and it really is the number one, cause for morning breath, if you would just use a tongue scraper and just before you brush your teeth and just do one swipe forward and see what comes off your tongue, you will be a tongue scraper for life. It is a game changer for people that have bad breath or people that just want to maintain low plaque levels in their mouth. Um,
Dr. Shah:
Is there a recommended brand for tongue scraper? Is there a type that you like to use? Um, what’s your, what’s your,
Speaker 4:
You know, uh, Philips, uh, the, the, the brand Phillips that makes Sinai Sonicare makes like a plastic, uh, blade that’s cheap, it’s reusable. You can use it for months. Um, I, I’m kind of biased towards that. That’s what we use in our office, but there’s like little like handheld spoon. They’re like plastic spoons that you see. I mean, there’s so many different kinds on the market, uh, but whatever works in your compliant with it, as long as it’s not gagging you, because that’s the biggest complaint is all, it makes me gag. If I, if they say that they’re like, well, don’t go so far back, start, you know, on the tip and kind of work your way and go a little bit further back each time until, you know, you can get to, you know, the furthest back you can, without gagging
Dr. Shah:
Aside from the tongue. What about people? The, the mouth, the people, if people ever do anything through the mouth and brush their mouth. Yeah. Not the teeth or the mouth, or is that something that’s a little overkill?
Speaker 4:
Um, I think that’s probably a little overkill. I think that’s where maybe a mouth rinse comes into play a plaque doesn’t really like attach itself to the mucosa as much as it does to like the, like the sulcus or like the gum line or the teeth biofilm typically tends to hang out where the white part meets the pink part, kind of like in that junction.
Dr. Shah:
Um, Dan, uh, for those people who are like this heavy tartar buildup people, is there any tips you have for them
Speaker 4:
Sonicare, you probably care. And in some people they brush, like I’m like they brush everyday twice a day, two full minutes, and they’re still getting built up. They just have a higher mineral saliva, you know, and they’re just kind of behind the eight ball, very, so they just have to literally use an electric toothbrush and literally go for the two full minutes, you know, don’t stop till that brush turns itself off, uh, twice a day minimum. Um, we’re huge fans of Waterpiks. So, um, Waterpiks are really great, especially if you have like bridges implants, cause that Waterpik is going to get in with that water pressure, that floss in a brush just can’t get.
Dr. Shah:
Yeah, it’s a great chip. Um, and then, uh, you talked about that. How about there’s a controversy, some people are against fluoride. Um, that’s been like a recent thing that I’m hearing more and more people about that. Uh, what’s the controversy. What are your thoughts about that?
Speaker 4:
So this is kind of a touchy area, but I, I would say fluoride is great for teeth. I mean, if you, if it’s used topically and you’re not swallowing it now, the whole controversy is especially in women because fluoride competes with iodine in the thyroid. So women are more prone to thyroid issues and thyroid is very important, endocrine glands. So I get it. I understand why there there’s concern about fluoride, especially in young kids. You want them swallowing it because kids, you know, toothpaste tastes so good. They just want to swallow it. But if you can just topically use it and spit it out and not swallow it, it’s going to prevent cavities. And you know, your mouth is the first step of digestion. So it’s not just about smiling. You need your teeth for a lifetime. So it’s a balancing act between being cavity free, preserving your God-given teeth, you know, and, you know, protecting your thyroid and protecting your bones from, from fluoride. So you just have to be responsible for, I,
Dr. Shah:
Yeah, I’ve tried some natural toothpaste, but they don’t seem to make my mouth is fresh. I tried some with a coconut. I tried some with other things in it and after I’m done, like something does not feel right. So I have to go back to my, my fluoride toothpaste and for baking soda. Um, um, yeah,
Speaker 4:
Baking soda is great by the way, in an oil polling with coconut oil is also really great too.
Dr. Shah:
Um, how often do you do people, do you do that and how often should you do that?
Speaker 4:
I have done it. I’ve done it for, you know, weeks at a time, but I just, you know, like it’s in the way he gets get too busy, but if you can do the 15 minute, uh, coconut oil polling, like while you’re in the shower, um, and just lightly kind of swish it around your mouth, you don’t have to do it like you’re doing scope or Listerine, but just keep it in your mouth and kind of pull it between your teeth. If you can hang, you can hang in there for 15 minutes and do that. Uh, I’ve seen people really control their gum disease with coconut oil,
Dr. Shah:
Really putting your mouth. Is it a little bit, or
Speaker 4:
Just, just a little teaspoon, a little bit goes a long way there.
Dr. Shah:
Cool. All right. Um, okay. So, uh, great information today. Awesome. Um, if people want to, um, to reach out to you, what’s the best way they can, they can find you and reach out to,
Speaker 4:
You know, uh, water tower, dental care. Um, it would be the best way.
Dr. Shah:
Um, is that, is that your website?
Speaker 4:
Exactly. That’s the name of our office and our website. Um, so if you just put water tower dental care, uh, Daniel ENESCO, which I have kind of a hard name to S last name to spell. So I, I always go by the practice name, uh, would be our best place in more on Facebook, Instagram under the
Dr. Shah:
Same name.
Speaker 4:
Yep. Water tower, dental care.
Dr. Shah:
Um, and, um, uh, kind of as a final thought, um, is there kind of a dental pack or a home remedy we can kind of leave our listeners with, or, you know, anything related to smile or teeth, or just in general,
Speaker 4:
Dr. Shay, I think you nailed it with the baking soda. I’ve got to say baking soda does an amazing job, like removing the stain and whitening your teeth and something as simple as just even swishing with hydrogen peroxide, which we all have in our house. Literally, if you do that consistently for two weeks, you’ll see your teeth. Whitened is all the active ingredient is in tress waiting strips. And you know, what we use in office is just basically a hydrogen peroxide or carbimide peroxide. And you know, those two, which are inexpensive you can do at home. And just honestly for flossing and brushing, especially now with COVID it’s about home care, just spend the extra time and it’s going to keep you out of trouble. Dentally speaking.
Dr. Shah:
Well, we’re just talking to, makes me want to get something under my cheek right now. So I’m going to sign off, um, you know, Dr. Desco, it’s just awesome talking to you. Thank you so much for joining us. Thank you for so all these
Dr. Daniel Aneszko:
Steps, and I know I’ve learned a ton, just talking to you, you’re the best. Thank you. I really appreciate this time with you. Cool. Thank you so much for joining. Okay. Take care.
