Guest Author:  Keith Bracy, DDS

Dr. Bracy practices the full scope of general, cosmetic and implant dentistry in Manhattan. He focuses on minimally invasive techniques and patient education.  Dr. Bracy has extensive experience treating those fearful of dentistry, and believes excellent care begins with careful co-diagnosis and communication.

More information is available at his website drbracy.com

If you are like many patients, chances are you have been postponing a visit to the dentist. In fact, a recent article in the Journal of the American Dental Association, titled “Where have all the dental care visits gone?” by Dr. Marko Vujicic highlights a 7% decrease in dental care visits, with “no need” and “cost” being the top reasons given to skip out on routine dental visits. Everyday, patients describe to me how dental care terrifies them, their fear of judgment by a dentist, and a multitude of reasons why they have delayed dental care. Let’s explore when and why you should see your dentist.

So when should you see a dentist? For the vast majority of patients routine dental visits every six months is the answer. If you are having any symptoms such as pain, swelling, bleeding gums, or toothaches you should seek dental care immediately. You should discuss your risk factors for dental conditions with your dentist, and come up with care schedule to best suit your risks and needs.If you need some motivation to make that dreaded dental appointment, here are 5 reasons why you should not delay.

1. Dental Care is Part of Overall Systematic Health     Oftentimes, patients dissociate the connection between oral health and general health. Your mouth is indeed connected to the rest of your body and what happens there can affect your overall health. There is overwhelming evidence to show that inflammation from common gum disease is correlated with increased risk for cardiovascular disease, diabetes, and pregnancy complications. Although dental cavities are commonplace, left untreated can cause serious infections that travel to other parts of your body.
2. Your Oral Cancer Risk Might Be Higher Than You Think    Your general dentist is your first line of defense against oral and pharyngeal (throat) cancers, through early detection and screening. Your routine dental examination should include an oral cancer screening during which your mouth, throat, neck and head are examined for signs of the disease. Tobacco and alcohol usage are major risk factors for oral cancers, but even if you do not smoke or drink, you can still be at high risk. According to the American Cancer Society Facts & Figures 2015, there has been a recent and rapid rise in oral cancers linked to infection with human papilloma virus in white men and women.2 Early detection and screening can save your life.
3. Dental Disease is Often “Silent”     Most people are unaware of common dental conditions such as cavities and gum disease as they may not show any symptoms or cause pain until it is too late. For example, the gum disease, periodontitis, is a condition in which the gums and bone that hold teeth in your mouth, gradually retreats and deteriorates. You might not be in any pain if you have this condition, and not aware of the problem until the teeth become loose from the retreating tissues. Routine, preventative visits help detect these common problems, and facilitate early treatment that betters the prognosis.
4. Routine, Preventative Care Can Save Money     The fear of the bill, following a dental visit might be scarier to some patients, than the visit itself! However, routine preventative visits can save you money and time. Many dental insurance plans provide for coverage of routine care like exams, x-rays and cleanings at very high rates, if not at 100% coverage. While the same plans often cover basic work like fillings at lesser rates like 80% and major work like crowns at 50% or not at all. If you do not have dental insurance, the fee for a routine exam, where conditions can be detected when small and easily treatable, will be much less than an emergency visit, when a major procedure is needed.
5. Changing Your Smile Can Change Everything     Like it or not, your teeth and smile are the first thing people may notice about you. Furthermore, the way your teeth look and function greatly affects the quality of your life. There have been many advances in dental technologies such as clear aligners to straighten misaligned teeth, dental implants to replace missing teeth, and lasers to change the appearance of your gums . These technologies and procedures can allow you to have the healthy, beautiful smile you always wanted. What your dentist told you was not possible 10 or 15 years ago, might be possible today due to these advances.

Prevention is the best medicine. Don’t delay, see your dentist today!

In my practice, I am finding many people who are having trouble sleeping.  The common factor is the use of electronic devices.  With tablets, cell phones, and TV’s every home fighting for our attention, our minds are finding it difficult to relax and recharge.  Studies have shown that there are light sensitive receptors behind our eyes that help our brains decide whether to get up and tackle the day or relax and prepare for sleep.  With many electronic devices emitting blue ray light, which are the rays which are found to stimulate these receptors the most, and screens so bright our bodies can be easily fooled into thinking it’s daylight.  Ever wonder why you feel a “second wind” after using your tablet even though you may have initially been exhausted.  In particular, TV’s and LED lights in our lamps contain much more blue ray lights than their predecessors.  While technology does simplify our lives in many ways, we need to make sure it is not affecting our health and wellness negatively.  Here are some tips to help you get better sleep.  Think about how even an extra half hour of sleep would make you feel the next day.  Will you be more productive?  Will you be less hungry?  Will you have more energy to run an extra 10 minutes?  Indeed, sleep has many benefits!

• Keep electronic devices out of the bedroom.  If you must have a phone for emergencies, turn it to vibrate and place it upside down on your nightstand.
• Avoid using electronic devices one hour before bedtime.  A Kindle or a reading device that does not emit strong light is fine.
• Start dimming the lights in your home an hour before bedtime.  I strongly recommend putting dimmer switches on your lamps and light fixtures.
• Avoid any television shows or internet media with intense topics.  Some people can get emotionally distressed after watching images of wars, terrorism, or disasters.  This can translate into restless sleep or worry that can affect initiation of sleep.
• Set a reverse alarm.  This is an alarm that you set on your clock or phone for a specific time each night after which all devices must be turned off and lights dimmed or turned off.  This can be quite effective if you are the type of person who likes to surf the web from one page to another or “binge watch” TV series.  Hours can go by without realizing it quite easily!   An alarm would help you to set limits.

Father’s day is a time to thank our dads for the sacrifices they made to make us who we are today.  It’s also a time to talk about men’s health.  Here are some facts that you should be aware about  (unfortunately, it’s mostly bad news but you can change most of it!):

• Men generally live shorter lives than women.
• Men in the US are less likely to have health insurance coverage than women. If you don’t have insurance coverage and live in the US, find out if you qualify here.
• Men are more likely to smoke, drink excessive amounts of alcohol, and work in dangerous professions such as firefighting, mining, and  law enforcement.  It’s important that you stop using tobacco products and drink alcohol responsibly (<2 drinks in 24 hours).
• Men have higher rates of heart disease.  Some of this can be attributed to uncontrolled chronic issues such as high blood pressure, diabetes, and high cholesterol.  Men are less likely to have regular physicals and routine medical follow-ups that can detect and treat these issues before they cause more serious problems. Get your annual physical this month!
• Prostate cancer is the second most common cause of cancer-related death in men.  Discuss prostate screening with your healthcare provider.

The phrase, “one size fits all”, does not apply to health screenings.  Researchers are finding that certain ethnicities have higher prevalences of diseases and that specific screening which takes ethnicity into consideration is important.  Here are some recent guidelines which I incorporate into my practice.

• Asians and Asian Americans:  BMI (Body Mass Index) cutoffs are lower.  Overweight is considered a BMI 23-26.9, above 27 is considered obese.  For Caucasians and African Americans, overweight is considered a BMI 25-29.9, and above 30 is considered obese.  What this means is that an Asian person with a BMI of 23 should be screened for diabetes, hypertension and hypercholesterolemia yearly and encouraged to lose weight through diet and exercise.  Asians and Asian Americans are at higher risk for developing diabetes than other ethnic groups, even if they don’t appear to be “overweight” physically.  The cause is not known, but experts cite environmental and genetic factors.  Here is a link to the Joslin Diabetes Center, Asian American Diabetes Initiative about the topic.
• Hispanics:  As with Asians, Hispanics are at much higher risk of diabetes.  Here is a link to the American Diabetes Association with information on screening and prevention.
• African Americans:  Colon and prostate cancers often appears earlier in this population.  Current recommendations are to start earlier screening from the America College of Gastroenterology and the American Cancer Society are to start screening at age 45 rather than 50 for other populations.  Screening for colon cancer usually consists of a procedure called a colonoscopy, while prostate cancer screening consists of an educated discussion with the healthcare provider about the possibility of tests such as a PSA (prostate specific antigen).  Breast cancer incidence in African American women is lower, but mortality from dying from breast cancer is higher.  This is thought to be due to less screenings performed for numerous reasons.  Here is a great discussion about breast cancer in different ethnicities from the Susan G. Komen website.  High blood pressure is also more common among African Americans, though we are not sure exactly why.  That means blood pressure screening is very important.  Early detection is important, here is a great site from the American Heart Association about the topic.
• Ashkenazi Jewish Population:  Many genetic diseases are common in this population.  These are generally of concern when couples try to conceive.  For example, Tay Sachs disease is a fatal disease that occurs when a child is born from two parents who each have one gene for the disease (the chance is 25% for each child conceived).  Here is a link to find out more about this and other diseases in the Ashkenazi Jewish population from Albert Einstein College of Medicine.

It is always important to ask your health care provider about these and other health screenings on your annual physical exam.  If you have a family history of any diseases you may also be at higher risk and should be screened for those.  Be sure to let our provider know about them.

Want to improve your health and wellness this summer?  Pick up one of these books before you hit the beach!  (Don’t forget the sunscreen and sunglasses!)

The Miracle of Mindfulness: An Introduction to the Practice of Meditation
by Thich Nhat Hanh.  This is a wonderful book about how to incorporate meditation into your life and reduce stress.  Though the author is a Buddhist monk from Vietnam, his technique is universal.  One of the tips I learned from this book is to stop multitasking.  No one truly “multitasks” (try telling that to your boss someday!).  Instead, we “toggle” between tasks, shifting our attention from one focus to another.  Accordingly, we should focus on our attention on the people directly around us, and not be distracted by out electronic devices.  We all know it’s dangerous to drive and text, but it’s just as wise to put the phone away when you want to spend quality time with your loved ones. Live in the moment.

Forks Over Knives by Gene Stone.  This is the book that started an eating revolution and has many celebrity followers such as former President Bill Clinton.  While I have not moved over to a completely plant-based diet, I have seen many patients with cholesterol issues improve their numbers with this lifestyle.

Dropping Acid:  The Reflux Diet Cookbook by Dr. Jamie Kaufman and Jordan Stern.  A MUST for anyone with gastroesophageal reflux disease [aka, GERD, heartburn, reflux, LPR (laryngopharyngeal reflux), indigestion].  Learn what foods can cause your problems and avoid them.  I was surprised to learn that not apples are created equal!  Granny smith apples are very acidic and can make your heartburn unbearable but Fuji apples do not.

Being Mortal:  Medicine and What Matters in the End by Atul Gawande.  We will all grow old and die.  But does that mean we must suffer?  This is a must-read if you have aging parents.  It depicts the current crisis of the US healthcare system as it relates to end-of-life care.