What NYC's Top Dentists Taught Me About Toxic Dental Work

Today on Midlife Conversations, I've got a power couple. We're talking with NYC smile design. We're talking dental. And I really wanted to do this today for a number of reasons. Number one, I've been going through my own detox journey as many of you have been following along. I went through the process of removing my amalgams. I'm now thinking about taking out my one root canal, even removing my pfm. And I have a lot of questions, a lot of questions, as I know you do too. So I wanted to have Dr. Rob Ramin Tabib and his wife, Dr. Elisa Milo here because they are cosmetic dentists, but they also concentrate on the health of dentistry too, which I like. That unique combination. I specifically wanted to talk with them versus just talking. Right. With a biological or, you know, holistic dentist. I love those. But I really wanted to get a more well rounded opinion, not a biased opinion. And that's why I wanted to have them on. I'm going to be asking them about amalgams, about root canals, about bone loss as we age, age, about porcelain fused to metal crowns. Do we need be concerned about that? About dental implants, ceramic versus titanium. What happens if we don't do a root canal? I want to ask about fluoride. I want to ask about cosmetic procedures. So many questions. So you'll want to hang on and listen. Thank you so much, both of you for being here today.

It's our pleasure.

Thank you for having us.

So let's back up a minute. I just want to get a little bit of your backup story. First of all, did you all meet in dental school since you, you are married and you run this practice together?

Well, I'll start, you finish. We both graduated the same year, but different schools in New York City where we never knew each other. Oh, so we didn't know we existed. So we got a job at a, we did our residency separate places and then we were, you know, just fresh out of residency looking for a job and we were both being interviewed the same day for the same job, for the same job in a big practice. And we're both sitting in the waiting room and Elisa was constantly checking me out.

And you know, they always say that. The guy always says that, right.

And so interestingly enough, we both got hired and we both started the same day at the same job and the relationship sort of started like that as friendship and we were just good friends and you know, she asked me out and then I said yes.

So we just think happened exactly how it happened.

Yeah, love that now, what you both don't know about me and what my listeners don't know about me is my actual first job after college was in dental. I worked in a dental lab, and I used to sell to dentist John Dennis. I used to know the idea of doing different types of lab stuff that I wanted them to send to our lab. And then I moved into a dental implant company, which I worked with for a number of years. So I know a lot more about dental than I ever thought I would know. And so this is a really, really important topic to me, especially as I've learned how it relates to my. My detox journey. So I have so many questions for both of you, so you can educate.

Us a little bit, too.

But, you know, but it's funny because some of my opinions about it have definitely changed over the years. Like, years used to say in the dental implant world, don't do a root canal, do a dental implant instead, because that's what I was taught. But now I hear bad things about implants, too. So I have so many questions for you. I'm just going to jump right in, if that's okay. Let's start with kind of the. The basic one, the amalgam fillings, because most my listeners are of the age where that was standard of care. Tell us about amalgams. Did Dennis still do them? Why do they do them? And do we need to be removing them if we. We have them?

You want to go? You want me to go? Go. So, yeah, I mean, amalgam is a very old, archaic restoration that was invented, let's say, in the 1800s, 1850s. And it's, it's a very controversial topic because American Dental association was really organized around dental amalgams because what happened was a lot of the barbers were placing dental amalgams and it became an economic situation. So they created the American Dental Associations to protect the dentists from losing the business, the business to barbers, and because they were doing all the profits. So the whole organization is really based around amalgam fillings. So to the point that if they said amalgams are bad and we need to eradicate them, there'll probably be a lot of lawsuits against them. So it's a very political thing. That's my feeling. That's my philosophy on it. When a product has been around for 200 years and they're. One of the ingredients is mercury, which is the most poisonous ingredient is. Why would you want that? I don't care if you tell me it's inert. I don't care if you tell me, oh, well, it's amalgamated with a whole bunch of metals and it's inert. No way. I mean, there is, there, there's a possibility that that could leach into your system and cause damage. So are dentists still using it? Yes. Should they be? No. Why has a lot of European countries banned it? And a lot of them have in the process of banning it and US hasn't. So it's something that I think is a really awful product and it needs to be removed. And of course, the removal of it is another controversy too, because you can.

Just remove that when you cut it.

Yeah, it, you get exposed to that. Right. When you cut it. So, so if somebody has amalgams in, should they be removing them? That's the first question I'm going to ask you about how to remove them properly. Should they remove them or do you, do you suggest they leave them alone?

Well, I think it depends on how they're coming in. Most, most patients will have old amalgams in their mouth and they may have them in like, I don't know, like 16 teeth, 12 teeth, like in all the back teeth. Because before there were sealants, before there was fluoride, before there was all this, you know, great home healthcare, you know, people got a lot of decays and therefore they got a lot of fillings.

Sure.

And that filling material was amalgam. So what I usually suggest to patients who are worried about it, if this is an old breaking down filling that has been in your mouth more than 12 years, this should be removed.

Okay.

If it's a very tiny one and it's shiny and it's smooth and, you know, we can wait on that. As opposed to somebody who has like, you know, 10 of them in their mouth and they're breaking down and they're leaching, you know.

Yeah, yeah. For me, the more urgent it is to remove them, the less you have, the less urgency that makes sense. They're really, you know, sometimes it's a little tiny.

It's not even on a biting surface.

You know, it's fine. You're not going to be that armed by it. But again, if you want to remove it, I'd say yes, remove it. But I think the more you have the urgency to remove, it increases dramatically. And it's not just what leeches out the silver. Mercury filling can expand and contract differently than a tooth expands and contracts. So if you drink something hot, the metal will expand at a different rate than a tooth does.

Wow.

It expands differently. It'll Cause little micro cracks. And those micro cracks will never be visible through an X ray or never cause harm. And the harm may happen when you're chewing on it and a whole cusp of a tooth breaks off at some point. And, and I take, every time I've taken out an amalgam filling, I've seen cracks within it. Yeah, all the time. It's, it's, you know, what if that crack is there, what do you think happens? The body will try to protect itself. Right. Because it knows something is leaking and something cracked. So it starts to protect its by forming a secondary dentin layer to ward off against bacterial invasion and anything that's forming there. So you start to make more dentin underneath it, which is a good thing. But it's insidious because you basically can have a silver filling and not know you have a problem with it. Yeah, almost. The pain with the silver filling is so gradual that almost disappears. You may have a major problem, have no pain because it's so gradual. Still something cracks open or you can get a blown out decay underneath it. A lot of times what I'm seeing is cracks or openings within the silver fillings and tons of cracks with it. And we have to protect it by putting a mesh underneath it to protect the cracks that are in between. So there's a lot that has to be done, not just for removal. And how do you rebuild it and protect it afterwards?

So, so basically not only do you have a restoration that has mercury in it, it's. It's also damaging your tooth more and almost predisposing you to more dental treatment. So it's just on a few different levels. It just makes sense to have them removed.

When you making sense now over the years until I went to the removal, why I would have a filling and then years later they'd be like, oh, it's a bigger cavity now or it's a bigger problem. It's like this never ending thing.

Sure.

I also want to share that. So when I was going through my whole gut health journey, which many of my listeners are familiar with, I did a total detox test and it showed that I had mercury in my system. And so where is the mercury coming from? I believe it was coming from the amalgam filling, that slow leakage over time. So that's a big reason I wanted to remove it. Which brings me to that next question about removal techniques. Because do you have to go to a biological or holistic dentist? Can a general dentist remove it? Can only certain cosmetic dentists remove it? And what's the proper way versus the not proper way? Like, my husband just went to remove his and they just drilled it right out. I'm like, what are you doing? Where?

With me.

There was a rubber dam. It was a whole process, I think.

I think, I think it's. It's not who does it, it's how they do it.

Right.

And you can explain that.

Yeah. I mean, you can go through such extremes in removal of it. Are, you know, at some point you have to say, do I need to go to a hospital setting in order to have this removed? And some of the recommendations are really drastic. You walk into a room and it's air filters. And. Yeah, I mean, it's a little bit of a dog and pony show. I don't know if it's that critically important. We went through that process where we wanted to do it, by the way.

They put the air filter.

They did the whole thing, air filters, you know, having chlorophyll and all that stuff beforehand. Yeah, it's critically important. But the most important thing is the rubber dam. You know, 90% of 98% I think, is of the protection is the dam.

Especially for the patient.

It's not just rubber dam, it's the proper placement of rubber dam. Because a rubber dam, if it's not price placed properly, it has leaks all around it. So you have.

Wow.

It takes a lot of dedication and time to seal that dam properly, to tie the dam down properly. I mean, I went to courses in Europe to learn how to place a rubber dam, which is pretty intense. There is no dentist in us who would go through that. Europeans are crazy about placing rubber dam. They're. Some of them are fanatics about it and some of them are just unbelievable. The artistry in placing a rubber dam, it. It blows you away when you start.

To see one versus it probably relates to how they. They've banned amalgam, so it, you know, it all kind of flows together.

Different story there too. Yeah, because they banned it, so now they're really worrying about probably getting in trouble for doing it wrong on their removal. You mentioned fluoride earlier, and I want to ask about that because you said that we used to get a lot of cavities because there wasn't fluoride. I grew up on well water, so I had lots of cavities. But now fluoride's controversial, so especially in the health space and. And I'm even bought into it where I'm like, I need toothpaste without fluoride. How much of that Is true or not true.

Okay. My feeling is that it's controversial no matter what you say. Right. Fluoride in the water system. I think it's not necessary. Do we need Lipitor in the water system to ward off, you know, so at what point do you say you need to have a. It's an epidemic that needs to be controlled with substances that you put in the water. So I feel that that is not something that should be done.

Okay.

Because you don't know how much. First of all, fluoride is in there.

Also, it differs between different water supplies. It difference If I drink 10 glasses of water a day and he has only three. But you're. To your point that you were raised on well water and you had a lot of decay. That points to the fact that there should have been topical fluoride. Okay. And, you know, systems in place for that. But instead of systems in place for that, it's, you know, fluoridated water everywhere, and. Which is really kind of uncontrollable.

So is the. So you're saying, if I'm hearing you correctly, the issue is that we started putting it in the water, so it's like, almost overkill, but you still feel topical. There's a benefit to that. With teeth.

Yes. Toothpaste, topical.

Okay.

I don't mind it. I think, you know, xylitol is another great, great ingredient to ward off decay, but in a topical format.

So you're.

It's like, apply it, but don't drink it, don't consume it. So. Okay, got it. Okay. That's a big distinction because, you know, in marketing, then we just hear everything has to be fluoride free. But then we're creating. And we could be creating another problem. So I wanted to hear both sides of that. That's. That's. That's great. Okay. Talk to me about how much exposure we get to, like, a porcelain fused to metal crown. I call it a pfm. But, like, in this idea of we don't want amalgams because of the mercury, and then do we. Do we not want any metal in our mouth? So what happens if you've got a crown? And then I've heard that, you know, when I worked in the labs years ago, the ceramic crowns weren't as strong as a porcelain fused to metal. And you put, like, a metal on the occlusal, like on the top on the biting portion.

Yeah.

Yeah.

So. So tell me about. Aside from appearances, because we think ceramic looks better. Do we really have to worry about your crown? Has Metal in it.

Okay, so let's say we did a pfm.

Yeah, we haven't done a PSM in a long time. So. So where porcelain fused to metal, in other words. So what is wrong with that? Actually, porcelain fuse to metal is a great crowned for a tooth if you use the right precious metals underneath it. What happens is that metals have gotten, Precious metals have gotten so high in price that labs have started to add other things in it, such as tin, such as other cobalt, all different types of metals. That cheapens the whole porcelain, the metal part that's fused to the porcelain. So when you start using metals that are just can cause allergic reaction, not too many people like to have tin in their body. So that can cause a gingivitis or cause an irritation or gum inflammation. And sometimes you wonder like, where did that come from? Is it because of the porcelain fused to metal? And I've seen porcelain fused to metal, which is all precious, you know, mixture of palladium, gold and all that stuff looks great. I mean it's works perfectly. And the problem is like how do you even make it so it disappears. The metal never shows. So it's, it's very technical to do it the right way. So the problem is not the metal. The problem is the type of metal, cheap metals that they add to it that cause a lot of the issues. So I think now the necessity for a porcelain fused to metal is just completely diminished.

Okay.

Crowns that are all porcelain, such as zirconium, lithium, disilicate, which a trade name is Emax, those are very strong. Very strong. Zirconium is actually a metal, but it's, you know, it's, it's, it's, it's a very biocompatible product. It's very, very strong. And usually I go to the zirconium, unless if there is an issue with bite problems that we want to use that. So we, we, we have no reason to go to EFM or porcelain fused to metals any longer. You have anything to add to that.

And so I'm assuming you would. So if somebody comes in and they, in your practice and they have that and they have an esthetic issue or they want it out, you're going to replace with the all you're not going to replace with a pfm, but you're not telling people to go remove all of their porcelain fuse to metal unless they're asking for it or there's a problem.

Yeah, of course.

Yeah, I would never. Unless there is a inflammatory reaction around the gum line because you can See, it's red. That is just isolated, let's say, to that pfm, then you want to remove.

Occasionally we have patients who have had tests where their metal counts are really high and they're having inflammatory response. In that particular case, then, yeah, you definitely.

Yeah, I'm that person, that one that's. That's like annoying. That's like, I have all these things.

I want to annoy. I mean, it's, you know, your whole body is responding to that. And there's so many things in our environment that collectively work together to do havoc, wreak havoc on our systems. That if this is contributing, you know, who's to say how much of. What's the percentage there you want to decrease that? You know, inflammation is our enemy. So in that particular case. But we, as a general rule now, if this is, you know, the tissue looks healthy, because what we like to say in dentistry is like, tissue doesn't lie. Okay, okay. If that tissue is red, we've got a problem. We've got a problem. It's the body alerting us. So we need to pay attention to it.

And one thing to add about pfms, when we used to do them, the labs that, when we worked with, they gave us a sticker that would say the type of metals that they use. And you put that in the patient's chart so you would know exactly something came up. You could refer to it and say, well, these are the metals. So, you know what? Now that doesn't even exist anymore. So you get a pfm, you have no idea, no idea what's in it. Could ask for. You know, I want it this way, this way. Unless you're using a very laboratory, you have no idea what's in this. So that's why stuff. Because most people who are doing PFM are doing it for reasons of economy and using it for reasons of economy. You're not going to putting. You're not going to be putting palladium gold in it.

Makes sense. And I remember the ones I had years ago, because I knew from the lab have actually gold on the. Like, I used gold in them because I knew that. But you're right, we used to have a label and know exactly what was going in it. They don't do that anymore.

Totally.

What about. Okay, this is my favorite one that I'm asking you about because I'm. I don't know how much is true and how much we've been convinced is true about root canals. So I want to ask about that now. I personally would not get A root canal. Knowing what I know now, I do have one that I want to remove. I'm hesitant to remove it. I'm being transparent because I, I've had multiple X rays. I've had, I even had a CAT scanner. I have zero infection right now. And I'm worried that removing it could create a bigger issue than leaving it in. So I want your opinion. We need help here. How would you recommend a root canal? Ever do. Do you think everyone should remove them? Tell us what you've got.

I have a question for you then. Why were you considering removing it?

Really? Honest. I watched that movie Root Cause, and it convinced me that it's a dead tooth and it's dangerous and we shouldn't have a dead tooth in our body because we could create other inflammations and heart problems. And I couple that with, when I worked in the dental implant industry where we would tell doctors that a root canal is not permanent. You're keeping a dead tooth there, so do an implant instead. So I'm, I've got this biased because of what I learned then years ago. 30 years ago. 20, 30 years ago. But then also watching that movie. So I'm, I have these, these questions now.

Yeah. So I'll give you one story about a patient that I have is over 90 years old. It's got about seven or eight root canals.

Okay.

So the question is like, should this, you know, it's anecdotal, but, you know, if the patient has that many, I would start to consider like, okay, maybe you should have had cancer by now. Yeah.

Yeah.

Something should have happened. Is it maybe a resistance that avoided it. So root canals definitely have gotten a bad rap because there's been a lot of bad root canals done. Really bad root canals. And the reason they got the bad rap is because they are not done properly. They miss the canals that are there.

So that means.

And they're not using a microscope to even look for these canals because she.

Referred to it as a dead tooth.

Right.

It's a half dead tooth then.

Okay, that's right.

And if it's a half dead tooth, that means there's living tissue in there that bacteria are going to find.

Okay.

And wreak havoc. The younger modern trained endodontists, those are the dentists who do root canals, are using microscopes when they do root canal.

Now, which is how mine was done, actually, years ago. I remember they actually used.

So when I was trained 35 years ago how to use, to do a root canal, I was just using my regular eyesight, not even Loops, not even like, you know, magnifying glass.

Wow.

To find the canals, it was all by feeling. They're now have it on a screen under the microphone, microscope.

And mine was done that way years ago.

Like I remember. Right. It's not even, I say, the young kids, I mean, it's. They've been doing it a while for now like that. But the point being is that if it wasn't done correctly.

Okay.

Because of the limitations of what they had to do it. Okay. And how are you. You're judging a procedure based on that isn't completed.

So if it's a dead tooth, why would there be periodontal attachments to a dead tooth? It would behoove you to think that body is rejecting it and it should start to remove it and have an infection all around it.

Okay.

There is periodontal attachment to the tooth still the tooth? Yes. Okay, fine. There's no nerve endings, there's no blood supply to it. It's completely sealed. But there is an attachment to it.

So what that means, I'm just gonna check, is that the tooth sits in your bone. It's not attached to your bone.

Okay.

There's a ligament, which is an interface between the surface of the tooth and the bone. It's alive. It has a blood supply. When you get a cleaning, if their instrument goes down below that, you're going to feel it there. Even though it's a dead tooth, what you're feeling is the periodontal ligament. And that allows the tooth to function and move a little bit. When you bite on something hard, if it didn't move a little bit, it would break. Right?

Right.

So when you have a dead tooth, there's still living tissue around it that's not rejecting it. It's actually attached to it.

Wow. Exactly. So the only entry point for products that could cause a problem is the end of the root. Right. It's a very tiny space. And if. If something happens, that body. Body starts to look at it and wants to get rid of it, you would definitely start to feel it, and you definitely start to see an X ray. There's an encapsulation around it. Then there is a problem there. Then there's definitely a problem there. But when you look at an X ray that has a root canal, perfect attachment to it, this tooth ain't going nowhere. Why, in the right mind, I would want to remove this?

Okay.

Yeah.

You're opening up to a lot of different things. An extraction of a tooth, you know, especially if it's intact and. And there's no, you know, you're, it's, it's. There's no visible infection. You know you're going to lose some bone. You probably need a bone graft. If you're, if you don't want to do implants because of the metals, then you have a space and teeth will start to shift. When your teeth start to shift, you know your bite's going to change. Your bite's going to change. You may get headaches. You know this, it starts.

There's a whole. Which is why I haven't fully done it yet. Like, it's just like I, I've been. And that's why I asked the question. And even I will say, even my biological dentist that I go to did say and she's a fan of not doing root canals and remove. She said, let's just keep an eye on it. You don't have an infection. I. It's so close to your sinus, I'm hesitant to have you remove it. She did say all that.

So.

So you just helped me realize like.

I wouldn't if I was me, I wouldn't touch it.

With a well executed root canal with no visible signs of infection or discomfort. Yep. The best implant is your own tooth.

Okay. And which makes sense. And I did like you said, I went to an endodontist years ago who did it that all the proper way. So if I'm hearing you correctly, if somebody has a root canal and it's infected like that is critical. You want to deal with that. Or if you think it was not done correctly, you might want to look at that. But I think it. So it sounds like keep an eye on it. Do you still recommend people get root canals or do you recommend them? Do they do an implant if they need it? Someone comes in, needs it.

And the only way I make that decision is based on tooth structure that's left.

Okay.

If the tooth structure that's left is adequate, that a restoration that I place on it will support it, prevent it from breaking. Absolutely will save that tooth.

Oh, and the strength of the tooth. There's no gum disease around it.

Got it right.

The tooth that's, you know, needs a root canal usually has lost some support. But if the support that's remaining, I can strengthen it with biomimetic approach and really make it a strong tooth. Yeah. I would not makes sense. I would not touch an implant. I love implants. The last thing I want to do is an implant. And I'll give you one more example and that would be myself.

Okay.

I'm 59 years old. At age 9, I dove into a pool and broke my front tooth. Had a root canal done and still in my mouth. I still haven't touched it. It's a front tooth, same tooth. I did have an issue, and I did go to a root canal specialist because at that time, the root canal was done perfectly. And what he did, he redid it and retreated it with no issues, with a microscope, sealed it. Have not had any problems since.

Got it.

I mean, that's going all the.

So I'm glad I asked you this, because this is like, this is a perfect example of scare tactics. Right. Like we. We watch a documentary and then everyone's thinking, we got to remove it. And I want people to have the information and know it's not always 100% that that's the situation to go down. Like, that's okay. So let me ask you then next about implants, because that's another question. So there's now this whole. You know, I worked in the dental implant world. We did titanium implants. Now there's this whole idea of ceramic implants being better for us. Do you have an opinion on that? Should people, if they are getting an implant, do you suggest they go towards ceramic or. And if they have metal, should they replace it with ceramic? Any thoughts there?

Well, I wouldn't.

I.

Removing a metal implant.

Yeah. Again, I. I mean, there's metal. Has that product has been used in hip replacements in a much bigger format than a small, little, tiny screw that's put in your bone? So it's. It's not. It's not a product that's really relegated to the mouth only. It's used in the replacement of so many different body parts.

Hips.

Yeah. I have one in my toe. And my bicep.

Yeah, there you go.

My whole thought was, like, if I remove my implant, do I then. What about my torn bicep that I did? What about my toe? Like, so there's. I have a lot of questions. That's why exactly.

It's a material that has been tested.

Ceramic better. I'm not the expert in it, and I don't. I would never espouse to be the most knowledgeable person in it. I just know that when I see an implant that's well integrated into the bone and there is good attachment to it, and I've seen implants from 20 years ago, and it still looks fantastic.

The body has accepted and there's no rejection, there's no infection, there's no inflammation.

Why would I want to remove that because it's a metal, you know, is ceramic better? I think the technology has really advanced that. I think what we're going to see is a big shift towards more ceramic implants. But at this point, I don't think it's a good idea to remove any implant unless dramatic, you know.

Yeah.

Definitely have to make sure that you use the right implant companies and, you know.

Yeah. In my personal case, I have one implant and one root canal next to each other. So I'm like. So if I went through that process, I'm like, worry about teeth shifting. And like you said, then you got to use. You got to use cadaver, but you have to like regenerate with cadaver. It's like a whole. It's a whole thing. So I think people don't really realize this. I've gone down the whole rabbit hole here because being like, I want to. Yeah. And. And I just. And I want people listening to know they have a choice here and not just to hear one thing and go with it. Because the one removing one thing can create another problem. So, like when you. When they say you're going to regenerate tissue, they're taking cadaver tissue and putting it in you, hoping that will turn over to your own. So you got that. And then you got an open area. And then your teeth will also shift. With this open area, they could shift.

So you.

All the money, braces, you know, we're going to have another problem. So that's why I wanted you to do this, because there's. There's a lot more than just, oh, just remove your root canal or just remove your implant or just remove this. What about next question? And then I want to. I have so many more questions for you, but let's talk about just cosmetic restorations in general, like veneers. Any downside to that for people? I also have veneers I'm a huge fan of. I'm like. I'm like a top dental patient here. I have like everything. Everything.

What, what. What have you heard as a downside?

So I love veneers, personally. I think they're. It's amazing for. It's really changed people's smile. I think they look great. The only negative I know of is that they could possibly need to be replaced in 10 years, 20 years, whatever it is, or if they're not done right. You're also weakening your own real teeth a little bit. But I don't know of any other, like, health negatives or. I just wanted to get your feedback on that. Because there's definitely people considering veneers, right?

Yeah. We've been placing veneers now probably over 20 years, and I have probably longer, so I. Not to pat myself on the back, but we have patients that we have seen come back and some of them drop out and come back after a while and see it again. And honestly, it looks amazing. The bond that's with the tooth is still intact. The. The problem that I see with veneers is that they are prepared a little too roughly, sometimes without any guides. If you're not a guided type dentist, you are a guessing type dentist, which means you're just guessing how far to remove the tooth to make thickness for the porcelain. The porcelain that needs to be placed could be 0.7 to a little bit more, depending on the color that you're trying to change or depending on, you.

Know, what you're trying to achieve, what.

You'Re trying to achieve. And if you don't know how much to remove, then you're just removing whatever. You're just making space and telling the lab, make me veneers. So let me cover these up with this veneer. And they'll never know if I removed enough or not. And I think that's really, really a bad approach because you want to preserve as much of the enamel as possible and remove as least two structure as possible to gain the same outcome as you would. The more you remove, the more chances of failure. If you know, when you design your smile and the design, now that we're doing completely digitally, that design of the smile, I get a guide back that tells me where I need to remove and where I don't need to remove, where I can just completely leave. It's all additive.

Wow, that's amazing. That's changed a lot. Yeah. They used to do almost a crown prep to put. I know mine were pretty much that, like years ago.

It's changed a lot, but it's not adopted a lot. That's the problem.

Oh, wow.

It's. No. To adopt this technology and really be completely driven by digital analysis and digital guided dentistry takes time and takes knowledge to really adopt that correctly. So, you know, fly to New York, remove it and send it to the lab.

Yeah, so fly to New York and go to them. Because this is like, this is a, you know, I will share. And this is just a plug for you too. Like, I. I've had three sets of veneers. I'm 52, but I've had three sets. The first set was done by a general dentist years ago that didn't know what they were doing. They kept popping off. And I thought that was normal. Like you have to go in every month and get it replaced. Then I had a prosthodontist do overkill and like really prep them down. And then I finally, gosh, about probably 10 years ago, went to a great dentist that did it the right way. And they've lasted and they, they've been amazing. But if I could do it again, I would go to someone like you that really knows this and understands that technology and says things like that I want to preserve the tooth the best that I can. Because the other way is it's not reversible. Like you're once you.

Unless you are 120 years old, you shouldn't have gone through three sets of.

Yeah, I'm like, this is math, doesn't add up.

Yeah, that just doesn't make sense.

But you also raised another, a point I'm not sure you realize. You were talking about, like we were talking about biomimetic and what we react to and veneer the porcelain. The tissue really responds well when it's done right. Like the tissue looks. You would never know that a veneer was there. It's not red, it's pink. And that requires that you have the right design, right lab and the right dentist is doing the preparation. You know how much space they're making. The other issue is if a veneer is done where instead of veneers, you really needed to move the teeth and you put a veneer on it, it's you biting your biting forces. If, if the teeth are not hitting in the proper direction, they're going to knock off or you're going to get a loose tooth and red tissue and say, oh, my veneers are causing this problem. No, it was the bite that was causing the problem. You should have done like Invisalign first and then maybe a very conservative contact lens veneer on top of this to change totally. So. So a lot of things come into play in terms of like, oh, is it good or bad for you? Well, in the right scenario, with the right dentist, with the right lab. Yes.

You know, so you can short circuit the outcome by going through completely veneer process. But are you serving the patient well and are you guiding the patient properly in the right format? Sometimes we need to put the foot on the brake and say, listen, I understand you want beautiful smile, but do you want this beautiful smile to last or do you want to have it replaced to be done three times and let me have you Speak to Natalie about that. You know, so, you know, it's. So listen, we. We've been in the. We've been in the. In this realm for. In this practice for a long time. I'm not saying that we do everything correctly, but we've done things incorrectly. The good thing is that we've learned from it and we've advanced through it. The problem becomes that you make up stories to patients to tell them that what they're doing is what's causing it. Or you can make up all kinds of stories why it's failing. But failure starts when you don't plan properly. That, to me, is the most dramatic issue that does not get totally content. Nobody contends with. Everyone wants to. Like all these kids coming out of dental school, they want to do cosmetic dentistry. They just like, that's it. I like, they want to become the cosmetic dentist next year. They'll go on YouTube. They'll take whatever thing they courses, quick courses to learn to do cosmetic dentistry, but they'll never want to learn to do dentistry.

They're not doing properly.

They just want to learn how to slap veneers on.

You know, I agree with that fully because my first set, like, they kept popping off. He kept blaming me. It was not. It was not. By the way, that dentist ended up in jail for a whole nother. He apparently wasn't licensed. There was a whole thing. It was years ago. But the second one was a prosthodont, so it was like an overkill over engineer of everything. And then my final set was similar to what. What you do. And I've. I have not had issues. My tissue's great. All of it's good. So I think it does come down to looking at who you're going to. There's another thing I want to ask you about, a little bit of a different topic, but you brought it up before we started the interview, and I'm so curious about it. You mentioned that as we age, there's a lot that changes and that you can do in dentistry to help you age. Well, can you tell me more what you meant about that? Because I know our face changes as we age, but what's going on with our teeth and our jaw and happening down there, and what actually can we do in dentistry to help with that?

Sure. I guess I'll take this one for. You can chime in. So, you know, as we age, our skin tone, you know, and elasticity changes and we see a little bit of sagging.

Yes.

What accentuates that, though, is the effects of aging on teeth. You know, we have habits. Ice chewing, just regular chewing, grinding our teeth, clenching our teeth. What that does is actually changes the top surface of your teeth and how you bite. And when you change how you bite, you see changes in your face. And one of the things that happens is the mid face or the lower third right here becomes more shrunken.

Okay.

So I use the example when I tried to explain to my patients, like when my grandmother had her dentures in, her face looked great, but when she took them out.

Oh, yeah, like that. Right. Luck. Yeah.

Right. Because every. What happens is your lower jaw swings up and you have, like, small pieces. And so from clenching and grinding your teeth or dentistry, that's gone bad. Like if you had three sets of veneers and you. They've chipped. And so when your teeth come together, it's not high enough, Your face is shrunk. Dentistry can change that.

So the only movable part of your head that's articulated is your jaw. What prevents the jaw from going further up into your skull is the teeth. If your teeth get worn down, the jaw will go further up near your skull. So the lower third of the face starts to shrink down. So you get the lower third of the face shortage. So an analogy would be like, oh, a lot of clenching and grinding exacerbates and makes it worse. So think of a. Think of a. A beach chair. You're sitting in the. You're putting a beach chair, right? And then you put a skinny kid over it. How far does that beach chair go down into the sand? Very little. Now, you put a very heavy Arnold Schwarzenegger to sit on it, that beach chair will start to sink and sink further down into the sand. So what's happening to the teeth is the same exact analogy as that beach chair. Your teeth are not in stone, they are in sand. A heavier sand than you have in the beach. But again, it's a sand. It moves, it shifts with forces that are applied to it. So if those forces from clenching are really heavy, teeth are going to sink down, upper teeth going to sink up, and this lower third of the face, we're going to really diminish in height. So how do you reestablish that when that happens? Well, a lot of times if the teeth are worn down, we have to rebuild that. And you have to rebuild it in a way that's conservative so you don't putting caps all over it. And we can do that. And that's a topic that could be very long, but you, you can re. Re Establish it with orthodontics and Invisalign. Invisalign does so much more than it used to. Now, really. Before, it used to just correct some of the shift in crowding and something Elisa does. Now, it's like you can do anything better than a conventional braces can.

I mean, in terms of, like, restoring the facial appearance, a lot of times we'll use Invisalign to set it up so that any type of restorative work that we have to do is so much more conservative.

Yeah.

It saves you so much dentistry by making the teeth into a better position. And that's where you hear about TMJ problems and things like that. Because when this is at the wrong height and it's all shoved in, so is the bone in here, and you're getting joint problems, you get arthritis, you get headaches, you get all kinds of inflammation in here. And a lot of times we hearing issues, and so it's all related. And so then as we restore this proper height with either Invisalign and. Or restorations, we are gradually knocking out. Here goes the headaches, here goes the.

That's amazing.

You know, it's. It's like a. And the body responds to that. You know, I never heard this.

I. You know, we. We think of aging and we. We always go to hormones. Like, it's your hormones, it's your. But you don't. We don't think of all these little things. And this is significant.

This is definitely structural, like, more of a structural thing.

So the condyle that sits in your jaw is a huge nerve and blood supply plexus behind that whole system. Your ear is right next to your condyle. So as your teeth wear down, your condyle starts to press on that whole nerve and blood supply plexus. Your. It's right slammed against your ear. You start to get ringing in your ear, and you don't know where to go. So you go to the neurologist, you go to this, and they put you on drugs, and they say, you need to take this medication. You need to take that medication. But there are a lot. And I'm not saying dentistry can solve every problem that you may have, but if you're not looking at it from a specific point of view that could be causing some of these issues, then you're missing the boat. Then you're just throwing medication and drugs at it. Or, you know, people have become really depressed and suicidal, you know, to the point that they're debilitated with all the medications they've been taking for the pain that they've been experiencing.

We're very fortunate in New York, like we have ENTs, neurologists that have, have suggested to their patients, listen, I've done what I can do. You need to have this joint figured out.

That's great.

You know, you're clenching and sometimes it's the reverse. I have a patient who comes in and we take a cone beam of their face and I'm like, listen, I can do this part for you, make you feel good, look good. But in order to make this a long term result, you have to have your septum address. You need to see this ent, you need to do certain things or sleep, you're not sleeping well, you have apnea. We need to address that as well. But in isolation, you know, nothing ever works.

Whenever we have to look at it.

From a holistic point of view, when.

We even do a tooth movement, any minor tooth movement, we take a three dimensional X ray of the jaw joint. We want to know where that is before we even start moving teeth. Because there may be some issues in the jaw joint that you know, need to be addressed beforehand or you need to see where, you know, the condyle is located. So those, if you're not evaluating any of that and not sending it to radiologists to see where.

Yeah, we'll send it to a radiologist just to make sure that we, you know, I'm not a radiologist. I don't want to miss anything because if I can make you feel that much better, you're going to look that much better.

Totally.

Everything is going to be a lot better. You're going to lower your inflammation, you're just going to feel so much, you're going to sleep better.

You get even having that pain, you're creating inflammation. That's just more inflammation in your body.

A lot of our patients are who talking about, you know, your audience are women in their 50s. The kids are off at school. It's my turn to fix this up. I'm not exactly sure what's going on, but we're part of that team and I tell them this has to be a team effort. You know, you can get a facelift, you can get a mini facelift, you can get, you can get fillers. But if you don't address these structural things and we don't all work together, this is definitely, you know, it's, it'll be better. But are you your best self?

True.

It makes sense, right? I mean, what about the, what about.

The yellowing of teeth? I Just thought of that. That's a big age thing that I'll notice on people that this yellowing of teeth that really age. But why does that happen and what is the best thing for that? Can. Should you just be bleaching? Does that. Is there an end cycle on that?

Well, two things happen as you age. You lose the enamel. Enamel is what can be really whitened.

You bleach.

Yeah. And the dentin, which is the layer underneath it start. Gets darker as you get older. So now you're having two battles. One is enamel loss and a darkening of. Of the dentin. Dentin was yellow to begin with. That's a layer underneath. And if it's getting darker and darker and it can turn into. From yellow to like orange and get. That's going to reflect through. So an older person will try to whiten it, but not to a great degree. You can actually whiten older teeth. It's never going to respond as well as kid that's 20 years old, that has full set of enamel.

Yeah, that makes sense. I never thought of that. That's what's not. It's because you're losing enamel and the dentin's changing. So I never thought of that. So you're trying to whiten the wrong thing. Basically. You're not starting with the right canvas.

Yeah.

So at that point you would recommend veneers at that point. Because that's really the only way that's going to change.

And I've told patients, you know, don't waste your money on, you know. And I've told patients not to do veneers and do whitening. I see beautiful teeth and patients come to us and like, I want veneers. I'm like, why? I am not touching your teeth. I'm not getting involved in. In a mistake at age 24 for you. When you have beautiful teeth, which you can do Invisalign to straighten it out and while you're doing the Invisalign, whiten it at the same time. Gorgeous teeth, you know, like everything has.

To be looked at.

Cosmetic dentistry. Dentistry need to be looked at from a medical standpoint. And I think that's what's being missed in, in, in our profession at times. And I'm not trying to blame our industry, but I think you can't consider everything as life changing. That, oh my God, if I put veneers, her life will change. Yeah, maybe this person is depressed about something and doesn't mean you have to throw veneers. 30, $40,000 veneers to make her feel happy Totally. There are other things that you can do that will not put her or him in a difficult situation for 30, 40 years. Set her up for multiple veneer replacements.

Well, we've had patients we were talking before about, they have their clenching and grinding and their face. They're uncomfortable and they have headaches and they come in with a long, a long laundry list of medications they're taking. And I'm like, you know what? Our goal here is to get you on the medication you actually really need and get you more comfortable. Slowly that you become more comfortable. And we can reduce the number of these type of things. And you know, that's a lot of personal satisfaction for us. And I think that that message needs to get out there. Because you talked about root canals being bad. Well, is it the procedure? Is it how the procedures. You know, you have to really look carefully at what is out there.

You know, I've got to tell you, you both I have worked in, I mean I worked in dental for a number of years. Like I said, I met with dentists all over the world, especially in our country and I you2 really get it. So I'm really impressed with like what you've shared and the whole well rounded approach and how you take the whole health but you're also practical. And that is not common unfortunately in dental. It's just not. I mean, I know you're not going to say that. I'm going to say it because I worked with Dennis over and over and I was the one in there showing them how to do the rest implants. And it's just, it was a lot of what you said, like they just want to go or they were chasing like one thing because it was a moneymaker or whatever it is. But I really like your whole approach and how you are cosmetic but you're also being practical. You're looking at the whole health. You're looking at what's real, what's rumor, what's just marketing, all of that. So I just want to hand it to you for that. I think it's amazing. For those of you listening, they are NYC smile design. If you are in New York or you want to go to New York or you're thinking about doing that, veneers especially, I highly recommend checking them out. They also have a great Instagram where he is sharing lots of different little tips. I hope you'll teach more on there because listening to you today, you just have so much to share and teach. Thank you for being here.

Thank you. And, and one last thing I would say is don't let your ego prevent you from learning the right dentistry and the right way of doing things for the patient, for the best of patients. Because that's what happens sometimes. You feel so jaded by the whole industry of cosmetic. Cosmetics. Cosmetics, cosmetics, that sometimes you short circuit the patients with pushing them into something that might not be their best benefit from the beginning.

That makes sense. Thank you both so much.

Sure.