Straight Talk

The lowdown on dental health from six top NJ dentists.

Illustration by Alex Caldwell.

Every year, New Jersey Monthly surveys the state’s dentists to learn which of their peers they would recommend to treat a family member. The result is our annual list of New Jersey’s Top Dentists. This year’s list represents 323 dental practitioners in nine specialties.

The dentists on our list practice in all parts of the state. Some have been on our annual list in the past; others are making their debuts. The list is meant as just one tool to help readers find the best practitioners for their dental needs. We are certain there are other excellent dentists around the state, and we encourage readers to seek information from multiple sources before choosing any kind of professional.

In compiling this year’s list, we went to extra lengths to assure that only the very best dentists are included. To that end, we formed a professional advisory board to review the names on a preliminary list. With the input from the board, additional deserving dentists were placed on the list. For the complete methodology, click here.

This year, we also assembled a round table of six of the top vote-getters in their specialties and presented them with questions about the state of the practice in New Jersey. This year’s panelists are Dr. Jason Auerbach, an oral and maxillofacial surgeon in River Edge; Dr. Howard Ehrenkranz, a general dentist in Livingston; Dr. Joshua Z. Epstein, an orthodontist in Manalapan; Dr. Rajeev Gupta, an endodontist in Toms River; Dr. Leslie Ann Klardie, a prosthodontist in New Providence; and Dr. Suzy Press, a pediatric dentist in Morristown.

Here are excerpts from our round-table discussion:

What are the biggest mistakes patients make in caring for their own teeth (or their children’s)?

Jason Auerbach: The problem is twofold…delaying diagnosis and delaying treatment. Unfortunately, many patients believe that if something isn’t bothering them, nothing needs to be done.

Rajeev Gupta: Not getting routine checkups and cleanings. In addition, when a treatment plan is established, avoiding or postponing treatment can cause more damage to their teeth and overall health.

Joshua Z. Epstein:
Sometimes the biggest challenge is to get patients to our practice by the age of seven or eight so that we can prevent possible serious orthodontic issues with a small percentage of complicated cases. The ideal is to be able to catch developing problems early with digital-rays and, for those patients who need it, embark on an early phase of treatment to help prevent possible chipping of teeth or the need for extractions or even surgery. Using a patient’s growth is one of the key tools of an orthodontist, so early interceptive treatment can save time and money and create an even better-looking smile.

Suzy Press: Probably the biggest mistake parents make in caring for their child’s teeth is in the area of diet. Most of the time, it is because they are unaware of the significant impact the food we eat has on our teeth. Foods that…can be broken down into sugar by the naturally occurring bacteria are very dangerous to our teeth. Many of the foods that are marketed to children are highly cariogenic—for example, sticky fruit snacks, gummy vitamins, sports drinks.

Leslie Ann Klardie: The biggest mistakes patients make in caring for their teeth is how to properly brush and floss. It is essential that we teach our children the proper technique in both aspects of cleaning their teeth
Howard Ehrenkranz: Ignoring what we teach [patients] regarding prevention of dental disease is the biggest mistake. The compliant adult who brushes and flosses regularly, has regular hygiene maintenance at the prescribed intervals and who uses a daily fluoride toothpaste (such as 1.1 percent sodium fluoride) will greatly reduce his or her dental problems. Children starting regular dental care early (18 to 24 months), who are properly cared for and instructed in dental hygiene, receive pit and fissure sealants to seal out decay and start using a daily 0.05% sodium fluoride rinse regularly at the age of five will have dramatically less dental decay than their noncompliant counterparts.

What are the most common misconceptions people have about dentistry?

JA: It’s unfortunate that so many patients believe that dentistry has to be painful, but I think the paradigm is shifting. Previous generations of patients have had many undesirable experiences, but with current techniques and technologies, there is no reason whatsoever to experience pain on any level in a dentist’s chair.

RG: The biggest misconception is that “having a root canal is painful. The truth is, root canal is a painless procedure. Patients requiring a root canal may have pain or infection prior to treatment. However, root canal therapy will relieve pain and help the patient keep their natural teeth.

SP: That teeth are just teeth. Optimal oral health is essential to having optimal general health. Research has shown that dental disease has been associated with heart disease, lung disease, risk of stroke, low birth weight and other medical illnesses. Dental decay is one of the most common diseases of childhood, being five times as common as asthma and seven times as common as hayfever.

LAK: That we only treat teeth. Oral cancers are caused by many risk factors, some including the use of alcohol and tobacco, poor nutrition, immune suppression and possibly ill-fitting dentures. And now with the presence of Human Papilloma Virus [HPV] and it becoming the leading cause of head and neck cancer, it is essential the dentist become the first line of defense against oral cancer. If found early, oral cancer can have a survival rate of 83 percent. Unfortunately, more than 37,000 Americans will be diagnosed with some form of oral or pharyngeal cancer this year.

HE: All too often patients feel that if they have a dental problem, they will experience pain or some sort of a significant warning. At least two-thirds of patients don’t have any symptoms until their problem is in an advanced state. Generally, the more advanced the problem, the greater the biologic and economic cost to the patient.

Every year, we hear about ways that digital technology is changing the practice of dentistry. What are the latest digital advancements in your office?

JA: We have just begun using our new 3-D scanner which, unlike most other scanners, can be programmed to select out specific areas for imaging in addition to scanning the entire maxillofacial complex if necessary. This variable technology allows us to control which areas we image, thereby reducing overall radiation exposure to our patients without compromising access to information and, ultimately, surgical outcomes. Additionally, we are among the first OMS offices in the country to use a specially designed iPad app for patient interfacing.

RG: The use of the digital radiography and the surgical microscope has brought the success rate of root canals and apicoectomies [surgical root canal] to the highest level. Cone beam computed tomography provides a 3-D image which was not previously available to endodontists. CBCT uses only 15 percent of the radiation used in a medical CT.

JE: We are paperless and HIPPA compliant, have digital radiography and utilize soft-tissue diode laser technology. We have been extensively trained and have the latest software to properly diagnose 3-D cone beam scans. Most recently we have worked with some oral surgeons to create medical models prior to corrective jaw surgery to properly plan the outcome of our most challenging surgical cases.

SP: We use Diagnodent and Spectra, both of which help, using fluorescence, to diagnose the presence of decay. We also use digital radiographs and an intraoral camera.

Our office specializes in restoring dental implants. We use a team approach utilizing our periodontists and oral surgeons to plan the specific placement of the dental implants with a digital CT scan.

HE: We can use computer-aided design and computer-aided manufacturing [CAD/CAM] to provide restorative solutions to both natural teeth and dental implants. Crowns, bridges and implant connectors are custom designed in zirconium or titanium to solve even the most challenging situations. Today, with the aid of the latest technology, we are capable of rebuilding our patients’ teeth and implants with restorations that are computer designed and manufactured, that are virtually indistinguishable from natural teeth.

Some patients may think replacing older fillings or capping or straightening adult teeth are purely for cosmetic purposes. What are the potential medical benefits of such procedures?

HE: There is a growing body of evidence of the relationship between the mouth and the rest of the body. There is already a proven link between periodontal [gum] disease and cardiovascular problems. The adage that “the mouth is a mirror to the rest of the body” is valid.

JE: Oral health has many links to overall health. Adult orthodontic treatment can greatly reduce the risk for periodontal disease. A proper bite will typically eliminate facial or TMD [temporomandibular dysfunction] pain. In addition, orthodontic treatment greatly increases the ability to properly clean your teeth and gums.

LAK: Having beautiful, straight and white teeth may be a desire for most dental patients. Ultimately, the ability to clean and maintain both the natural and prosthetic replaced teeth becomes priority for long-term health. Ill-fitted and chronically leaking restorations can lead to periodontal disease, tooth loss and the exacerbation of systemic diseases.

SP: If a restoration is defective [for example, fractured] and is no longer clinically acceptable, then it is appropriate to have it replaced. Leakage around the margins of the filling or the fracture can lead to recurrent decay. Untreated dental decay is progressive and becomes more complicated over time. Orthodontics is not only cosmetic but can improve the overall and long-term health of teeth. If teeth are not in an optimal position where they have enough bone support, and the tooth/teeth are not able to support the forces of chewing, the tooth may be at greater risk for bone loss and dental decay.

What is the toughest part of being a dentist?

JA: Balancing the time and effort it takes to succeed against what is ultimately and unequivocally the most important thing in the world—time spent with family and friends.

RG: Calming a patient who is terrified because they have heard root-canal horror stories is definitely one of the toughest parts of my job.

JE: The toughest part has nothing to do with orthodontics, but with watching one of our patients go through tough times, either through sickness or family issues. We build relationships with many of our patients and their families outside of the world of orthodontics, and we want only the very best for each and every one of them.

SP: The toughest part, emotionally, is when the patient or parent and I are just not on the same page—when we do not place the same value on oral health. Another tough situation is the difficult-to-manage child—and this may be for any number of reasons—because it makes our treatment a challenge to complete… and it makes it stressful for both the provider and the parent.

LAK: Watching our older patients age. They have been with me long enough that I consider them part of my extended family. Their medical challenges and life worries become my concern.

It is a challenge to stay on top of everything that is going on in all aspects of my profession. Dentistry is a continuous education.

And the best part?

JA: To be able to convert the dental phobic—that is perhaps the most truly satisfying thing I do. I love it when a patient walks in anxious and walks out completely and surprisingly—to themselves—at ease.

RG: As an endodontist, the best part is relieving patients’ pain. It gives me great pleasure to help them conquer their fears and anxieties about root canal and dental treatment in general. There is nothing better than a patient leaving our office saying this is the best experience they ever had.

JE: Having the ability to transform a smile—especially watching a shy individual who was previously embarrassed about smiling, now coming into our office with a radiant and confident smile.

LAK: Being able to utilize the vast selection of new cosmetic and restorative dental materials available today. We have the ability to create gorgeous, functional smiles for all our patients, satisfying their needs, wishes and budgets.

HE: When patients entrust their care to me. I enjoy meeting and perhaps exceeding their expectations.

SP: I am very passionate about what I do, so educating patients and parents about how they can have optimal oral health is one of my favorite things to do. I guess I just enjoy talking and spending time with my patients.

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