Uncertainty is Stressful

None of us know what will happen next with the Corona Virus pandemic, and this uncertainty has created high levels of stress and anxiety in the world.  How we handle the stress varies, but many of us are taking out our stress on our teeth.

Bruxism, the clenching (biting down hard when there is no food to bite through) and grinding (rubbing the bottom teeth against the top teeth) of teeth damages the teeth, the periodontium (supporting structures of the teeth), and the jaw joints (aka TMJ, temperomandibular joints), and stresses the muscles of the face that help you chew. 

Some signs that you are clenching your teeth are:

-Wearing down of the biting surfaces of the teeth

-Chipping, cracking, and fracturing of the teeth

-Abfraction, the denting of the root surface at the necks of the teeth

-Loss of the bone that supports the teeth, so that the roots show, despite good dental hygiene

-Tooth pain, or dead teeth (from suffocating the teeth when cutting off their blood supply)

-Shifting of the teeth with increasing vertical overlap of front teeth, increasing spaces between the upper front teeth, and increasing crowding of the lower front teeth over time

-Facial pain and headaches

-Cracking noises from the joint in front of your ears when you open and close your mouth

There is no cure for bruxism, but you can mitigate some of the deleterious effects by:

-Making an effort to not close your teeth when you are awake, but not eating

-Wearing a custom hard, acrylic (plastic) dental appliance on all of your top teeth (which bites evenly on  all of the bottom teeth)  when you are sleeping so that you do the damage to the guard instead of to your teeth. (Dr. Okun can make this “occlusal guard” for you.)

-Limiting chewing (i.e. eat a softer diet that does not contain foods that have resistance to bite through) when you are experiencing periods of facial pain and headaches

-Using ice paks or hot compresses on the tender muscles on the sides of your face and head

-Puffing out your cheeks, as if you are blowing bubbles, to stretch and release tension in your chewing muscles

-Taking anti-anxiety herbs (such as Valerian, Lemon Balm, or Chamomile) in tea or pill form before bed

Uncertainty Stress and "TMJ" Facial Pain

 

No one knows what’s going to happen next.  Will schools open for “ in person learning” this month?  Will gatherings of students start a second wave of the COVID19 pandemic?  Will restaurants open for indoor dining?  Will gyms be able to meet their overhead expenses with only half the number of clients in order to meet social distancing guidelines? Will small businesses survive the long shut-downs? Will parents be able to go back to work when their children are staying home for remote learning?

One thing that is certain is that uncertainty is a stress that takes a toll on our health. 

One way many of us deal with stress is by clenching and grinding our teeth.  Unfortunately bruxism, the clenching and grinding of one’s teeth, is not benign.  It wears down the surface of the teeth, cracks and chips the teeth, accelerates the bone loss from gum disease, causes root resorption (shortening of the tooth roots), kills the nerves in the teeth, causes undesirable shifting of the positions of the teeth, and causes spasm of the chewing muscles and changes in the jaw joints. (Symptomatic temperomandibular joints and associated facial pain are often referred to as “TMJ”.) There is no cure for bruxism, but there is something you can do to minimize the damage it causes. 

The best treatment for “TMJ” and bruxism is to wear a hard plastic guard on all of the top teeth at night.  This “occlusal guard’ should cover all of the top teeth and touch all of the bottom teeth evenly when the teeth are closed, so that the teeth are all splinted together and share forces evenly. That way the damage from the excessive forces is done to the plastic instead of to the teeth and their supporting structures. The guard should never be soft; a soft guard will allow the teeth to rock back and forth as the plastic flexes.  Although Soft guards protect the teeth from chipping, they can accelerate the loss of the bone that keeps the teeth in the mouth.  The guard should cover every tooth on the top, and touch as many bottom teeth as possible; that way the teeth don’t shift, altering the bite.  A properly made custom occlusal guard is not something you can buy over-the-counter in the drug store.  Dr. Judith Okun has years of experience treating TMJ and facial pain with properly made occlusal guards.  Call her office at (914) 253-0722 to set up an appointment to evaluate if you are taking out your stress on your teeth, and if you could benefit from the night time use of a custom occlusal guard.

Okun Orthodontics is Now Open

Dear patient,

In a surprise announcement by Governor Cuomo on May 31, all dental office in New York State are permitted to open June 1, 2020. We are so excited to be able to get back on track with all of your treatments.  In order to provide a safe environment for you when you are in our office, we are following the guidelines of New York State, the Centers for Disease Control, the Department of Health, the New York State Dental Association, and the American Dental Association for infection control and social distancing. Please read this letter so you know what to expect when you come to our office.

Everyone in the building must wear a mask over their mouth and nose at all times except when it is necessary to remove it for dental (or medical) treatment.

Call from the parking area to see if we have a room open for you.  Reception area seating has been limited to maintain social distancing. We have also eliminated high touch items from the reception area; there will be no blocks, books, magazines, patient information pamphlets or game cube controllers available until the Corona Virus is no longer a threat, so there is no entertainment waiting for you in our office. We are making an effort to schedule more lightly to minimize wait times and maintain social distancing; this might mean that you will be offered fewer options when scheduling your appointment.

Only one person may accompany a patient into the office.  Please leave additional “visitors” (siblings, friends, parents) at home.  If a second parent would like to participate in a treatment discussion, we will include them over a video-conference medium like face time or Skype.

Take the stairs; avoid the elevators if you don’t need them. The doors to the stairways are propped open so that you don’t need to touch them. The elevators are limited to 2 passengers at a time.

Use the bathroom before you leave your house. We can’t control the number of people in the building’s restrooms.

Please wait at the door to the office until there is someone at the front desk to greet you, take your temperature, and ask you screening questions.  If you or someone with whom you have spent time has had a fever, cough, shortness of breath, inexplicable loss of taste or smell, or has tested positive for COVID19 in the last two weeks, please call to reschedule your appointment. If you come with these symptoms we will not be able to treat you and we will be rescheduling your appointment anyway.  Also, if you develop these symptoms within 2 weeks of the time you were here, please call us so that we can notify anyone with whom you may have had contact in our office.

Once you have passed pre-screening, you will be directed to a sink in the treatment room for all parties to wash their hands with soap and water.  Patients will rinse with ioRinse to minimize the number of viable microbes that may be aerosolized during treatment procedures.  IF YOU ARE ALLERGIC TO IODINE PLEASE LET US KNOW SO THAT WE MAY GIVE YOU AN ALTERNATIVE RINSE. Please throw paper towels in the green pail near the entrance to the room, not under the sink.  Please save your cup in case you need it to rinse during your appointment.

After your appointment, please wait in the treatment room until there are no other patients waiting at the front desk.  Then walk to the reception room and speak to the front desk staff through the glass window to schedule appointments or make payments.

We look forward to seeing you again and are happy to answer any questions you may have about the steps we take to keep you, and every patient, safe in our practice. To make an appointment, please call our office at (914) 253-0722. 

Thank you for being our patient. We value your trust and loyalty and look forward to welcoming back our patients, neighbors and friends.

Sincerely,

Dr. Judith Okun, Tracey, Corinne, and Deborah

The Power of Prayer

Years ago I read a Reader’s Digest Summary of a scientific study on the Power of Prayer which had been published in a medical journal. The patient records of cardiac patients from several hospitals were compiled and then divided into two groups, to make each group (the test and the control) equal by severity of illness and types of treatment.  The names of the patients (with some personal information about each of them) in the test group were given to strangers with the instructions for each person to pray for his/her assigned patient “in any way you see fit.”  None of the patients or hospital personnel were told who was in the study group.  At the end of the study there was a statistical difference between the groups, as if the test group was given a “miracle drug.”(Note that this study would have been illegal in today’s world because of HIPAA privacy laws.) 

We are living in a unique time.  Every continent in the world, except Antartica, has been affected by this COVID-19 pandemic.  Our hospitals are overwhelmed with the sheer numbers of infected patients who need care. There are not enough respirators and personal protective equipment to meet the needs. Businesses and schools have been closed to limit the spread of the illness. Routine medical care has been put on hold. Dentists cannot deliver needed care to our patients because the illness is spread by both breath and saliva; Dental procedures aerosolize the virus, and the virus stays airborne for up to three hours. Dentists do not have hospital air filtration, hospital gowns, and N95 masks which would be necessary to deliver care in our offices. 

We need to slow down the rate that this virus is infecting people, and we need to limit the number of people who are infected- both those that are ill and those that are asymptomatic carriers. Social distancing is one tool we are using to limit the spread of the virus, but it is not enough.  We all need to pray, in whatever way is comfortable for us. Pray for a speedy end to this pandemic, for a speedy and complete recovery for the people who have been infected, for the mental health of all of us living in social isolation, for the return of a healthy economy, and for the return of our normal lifestyles, before the virus took over.- A personal note from Dr. Judith Okun

One Day, A Corona Virus Update

Dear Patients,

Once again, I need to stress to you that the New York State "stay at home" law has deemed all of dentistry “non-essential business”. This law only permits dentists to see emergencies of pain, infection, and trauma that might cause you to go to the emergency room. New York on Pause was put in place to enforce social distancing to slow the spread, and hopefully decrease the total number of Coronavirus cases. All of us should be doing our part in this social distancing effort.

The Governor's original “'stay at home” mandate extended through April 19, 2020 and was soon extended to April 22. As of today the American Dental Association is recommending that we extend the policy to only see emergency procedures through April 30. The end date seems to change every few days as they learn more about the spread of the virus and its impact. Since we do not know when we will be returning to work, we are delaying rescheduling patients for at least another week, in hopes of not having to call you every week to reschedule your appointments.

It causes me much distress to tell any of you that I cannot see you to adjust your braces, take care of your loose brackets or poking wires, or keep your treatment on course for a timely debond (removal of braces at the end of treatment.) Some of you have been worrying about what impact this delay will have on your treatment. To set your mind at ease, I want you to know that if the NY Stay at Home law continues only until the end of April it should not have a dramatic impact on most of your treatments. 

If it extends longer it will mirror the experience of our patients who attend sleep-away camp, and the impact will be related to how well you took care of your orthodontic appliances. This means, those who followed the rules about avoiding sticky/chewy foods, cut food thin, took smaller bites and kept up with oral hygiene will usually not prolong the time it takes to successfully complete their case. Those who don’t keep their mouth and orthodontic appliances clean, don’t wear their appliances as recommended, eat food they shouldn’t or in ways unsafe for their braces will need to be “put back together” after this unforeseen delay and may very well extend their treatment time. 

The social distancing law does not, prevent us from having virtual treatment visits. Some of you have already taken advantage of tele-dentistry by emailing to me a photo and brief description of your orthodontic problem (along with your phone number) so that I can call you back to discuss your issue. If we are not back at work by the beginning of May and you wish to have a virtual visit, you can email me at drj@okunortho.com and provide me with your cell phone number for a “What's App” or “Facetime” call. For some patients this will only give them the assurance that their treatment is on track. For others I may change the direction of elastics or the force of the headgear. If you are running out of elastics, please let me know so that I can mail more to you.

In the meantime let's use our stay at home time productively. I am forever hearing people say “one day” I will have time to do this or that. As this Coronavirus Pandemic has shown, we don't know what tomorrow will bring. Instead of waiting for “one day” to have less time at work and more time with our families (the two most common end-of-life regrets), let's take advantage of this unexpected opportunity to bond with our families and make special memories. If your family is still working in an essential business, thank you for all you are doing to keep all of us safe at home.

“One day” we will all be back at school and work. Hopefully it will be soon, and we at Okun Orthodontics can get back to giving you the orthodontic and TMJ treatment which you deserve. I look forward to hearing from you,

Dr. Judith A. Okun 

Stay-At-Home But Keep Your Treatment Moving Forward

Okun Orthodontics remains closed, except for emergencies, until at least April 20, because of Governor Cuomo's executive order for New York State to close non-essential businesses in order to limit the spread of corona virus. We are permitted to see emergencies of pain, trauma and infection. If you are having an emergency, please take a picture of the problem, and email it with a description to Dr. Okun directly at drj@okunortho.com.  We are still returning phone messages, so please feel free to leave messages on our phone answering machine (914) 253-0722.
No one knows how long this state of emergency will last, and how long non-essential businesses need to remain closed.  Please confirm with us that your appointment is still valid before heading out to see us. Please also TAKE THIS STAY-AT- HOME EDICT SERIOUSLY. Even though there are no cases of COVID-19 in children, your children can still bring the virus home to you on their hands and clothes.  The longer that people disregard the social distancing guidelines, the longer our lifestyles and the economy will be held hostage by the spread of the virus.  Today I was speaking with a 90 year old woman who was reminiscing about the polio epidemic of her childhood (causing infantile paralysis.) She remembers the closure of swimming pools, movies, and ball games.  That epidemic came to an end, and so will this one.
Remember that we still have a portal available through our website www.okunortho.com for you to view your appointments, images, and financial information.  You can print out any information you need to submit your healthcare finances for flex plans and tax documents.
Many of you are home schooling your children.  We will be posting home schooling ideas in future posts.  As always, remember to keep your teeth and braces clean, use fluoride rinse, wear your elastics, retainers, guards, and headgears as prescribed.  This current situation may slow down the progress of your treatment because I can't see you monthly, but you can certainly keep your treatment moving forward.
Dr. Okun

Keeping You Safe at Okun Orthodontics during the CoronaVirus Pandemic

We closed our office at Okun Orthodontics, except for urgent care/emergencies, for the last three weeks of March, ending April 5, 2020, at the recommendation of the American Dental Association and the Department of Health because of the COVID-19 pandemic. When we re-open in April we will continue to follow precautions to limit the spread of Corona Virus.  Steps we have incorporated for the foreseeable future include:

Distancing: All patient families will be sent to different room to await their turn.  The goal is that one family does not breathe on another.  If your family group is too large for the treatment room, please have some of your family members wait in the car.  If anyone in your family is sick, please leave them at home. In addition, we will not be greeting anyone with handshakes and hugs.

Hand Washing: Upon entering a treatment room, everyone will wash their hands with antimicrobial soap and water.

High touch areas will be minimized and disinfected: Doors to the stairwells and to our office are propped open so that you do not need to touch doorknobs. Handles of waiting room chairs as well as treatment room surfaces will be disinfected frequently.

Pre-treatment rinsing: We have ordered ioRinse, a natural and organic antiviral mouthwash which does not contain alcohol, for patients to use before treatment. IoRinse has been proven effective at inactivating Coronavirus, Rhinovirus and Norovirus at 25ppm molecular iodine. The ioRinse formula is 4x the experimental strength. By pretreatment rinsing we will minimize generation of airborne virus during our procedures.

UV light: We have six Germguardian UV-C Air Sanitizers to kill airborne pathogens. They are located in all "patient access" rooms of the office.

Air circulation: We are leaving the windows open and are using fans to circulate the air. Before the age of antibiotics Tuberculosis and Influenza were treated with fresh air and sunlight. Patients in open air tents did significantly better than patients in closed barracks.

During difficult times it is important to work together. I have always stressed the team approach to our patient’s treatment and look forward to your participation in the team effort to control this pandemic crisis.
Judith A. Okun DMD
14 Rye Ridge Plaza, Suite 243, Rye Brook, NY 10573 (914) 253-0722

Orthodontic emergencies during the CO""VID-

Dear Patients,

Under normal circumstances, I have always made every effort to see every “emergency patient” in a prompt manor. Unfortunately, we are not living in normal circumstances.  I am following the guidelines of the American Dental Association and The Department of Health in keeping the office “closed” except for urgent or emergency care for the next two weeks to minimize the spread of Corona Virus.

If you are in pain please call.  I will be seeing emergency appointments on Tuesday March 24, Wednesday March 25, Monday March 30 and Wednesday April 1, by appointment only.  We will resume a full schedule starting the week of April 5.

Please read the following guidelines for emergencies:

Loose brackets: While a loose bracket is an emergency that we would like to see within a few days during normal times, during this CoronaVirus pandemic we need to follow a different standard.  If the loose bracket is not causing pain, and is not attached to a chain elastic (that is where the colored circles are connected to each other in an elastic chain), it can wait until after the current ban on elective treatment.  If you have a question as to whether it is an emergency, take a picture of it with your phone and email it to drj@okunortho.com.  Dr. Okun will evaluate if it needs to be seen immediately.

Loose bands: If the metal ring on your back tooth comes loose it should be removed so that you don’t chew on it.  If you can’t remove it from the end of the arch-wire it is an emergency.  If it is attached to a palatal expander it is an emergency. If removing it prevents you from wearing a head-gear we need to evaluate on a case by case basis. Call the office and leave a message.

Arch-wire pokes: If the arch-wire has slid to one side and is poking you please try to push it to the other side using a needle nose plier.  If you cannot, and if wax does not stay on the end, this is an emergency, but may need to wait a few days until we have a cluster of emergencies to see.

If a retainer or guard is broken, wear the larger piece but save the smaller one. Take a picture of it and email it to us to see if you need to be seen immediately. If a retainer is broken and the pieces stay together when it is in your mouth and are held together by the wire when it is out of your mouth, continue to wear it but call so that we can schedule a repair appointment.

I will continue to check the office answering machine (914) 253-0722 so that I can return your calls. If you are having an emergency that can’t wait for a call back please also email me at drj@okunortho.com.

As Mayor Tom Roach (of White Plains) tells us, “We are stronger together when we stand apart.”  Stay at home, stay healthy, and I’ll see you soon.  
Dr. Okun