The days of tying a string around a loose tooth, tying the other end to a doorknob, and slamming the door to pull a tooth, are gone.
Dentistry has entered a new era.
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Until he left dentistry, Shapira was among Coastside dentists who had practiced here for a long while. All share common denominators of training, skill, compassion - and flexibility in the face of progress.
Computers, digital X-rays, smaller-than-the-eye-can-see instruments and invisible braces are only a few of the once-undreamed-of dental wonders that are now commonplace.
And it's all in the hands of the kindly family dentist.
"There has to be a balance," Shapira said. "The human aspect of medicine and dentistry has to come into play. We don't forget that the patient needs to understand the ramifications."
So, what do you do when faced with a digital dentist? Just open wide.
Yesterday and today
The words "See your dentist" have traditionally struck terror into many hearts. But it's not so bad anymore.
Modern technology has redefined the dentist's office from the ground up, Shapira said. "Everyone's trying to re-invent the wheel."
For example, you can now use a new electric toothbrush that incorporates a toothpaste receptacle. Touch a button to squirt your dollop of toothpaste onto the brush.
You can relax - really - in the dentist's chair now. It's been revamped, with different cushion design and ergonomic shaping, for the comfort of patient, dentist and hygienist. Even armrests are new.
Miniaturization has come to dentistry. In oral surgery, dentists incorporate tiny microscopes to scan oral tissue. They manipulate micro-cameras that slip down the side of the tooth to capture images of the root. The process isn't pain-free; you'll need anesthesia, Shapira said.
Drill bits have evolved beyond the big mosquitoes of old. Today's instruments have supplanted the older drill bits that used to wear out due to the effects of revolving from 30,000 to 100,000 rpm.
There is a new test, Shapira said, in which doctors analyze a patient's saliva content and, based on its chemical and protein makeup, determine if the patient is at risk for periodontal, or gum, disease.
Good news for patients
Once upon a time, being told you needed a root canal brought sympathy cards from friends. With good cause, too, said Dr. John Moon. He bought Shapira's practice at 611 Church St. in Half Moon Bay, and he and Dr. Bonnie Akhavi, perform general and cosmetic dentistry, endodontics, oral surgery and periodontics there.
Once, Moon said, a root canal dragged over several appointments. Now, he uses a hand-held rotary machine to quickly, effectively clean those infected canals.
"It's like a vacuum cleaner you plug in," Moon said.
Having an implant once meant losing teeth and getting a partial denture. Now, implants either bond to the bone or are attached in place by a titanium screw. Crowns then go on, often immediately.
The technology is successful in replacing one or multiple teeth, said Dr. Robert Moody. He does general and cosmetic dentistry and whitening procedures, crowns, bridges, restorations and implants, in the practice he shares with Dr. Tina Yoo, at 538 Main St. in Half Moon Bay.
"We've seen dramatic increases" in implant technology, he said. "It's reliable and different, nowadays."
Cosmetic dentistry got a facelift too. To whiten a patient's teeth, Moody no longer uses lasers which can spawn problems.
Instead, he applies a whitening agent and uses a "curing light" to speed up whitening. It costs more than commercial whitening strips, Moody said, but patients like it: "Sometimes patients want quicker, rather than take-home."
He also noted that "very popular" treatments like porcelain crowns, veneers, and removal of metal or timeworn fillings, are on the rise.
Today's thin, shell-like, translucent porcelain veneers no longer mean chiseling away the tooth below. Instead, patients slip them into place "like a press-on nail," Moon said. It is popular among teens, he added, whose teeth may be discolored as a result of the antibiotic Tetracycline given to their pregnant mothers generations ago.
Getting rid of those old metal fillings - the ones made with amalgams of mercury and silver, of which there are 140 billion in existence, says Dr. C. Ray Sheppard, of Half Moon Bay - is urged by many dentists for reasons other than vanity. The stuff is not flexible like organic tooth material and can cause cracking in the enamel over time.
Now dentists use a composite plastic material in natural colors. It "holds the tooth together in a better way," said Moon, and "can really look exactly like the tooth."
It gets even more basic - down to anesthesia. Moon says he often numbs his patients now with non-invasive skin patches. "Sometimes you don't even need to give a shot."
In terms of advances in oral surgery, Moon cites the use of synthetic bone material. Surgeons can also graft necessary bone material from patients' hip bones, which are similar in density to jaw bone structures.
And he notes the use of lasers to reshape gums affected by periodontal disease; "not just the tooth but the gums too, so the teeth match that."
Dentures today are metal-free, Moon said. "No one can tell" they are anything other than your teeth.
'Metal mouth' no more
When Coastside teens and adults need braces, they head for Dr. Alexa Alborzi, who is in at 705 Purissima St. in Half Moon Bay on Tuesdays. (She also practices in San Mateo.)
Alborzi uses "Invisalign" and "almost-invisible 'ceramic braces'" on her mostly teen patients.
But new to her profession is the innovative "self-ligating Damon" braces. Now around for seven to eight years, the Damon system blends engineering and computer technologies. Each tooth has its own aligner, programmed for that tooth's specific desired movement.
The result is a gentler, more natural means of tooth realignment than with conventional braces. Treatment time tends to be shorter, by as much as 25 percent, Alborzi said. And she noted that Damon is good for grownups.
"It's especially ideal for adults because it is gentle," she said.
Computer technology, D.D.S.
Most of dentistry's major advancements have to do with computers.
"We are heading for the paperless office," said Shapira. Everything once limited to paper - photos, digital X-rays and records - are now at the touch of a mouse.
"It's all in the computer," said Sheppard.
Computers also simplify the process of referrals to specialists. And they make it easier for regular patients to consult their doctors.
"You don't even have to drive to the office" unless the problem is a new one, said Moody. "I just access (the) laptop and get information on the patient."
The use of computer-driven equipment in dental and surgical procedures is on the horizon, Shapira said.
"More and more and more in medicine, you work through command modules," he said. "I predict the day we'll have automated assistants. I'm serious."
Computer technology is big in Sheppard's office at 890 Main St. in Half Moon Bay. With help from his new CEREC computerized system, he makes crowns and restorations. And forget about the lab.
The computer system, he said, "eliminates those steps."
But technology still has not eliminated the dentist. And it won't, said Shapira.
"Robots are more exacting," he said. "Hands shake, eyes get tired. Technology is more practical.
"But it's technology guided by humans. Human vision and human judgment. You can't take that out."
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