Dr. Sanjay Shah

All of us have had situations where a visit to a dentist has drilled a hole in our pockets more than our teeth. Of lately, dental health and dentistry has gained a lot of demand and attention. Dentistry has also evolved and moved into modern stages and combines technology and medical science efficiently.

While it is difficult to get appointments from a dentist, we managed to squeeze in for an interview with Dr. Sanjay Shah, Bachelor in Dental Surgery and specializes in Smile Designing, Painless Laser Treatment for gums, Cosmetic dentistry, Full Mouth Rehabilitation and many more.

In the interview he throws light on the various procedures of dental surgery and also provides healthy tips and suggestions on ways to maintain a healthy dental structure.

Can you tell us more about the Smile Designing procedure?

Smile Designing as a procedure has been existing since maybe fifteen-twenty years in Bombay. We have been doing Smile Designing since almost twenty years now. It is a procedure by which we change the look of the patient, change the alignment or the colour of the teeth depending on the requirement of the patient. The way we do it is such that it gives a complete makeover to the smile. A negative smile can be converted into a more positive and a million-dollar smile.

When you mention that the procedure offers confidence to the patients, how exactly is that achieved?

I’ll give you an example of a patient who came to me. She was a dancer and a minor celebrity in the television industry. The only problem was that while she would dance, she was unable to smile just because her teeth had some concavities. They would look very ugly, unsightly and had brown stains. There were cavities in the front teeth. So, she came to me one day and told me her plight. Even when she laughed, she would normally cover her face while laughing or cover it with a handkerchief because she was very ashamed of her teeth. So we did a complete makeover using porcelain laminates. Porcelain laminates are the best way to give a confident smile. We completely covered those areas, those concavities, those black stains with the laminates and aligned the teeth in such a way that it was quite invisible that we had something. At the same time they looked ravishingly beautiful. All her friends who met her that day just could not recognize her because she was a totally different person as a personality also. She was giggling and laughing. The next day when she came to me she got a bouquet of flowers and gifts. She told me that her personality had changed, not only her smile because her confidence was boosted up. So this is one way a person would feel much more confident.

Can you throw some light on the Full Mouth Rehabilitation procedure?

What happens many a times is that some patients neglect their teeth for a really long time, maybe years and years. They are in their forties and fifties or even in their thirties. They have never been to a dentist. So what happens is that many of their teeth lose a lot of bones/strength and a lot of cavities form. Basically we do a Full Mouth Rehabilitation, in which almost every tooth requires some treatment or the other and every tooth requires a root canal, crown or a bridge. A bridge is something in which you replace a missing tooth with the support of other teeth or an implant is required. As an example I will like to tell you about a patient who was almost 70years old. She came to me and she was not able to chew at all because she did not have many teeth. She had been wrongly treated by some people. Her good teeth which could have been saved by root canal had been extracted. She was absolutely crestfallen because she could not eat anything. We did a Full Mouth Rehabilitation procedure and we gave her teeth back. She could eat from the very next day after we fit in the bridge. Then, she called me up and said “I have not eaten a pizza in so many years. I could eat it now. And peanuts also.” That was really great. So Full Mouth rehabilitation is an extensive treatment in the entire jaw both upper and lower which covers a lot of modalities of dentistry. It is Smile Designing. It covers periodontology and also covers endodontics. These are different ways to salvage existing teeth and improve the smile also.

Do you feel that Full Mouth Rehabilitation is a better option than extracting teeth?

Absolutely. I’ve heard of cases in the US where people have sued the dentist for wrongly extracting teeth which could have been saved. They have been sued for a million dollars and patients have won the cases there. In India the system is very different.

We have also come to know that the latest buzz in the industry which is the transparent braces or laminates. Can you let us know more about the procedure and technique?

Transparent braces are different from laminates. Transparent braces of porcelain braces as they are called are basically very good to look at because they do not look like metal ones. From a distance, when a person is talking or smiling, it is not very visible that he has something on. But they do tend to stain a little bit yellow with time. So they look a little unsightly over a period of time. Metal braces give you a ‘tin smile’ as they call it from day one. But there is a saying in orthodontics that ‘once a tin smile always a tin smile’. So it’s a temporary setback for the looks but it’s great if you are doing metallic braces. If you are doing ceramic braces the looks are definitely better. Laminates are different all together. It is a commonly used in Smile Designing. It is a thin layer of porcelain kept on the tooth and stuck on the tooth in such a way that the entire look of the tooth changes. The colour could change or the shape could change depending upon the condition of the patient.

How effective are the laminates? We have heard that metal braces are more effective as compared to the laminates or attractive braces.

If you consider strength wise, they may be a little bit stronger. But with the modern porcelain braces all the small differences have been ironed out. They are equally good or better probably but they are much more expensive. These porcelain braces are a lot more expensive than the metal braces. So the patient has to shell out a lot more money. That is the drawback on the pocket.

Also we have heard about the teeth-whitening agents present in chewing gums, how effective are these?

I think these claims are not very good. Most of the times these teeth whitening gums and toothpastes, especially the toothpastes, contain a little bit of an abrasive agent which will remove minor stains. So if you drink a lot of coffee or smoke a lot or have Tobacco, they might give you a temporary or slight lightening of the colour of your teeth. Chewing gums – I don’t think they do any good. They contain some bleaching agents and soda-bi-carbonate, etc. It is supposed to make your teeth look shinier but it’s just a very temporary phenomenon. You should actually do a professional bleaching where there is an in-house bleaching available with the dentist or there is an in-office which we do here. The in-office bleaching that we do here is with the help of plasma arch-lights. We have a very good system here in our clinic, where in 45 minutes the patient’s teeth become a lot whiter that they were. Sometimes we have to do two or three sessions to make them still whiter if the patient wants. We can make the teeth at least three or four shades lighter depending on the original shade. So that is a more permanent cure than using toothpastes. Toothpastes and chewing gum are temporary and for a couple of days you might feel better, but it goes back to the same thing. If you are using an abrasive toothpaste for a very long period of time it tends to remove the protective enamel on top of the tooth. So the enamel is also abraded out because it contains abrasives or polishers. So that way long–term usage of these toothpastes may be detrimental to your enamel. It also depends on the way that you brush and the technique that you use.

Laser treatment is also available in dentistry. How much has it come up and what are its uses?

In our clinic we have been using lasers since almost four years now. We are a group of pioneer dentists who started laser. It is growing a lot more popular now but in Mumbai still not even 1% of dentists have the laser equipment. Maybe 10-20 doctors have the laser as equipment. It’s a very new line as far as dentistry is concerned but it is an excellent method for doing all soft-tissue procedures and hard-tissue procedures. The pain and bleeding is much less. When the patient comes to us for a flap surgery of the gums for example, he is very scared of taking injections. He is very scared of the blade which is used to cut the gums open. With the laser, there is no need for an injection; there is no need for any stitches. We can just lase that area. The verb is lase. When we lase the area, we actually go around the tooth with the laser beam. A laser beam is basically touch specific. It will only affect the area which it touches. The depth of the operation would be around 1mm. So there is no risk of punching a hole in your tooth. There is a misconception that a lot of people have, that the laser will go through your teeth/gums because they have seen the laser cutting through metal in those James Bond films. This laser is a dedicated laser used in dentistry. It is a FDA approved laser and it’s gaining a lot of popularity because there is no bleeding. In fact I had a case yesterday where a patient was suffering from sub-mucus fibrosis, which happens to patients who cannot open their mouths and there are fibrous bands formed inside because of tobacco and beetle nut chewing. In such a situation we have to cut the cheek because it forms a lot of fibrous bands which are pre-cancerous. So when we cut it with a normal blade, there is a lot of bleeding. Yesterday we had a case where the patient was very scared that he would be taking injections and we would be cutting his cheek. I just put a spray and cut the whole area. There was absolutely no bleeding because the laser cuts and it stops the bleeding then and there as it cauterizes the blood vessels. It just punches the blood vessels closed so when we cut it doesn’t bleed. That’s the best part. And the healing is also much faster because the tip of the laser itself is at approximately 250 degrees Celsius. So it sterilizes the area as it cuts. Because it is sterilizing, the chances of re-infection or post-operative problems is fantastically low. So it is absolutely a marvelous in dentistry.

What about the cost factor? Is the procedure too costly?

I personally have not started charging more because I have incorporated the laser. I would charge the Laser procedure in the same manner as a normal gum surgery or normal treatment because I’m absorbing that in my own investment rather than taking it from the patients. But there are dentists who charge a lot more for the laser. It’s the prerogative of the dentist – what he’s going to charge. But suppose as an example I charge Rs 500 for one tooth laser, so the charge would go according to the number of teeth we have to lase. I’m just giving a brief example but there are dentists who charge 2 or 3 times what I’m charging. Because the laser is a very expensive piece of equipment.

Can you give us some tips and suggestions for good oral care and dental health?

The most important is your diet. Your diet should be free from refined sugar as much as possible. Once in a while having chocolates is not a problem but a daily dose of sweets and chocolates will definitely cause a problem. If you are having fibrous fruits and fibrous foods, they act as natural cleansers. An apple contains fibers. So if you are eating an apple everyday it naturally cleanses your teeth for example. Anything which is fibrous form of food is very good for you. Also, if you are brushing regularly twice a day that is very important. And you have to floss. Most of the people in India are not aware how important floss is. In fact it has been discovered that if you have plaque and tartar beneath your gums or if you have periodontitis or gum disease, the same bacteria that are present in your gums can go inside your blood vessels and can actually block your heart arteries.

So they might be precipitating your heart attack. You might not have any other symptoms or causative factors. You might not be obese; you might not be smoking; you might not be drinking heavily; you might not be a sedentary. All these factors might be positive. But if your gums are really bad the chances of you having a heart attack increases by 20 or 30%. The other thing that I would like to recommend to all the patients and all the people around is that have a half-yearly check-up, or if possible three times year, with your dentist so that you have a constant vigil on your teeth condition. Most of the people feel that if your teeth don’t pain, you don’t need a doctor which is absolutely opposite. In fact you should go to the dentist because you are not having any pain so that you don’t have any pain in the future. You have to go to the dentist whether you have pain or not. It’s very important.

So if the dentist catches something like a small cavity and fills it at that time, it will not develop into a root canal problem; you will not go into an extraction later on. It is important that all your teeth remain in your mouth for as long as you live. Egyptian mummies of 5000 years ago have all their teeth in the skulls. The bone can hold the teeth even after so many years. This is obviously in a lighter vein. But even if you live to be a hundred all your teeth should ideally survive if you take good care of them. A lot of people have this notion that after 60 you will need to wear a denture or need implants. No. You can save your own teeth. You don’t need any implants. You don’t even need to extract a single tooth. You should go to a doctor who believes in conservative dentistry, who believes in conserving your tooth. Because after all God is the final dentist. We are not above God. So if you save what God has given, that is the best thing. We can only do a little bit of a patchwork to mimic what he has done. But what he has done is marvelous. So let us save that and work towards a better oral hygiene. Also tobacco and smoking is an absolute no. It can create a lot of problems apart from oral cancer. It can abrade your enamel very fast and you will need a lot of treatment very soon.

Thanks a lot for your valuable inputs and letting us know in detail about the various procedures and giving us insights on Dentistry.

You are most welcome, the pleasure was all mine.