By Cindy Atoji Keene
Arlington dentist Joseph Maniscalco said most people start life with bright white smiles, thanks to a protective porcelain-like enamel surface. But over the years, this hard enamel wears down, and teeth become transparent, allowing the yellow dentin layer to show through. “My job as a prosthodontist is to fix smiles; whether it’s discoloration or chipped teeth, whatever I put into mouth should disappear so no one knows you have dental work,” said Maniscalco, who specializes in dental implants as a substitute for missing or unhealthy teeth.
Q: You say that putting pure white teeth in someone’s mouth might actually make them look ridiculous – why is that?
A: If you look at a bathroom porcelain sink, it’s usually never solid white, but has subtle hues. Likewise, there are different characteristics for individual teeth – some are very glossy and shiny while others have a muted appearance and are less reflective. Teeth can have white halos or speckles, while older teeth have micro-cracks that pick up staining. Men in particularly often might have trauma to their two front teeth but if you put two perfect white goofy-looking crowns in their place, it doesn’t blend in or look nice as it should.
Q: What sort of patients might need implants?
A: If teeth are missing or failing, it isn’t a matter of just looking unsightly. The other teeth can begin to tilt and possibly cause bite problems, expose the root of other teeth, also make it difficult to maintain oral hygiene. The off-kilter bite and the weakened teeth can begin eroding the bone under the missing teeth. A bridge or dentures are a temporary fix but dental implants are a more permanent option. They’re set directly into the jawbone and actually fuse into it.
Q: How have implants changed over the years?
A: Most implants are made of a screw or post made of commercially pure surgical titanium that serves as a root; it has properties that help it permanently fuse with our bones. The crown, the part of the implant that you see the most, is usually made of porcelain. There have been lots of advancements in the titanium, including making it a certain roughness so it adheres more strongly to the bone as well as coloring the titanium, making it partially pink instead of gray, which blends in more with the gums.
Q: You’re a prosthodontist, a dentist who specializes not just in the restoration of teeth, but also mouth aesthetics – does this mean that you are joining the dentists who are also providing Botox and dermal fillers?
A: Some dentists like to do cosmetic enhancements as an adjunct; if they’re doing a big reconstructive case, for example, they’ll add a little Botox to reinforce the effect. Dentists are specialists around the mouth, and oral surgeons specifically on the head and neck –I could certainly do cosmetic work but I’d rather leave it to the dermatologists. It’s akin to having a hip replacement – would you rather have it done by the guy who does hand surgery all day or the guy who does hip surgery?
Q: How did you get into dentistry?
A: My last name in Sicilian means ‘blacksmith’ – my family has been working with their hands for centuries. I went back to my roots and used the gift I was given, putting it to good use to help fix people’s smiles.
Q: According to a recent report, more and more patients are seeking dental treatment in hospital emergency rooms. Why do you think that is?
A: A lot of people are putting off dental work, so if they get a toothache at 2 a.m., the only recourse usually is an E.R. But unless it’s life-threatening, very few E.R.s will do oral surgery. They’ll give you painkillers, possibly antibiotics, and tell you to call your dentist in the morning. In an extreme case, when needed, the physicians will drain the infection but still will not touch your teeth. And if they triage, you’ll sit there for hours because dental is at the bottom of priorities.
Q: Many dentists run their own practices. Do they teach you about dental management in dental schools?
A: We’re trained on the science of dentistry and not how to run an office. The information that a dentist needs to know about running their own business – rent, utility, overhead, accounting, etc. – is barely acknowledged. And most dentists are horrible business people who want to just focus on helping the patient.
Q: Have you had work done on your own teeth?
A: When I was a kid, I was allergic to milk, so I used to mix sugar into water when I ate my breakfast cereal. So I have old-school silver fillings on my teeth. And I keep bleaching trays in my desk – every once in a while I’ll throw them in and whiten my teeth.