When you smile, the whole world smiles with you - or so we would hope.

Our smiles say so much about our personalities.

And so, it's important to take excellent care of our teeth.

From brushing to flossing, from removal to replacement, from crooked teeth to braces.

This show will focus on the importance of good oral health and dental hygiene, as well as learning some basic facts about different kinds of dental procedures - all designed to improve or enhance our smile.

We'll even meet someone who transformed his smile with the help of prosthetic dentistry.

Welcome to A Su Salud - cheers to good health.

I'm your host, Genesis Ortega.

Happy New Year.

We're broadcasting from inside the PPL Public Media Center in Bethlehem, Pennsylvania.

Let's introduce our first guest, our medical expert, Stacey Kouda, who is a Star Wellness regional dental manager with St. Luke's University Health Network.

Let's start with the basics.

What are the best ways to maintain a good oral health?

- The best way, honestly, is to brush your teeth daily twice a day, and to make sure you're going to visit your dentist at least twice a year for your annual cleanings and screenings.

- What can happen if you don't take good care of your teeth?

- Your dental health actually ties into many aspects of your overall health.

- Poor dental health can actually lead to diabetic issues, and it can actually affect your heart for cardiac issues.

So taking care of your teeth - it seems rather simple, but it's really important for overall health and well-being.

- Is it safe to go to the dentist now during Covid?

- That is a good question, something we get asked all the time at our sites.

And yes, absolutely, it is safe.

At Star Wellness, at all of our locations, we've taken all the necessary steps recommended by the CDC to correct our air flow issues, to make sure that it was safe for our patients and for our staff.

So you can absolutely rest assured that you're safe when you're coming to visit us.

- So what are what are some of the measures that dentists and dental hygienists are taking into account when seeing patients?

- So with Covid, something that a lot of people didn't realize, that dental - actually, in the forefront of Covid, we were paying close attention to aerosol spray.

So every time you go to the dentist and they're working in your mouth, and they're using water and air together, it produces aerosol tartlets that go into the air.

So that is how Covid is transmitted, actually.

So with dental work, you need to be super cautious that you are directing the airflow to a HEPA filtration system.

So one of the first things that we did is, in every one of our operatories, we installed a HEPA filtration system, and we also got our dental hygienists something called external suction units, which also is taking those aerosol tartlets and sucking them away from the patients and the staff members to make the air as clean as possible.

- Now, when we talk about problems that can be presented, one of them is gingivitis.

And so, I think flossing is an important part of dental routine.

So I think a lot of kids I've heard ask, is flossing really that important?

- It absolutely is, if you don't floss your teeth, you're missing a big, big amount of surface area in between the teeth and down under the gum line.

One thing that I found particularly interesting - like you mentioned, kids, they don't realize that it's important.

When we went to Allentown School District this past February to do Children's Oral Health Month visits, we had our dentists demonstrate for the children what flossing actually accomplishes - it's taking the germs that you don't see and pulling them up and out, and giving you a more fresh, more clean smile.

- Let's talk about more fresh.

How can you maintain good breath?

Like minty-smelling breath?

Is that just brushing your teeth and chewing gum?

- It's brushing your teeth, but also brushing your tongue.

A lot of people also don't realize the benefits of brushing your tongue.

There's a lot of bacteria that can live on your tongue that can lead to oral health issues.

So it's important to pay close attention to that, too.

- Good smile, that's what everyone always wants.

Nice, bright, white smile, teeth whitening.

You know, where are we headed in terms of teeth whitening these days?

- Teeth whitening is absolutely something that lots of people are interested in nowadays to get that white smile.

But it's actually really pretty easy to accomplish on your own if you're using whitening toothpaste for sensitive enamel or sensitive gums that actually can help brighten your teeth naturally at home.

- What are some other symptoms of problems?

Bleeding gums, I've heard, you know, is one symptom that you can tell that something's wrong in your mouth.

But what are some other ways that people can tell that there's another health issue in their mouth?

- Something that people should pay attention to is cold sensitivity to the teeth.

If you are, every time you take a sip of something cold, if you get a zing through your mouth, that usually is a warning sign that there might be something going on that could lead to the root canal of the tooth being infected or damaged.

So, if you're feeling constant sensitivity to cold, that's something you definitely want to pay attention to and get to your dentist to have it checked out in hopes of saving that tooth.

- So, they do a root canal then if you have teeth sensitivity?

- So what they'll do is they'll do an exam first to see if the tooth is salvageable, and if they're able to get in there and fix it, yes, the root canal usually is the most common course of treatment for that.

- What are things to keep in mind?

You know, as you know, people are thinking about their oral hygiene, probably go to the dentist twice a year as recommended.

What are some other things overall to keep in mind?

One of the things I would love to share with the community is I think there's a general idea out there that dental care is very expensive.

And I think that's something that tends to keep people away from visiting the dentist.

With Star Wellness, we offer a sliding fee scale.

So, no matter if you have insurance or no insurance, everybody's able to come and see one of our dentists and get the dental care that they need.

So, I just want people to know that, so that finances isn't what's going to keep you away from the dentist.

- Are there certain income requirements in order to qualify for coverage through Star Wellness?

- So what happens is, when you come into one of our offices, if you do not have insurance or you are being recommended for treatment for something that's not covered, you'd meet with one of our financial counselors.

And, based on your family income level, you get placed on one of the levels of our sliding fee scale.

- Wonderful.

Thank you so much, Stacy, for this conversation on oral health, I appreciate it.

- No problem.

Thank you so much.

- Our next guest is someone who decided that he wanted to transform his smile.

And with the help of prosthodontics, he did just that.

Luis Santiago, thanks for joining us today.

- Thanks for having me, Genesis.

- Let's talk about your smile and your self-esteem before you decided to have the procedure.

Did you like your smile?

- Well, no.

I mean, kind of from a young age, I was never really happy with my smile, as a kid, kind of being teased a little bit.

You know, kids can be cruel, but as I said, you know, as I grew up and got older, it was always something that I was a little bit self-conscious about.

So when I heard of actually a family friend who does prosthodontics and can change smiles, and after meeting with him and talking with him, I thought it was something I'd give a try.

- So you chose your doctor because of word of mouth.

Did you do any other research when it came to choosing your dental specialist?

- I actually didn't.

- So I have heard a lot about him.

Obviously, he was a family friend, but I know that he's very well-known in the prosthodontics community.

So, he actually travels around and teaches other doctors how to do reconstructive surgeries.

Obviously for smiles.

I believe he mainly focuses on people that have teeth issues as a result of traumatic injuries, car crashes, motorcycle crashes, sports injuries, things like that.

So I figured if he can fix them, hopefully my teeth aren't that bad.

- So let's talk about the treatment itself.

How old were you when the treatment started?

How long did it last?

Was it painful?

- Yes, I was about, I believe, 27 years old.

It lasted about three months.

- So the processes will come in, they'll take some X-rays of your mouth, take some molds.

They'll decide basically the length, the size, what type of teeth they're going to use, and then they'll put some temporary ones in.

So, after they put the temporary ones in, then they'll send out and make sure that you like that smile over that amount of time, but then also send out to have the permanent teeth made.

And then, you'll come back in, they'll remove the temporary ones and put the permanent ones back in.

So it took probably about three months till it was all said and done.

And, in terms of pain, it...

I would say the doctor that I used, they're very pain-conscious, so they do a very good job of making sure that you're comfortable throughout the entire procedure, making sure that you're not in any pain either during the procedure, even thereafter.

I will say there definitely is some pain involved when you're messing with your mouth and kind of very, you know, the teeth are very sensitive.

But it wore off after a few months, and it was definitely worth it.

- So tell me this, Luis, at any point during the procedure, during those three months, did you have any regrets?

Did you think, "Maybe I shouldn't have done this?"

- I will say there were definitely some...

There were definitely some days where you kind of look in the mirror and ask yourself what you're doing, especially before you get to see the end result.

But in terms of regretting it, I've never regretted it one day.

Yeah, I'm really, really happy that I did it.

- So, what was it like when you finally saw the end result?

- It was...I don't know, I feel like I look like a new person, you know, definitely, and increased my self-confidence.

What I found was strange was that even people that I was close with, coworkers, people that I knew, that I've known for years, could notice that something was different about me.

But no one could really point out that it was my smile.

- Yeah, I totally get that.

I mean, what would you say to other people who are considering doing the same thing?

- Yeah, I would say, you know, probably do a little bit more research than I did about it.

I think I got lucky and everything turned out really well, and I was lucky enough to pick somebody that was great at their craft.

But definitely do your research.

And, you know, if it's something that you feel is truthfully going to give you, you know, a little bit more self-confidence and, you know, something that you think is going to improve your life and the way that you feel about yourself, I'd say go for it.

You know, it's obviously a huge investment financially.

It's an investment in time and kind of...

But I, you know, like I said, I've never regretted it a day in my life.

And now something that I normally was self-conscious about is the one thing that I'm complimented most on.

- Yeah.

And I want to talk about that because, I mean, it's a smile transformation.

Sometimes, you know, people say that the smile is the first thing that people see when they interact with someone.

So, how do you feel about yourself now, versus how you felt about yourself when you were a kid and you were getting picked on?

- Yeah, no, it definitely is a boost of confidence.

You know, it's one thing that I'm remembered for a lot of, you know, I so I'm now in my role...

I'm a national sales trainer.

So, I fly around and give sales training to different dealerships in my role.

And the one thing that everyone kind of always comments on is this guy that walks in with this big, brilliant smile.

And it's one thing they kind of, you know, always make comments about or something that leaves a lasting impression on them.

- How does your partner feel about your new smile?

- She loves it.

Yeah, she loves it.

- Awesome.

Well, Luis, thanks so much for being with us today.

You're radiant, it looks, it shows.

I'm very happy for you.

Thanks for joining us and telling us about your story.

- Genesis, thanks for having me.

- Our next guest on the show is a local orthodontist who's been practicing for over 20 years right here in the Lehigh Valley.

Dr. William Cherry, thanks for joining us today.

- It's a pleasure.

Thank you.

- So let's start off with this, let's talk about your patients.

What's the average age of some of your patients?

- Well, the majority of the patients are somewhere between nine and about 15, but we have a range that goes anywhere from six to 80.

You can really move teeth at any age, but the ideal time to do it is the early adolescence.

- So starting with that, how important is it to have good health hygiene, dental hygiene when you're young?

- Extremely important.

If you don't take care of your teeth, they can become...

Develop cavities.

But with braces, we actually align the teeth, so it's easier for them to clean.

The whole digestive process starts with the mouth.

And if you can't chew your food properly, the digestion doesn't take place as well.

- Now, Dr. Cherry, I have an 11-month-old.

So what can you tell me about baby teeth?

Is it important - right now, he has about six or so teeth in his mouth, but is it important for babies to lose their teeth on their own as they're growing, or do they require removal?

- That's a hard question to answer definitively.

Most of the time, I prefer to have nature take its course.

However, when people have crowded teeth, sometimes we take out some baby teeth early just to make room for the permanent teeth.

Also, the other way that we sometimes will take out baby teeth is if the permanent teeth are trying to come in, and the baby teeth just won't leave.

So... - Well, let's talk about braces now.

You know, I understand there are different types of braces.

Some are invisible, some aren't.

So let's talk about that.

-Braces have been around for about 120 years.

The traditional kind are metal that are attached to the teeth.

They used to be banded, but now we just bond them directly to the teeth.

That involves wires and forces that are exerted onto their teeth from the braces.

About 20-25 years ago, they developed aligner therapy, and some might know it by Invisalign.

But there's other places out there that do it.

And what that does is it uses the external forces from the aligners which are in incrementally different positions per aligner, and it exerts the force that causes, the teeth to move from that side, rather than from the wire in the braces.

So they basically accomplish the same thing, but they do it coming at it from two different angles.

- I remember when I was growing up, my brothers had braces.

And one of the things they said was that braces were painful.

So, are there any easy fixes when that's the case?

- Well, in the years past, we used wires that were a lot more, a lot stronger and exerted more forces.

These days, with the wire systems that we - wire braces systems that we use, we use only a fraction of the forces that we once used.

So, at most, it's a day or two that people have minor discomfort.

With the aligners, same thing, because you're exerting forces.

But they also don't have any sharp edges, so they tend to be even more comfortable.

- So how important is good oral care when a patient is wearing braces?

- With braces, there's lots more nooks and crannies that can affect... Can accumulate plaque, plaque is the enemy.

That's the thing we want to make sure stays off the teeth.

So, if you don't practice getting underneath and around the braces, you can get areas where plaque will build up and cavities can start.

In addition, if you leave them around the gums, you can get gum disease.

And sometimes that results in some bone loss, as well.

So, it's really critical.

That's one of the things that we look at every appointment, make sure that the patients are doing a really good job.

And if not, we try to teach them what they need to do and, if necessary, we'll bring mom or dad back and go through the steps again.

That's probably the most important thing you can do at home to help yourself.

Other than some of those infections you just mentioned, that can happen if you don't take care of your teeth while you're wearing braces, are there any other risks that come into play when someone is wearing braces?

- Well, you have the risk of injury to soft tissue, if you're playing a sport or whatever.

If you get rapped in the mouth, the inside of your mouth can get fairly cut up.

The other one of the other longer-term risks is... And again, this has mostly gone away, but you can have some root loss as a result of having the braces on for an extended period of time, and/or putting too much forces on.

In years past, sometimes the forces were too great, and the teeth resorbed the roots a little bit, and sometimes significantly.

So, those are the major... on disease-related things.

- So what's the average time that someone should wear braces for?

- Most cases can be treated well in 18-24 months, and some are more difficult than others.

Some actually require two phases, where you do a bony shift at an early age and you line up the teeth later.

- In my home country, in the Dominican Republic, oftentimes older people end up getting braces, sometimes in their late-20s and 30s.

Are you seeing that case in your practice, as well, or are you seeing more people veering towards Invisalign braces?

- Well, Invisalign has really expanded the adult market.

I got to say that before, I had people that wanted straight teeth, but they weren't going to wear braces.

I have a fair number of patients in their 40s, 50s, and 60s that never liked the way their teeth were, and are now interested in getting them taken care of.

And also, the other thing that happens when you get older is your teeth tend to crowd.

And if they're crowding a little bit and you're 25, and insignificant when you're 45, maybe that's the time you need to kind of go in there and set yourself up for the rest of your life with not only a beautiful smile, but teeth that you can clean easily.

- It's interesting you mentioned spacing, because I've noticed as of late that my teeth have started moving.

How normal is that?

And, you know, what's the time frame?

Should I be seeing my teeth move for the next 5-10 years?

- Actually, teeth move throughout your life.

And that's how the teeth age.

Nobody bats an eye when you're 40 years old, and you need to get new glasses because your eyes have changed.

Well, your teeth are part of that same body.

And the way the teeth age is the back teeth push forward and the smaller front teeth without any support will tend to crowd and overlap.

We talk about when we finish with the active orthodontic care, we talk about lifetime retention because that's the only thing that really works.

I equate the retainers as eyeglasses for the teeth.

- It's funny that you mention retainers - again, I remember one of my brothers had to wear retainers, they actually decided not to and their teeth spaced out again.

So, can you tell us how important is wearing a retainer after you have braces on?

- Absolutely important.

There's two phases of orthodontics.

There's the active phase where you're moving teeth, and then, there's a retention phase, which is much, much longer.

It doesn't involve as much time per day.

After a couple of years, you can put them in three nights a week and maintain.

However, when you stop, Mother Nature takes over, and Mother Nature wants to crowd your teeth.

So, if they started with a lot of spacing, it may space your teeth.

But generally, more often, they tend to get more crowded.

So, retention is as important as moving the teeth.

And it happens whether you've had orthodontic care or not.

Even without braces, patients will tend to get that same thing happening.

We've kind of determined it's a natural aging process.

- Wouldn't it make sense to instead wear braces longer than 18-24 months, or is that just not the same thing?

- It's not the same thing.

The movement of teeth is one thing, the retention is another, You can hold them for five years - as soon as you take them off, the natural processes take over.

So, you're better off investing time in the retention area.

Plus, I talked about resorption of the roots - after 3-4 years, that process accelerates.

So, we don't want to do root damage just by holding the teeth in with braces too long.

- That's noted, doctor, You know, with the added complications of Covid-19 exposure, how has that affected the way that you see your patients?

- Great question.

We always wore masks, gloves, and goggles or eyewear.

Covid has added several layers, in addition to the HEPA infiltration of the air.

We are now wearing fluid-resistant gowns, disposable gowns, full face shields, and the treatment areas and anything that surrounds it are wiped down.

In between patients where the patients were, but then, also the whole operatory kind of gets a once-to-twice a day after the morning session, then after the afternoon session.

In addition, we have closed down our waiting room.

When you pull up, you call our office staff.

They'll do a brief phone interview to see whether or not you've been traveling, or you have any symptoms.

And then, we send out one of our employees who will escort just the patient, not the whole family - which is what happened in the past, where we just have the patients come in and we escort them directly to the chair, and directly from the chair to the door.

When the patients first come in, we take everybody's temperature.

So, know if you're running a fever, we don't take you into the office.

And that's the way we keep the office safe.

I feel safer in my office than I do sometimes when I'm out getting food or whatever, food shopping, just because I know the precautions that we take.

So it's really a safe place to be.

- All right.

So, let's talk about your patient Danny Rapke.

- Danny is a... Young man who came to me, and his teeth were very crowded and he was very narrow - his arch was very, very narrow.

And when you have a V-shape versus a U-shape, it creates problems getting the teeth to fit in and fit the face.

So one of the things, one of our goals of treatment for Dan was to get some side-to-side expansion.

And we were able to accomplish this and create enough room to get his teeth in.

He's still in treatment.

I do have his mother's permission to talk about him today.

Right now, he's in the stage where he has an elastic-wear.

Elastics are an important part of braces.

The braces and the wires go on the top and bottom, but the elastics make the connection between the top and the bottom and allow us to exert the forces that will move the teeth against each other, so they can be lined up.

- Well, thanks again, Doctor, for being with us today.

I really appreciate your time.

- My pleasure.

Thank you very much for inviting me.

I appreciate it.

- I want to thank our St. Luke's University Health Network experts and our guests for being with us today.

And thank you for tuning in.

We look forward to seeing you again soon.

It's a brand-new year and an entire new slate of topics we hope to cover.

So, that being said, if there is a medical subject you'd like for us to cover, send me a message on social media.

You can find me on Facebook and Instagram.

Plus, you can tune in to hear more of my reporting on 91.3 FM WLBR news, your local NPR News source.

I'm Genesis Ortega, and from all of us here at Lehigh Valley Public Media, stay safe, be healthy, and cheers not only to the new year, but to your health.