Trish Howser: you guys are emailing me and I’m getting emails all the time and you’re sending information in. And if there’s anything wrong with my teeth, please let me know and I will let Joyce know and she can make sure she gets it taken care of. So there’s always someone to fix something in this world, isn’t there in the day of technology which is – I was talking to — I’m always asking Dr. Joyce questions. So I had her come on so that she could answer all my questions. So I’ll be rambling and going on and on and on about my mouth and of course, I did get a few questions from other people that had emailed me on questions they want me to ask Dr. Joyce and maybe you’re afraid to ask your dentist. My dentist is open.
So let’s — first thing I want to do is find out how did you become a dentist? And how she became a dentist because I just can’t imagine looking in people’s mouths all day and I might have — some people have bad breath. So that’s one of the questions that came to. My question is, how do you have to sit there and smell bad breath all the day? But maybe it’s not. Maybe that’s why they have you wincing constantly. Every time I turn around, it’s rinse, rinse, maybe they’re saying something about me. So let’s go ahead and ask Dr. Joyce. How do you become a dentist and how did you become a dentist?
Joyce Kasunich: Well Trish, I went a different way of becoming a dentist, usually go four years of college and you can go right into dental school. I, however, took a long about way of getting there. I took five years off after high school. I worked as a dental assistant for a doctor in Pittsburgh. And he actually was my basketball coach at the high school. So I worked with him and he taught me a lot. I was going to go to a school similar to like a boutique out this area back in Pittsburgh. And he’s like you know, just come with me, work on the job training. So I worked with him for about two years and unfortunately, he got ill. So I was looking for another job, and I worked for a dentist in Shadyside and I worked there for about three years. And I thought to myself there were these girls there and doing a different type of job that when I went to the dentist. I always had the dentist clean my teeth and things that way.
Well, here they were dental hygienists and I thought to myself, oh, I could — I can do that. So I started taking some classes at that community college, local community college and applied myself and I got accepted into the University of Pittsburgh Dental Hygiene program back in ’88, graduated in ’90. But once I was in hygiene school, I knew then I am going to be going to dental. So after that, I had to take some more classes to get myself prepared for the dental school level. And it took me about three years and then I was in the 1993 class at Pitt and I graduated in 1997. So – but usually like I said, the normal four years college, four years dental school and then if you want to go on after dental school, you can become a specialist and a doctor that does root canal is an endodontist or a doctor that does braces is an orthodontist. So there’s oral surgery, there’s different specialties out there that branches off after four years of dental school.
Trish Howser: This is kind of off the subject but you see all those advertisements for Botox and all that. Now –
Joyce Kasunich: Yes.
Trish Howser: Are many dentists getting into doing that?
Joyce Kasunich: There are a few that I can — I think of, there are a lot of CE courses out there that are available for the dental professionals. The guys that I work with and myself, we have not gotten or into that quite yet. Actually this funny thing is, is next week there is a webinar through the Academy of General Dentistry that I am taking and it’s all about Botox and dermal fill. So picking an interest but I have not or we have not been able to get — to get into that.
Trish Howser: Yeah, I don’t know, I mean it’s funny because you see some of these movie stars that have had that gone. And it’s just not pretty. I mean they look like clowns. I think really – and I just wonder what specialty you did and is it just plastic surgeons that are doing more of it or a lot of dentists or –
Joyce Kasunich: Or there is dermatologists and then different – there’s a group of different types of doctors that can do, the Botox and things that way. So I don’t know if there’s a particular — it’s not just one doctor that’s allowed to do that.
Trish Howser: Because – those specialized in the face and those muscles and how all that works?
Joyce Kasunich: And that’s kind of like, what they are thinking is why always aren’t the dentists – can, should be able to do that, and do that which some of them obviously do. There is classes all over there. So there’s a group in Miami, I believe, that’s called the dental spa and that’s all they teach is Botox trying to get your practice into more of a relaxing because people are so nervous when they come in, type thing, to do Botox and spa, or massage and things that way. So it’s out there.
Trish Howser: Are they dentists? Is all that stuff covered on my dental insurance?
Joyce Kasunich: No. All will not be covered.
Trish Howser: Because I tell you what, I really want to know how to get that massage, that’s it.
Joyce Kasunich: I am liking that but – now, I don’t think that’s covered. So –
Trish Howser: It’s interesting, this is a little off the topic but I was talking to someone about what you pay for and all the extras and they were saying about — we’re talking about hourly rate on cars, to get your cars repaired, get this done, get that done. And he said yeah but you’ve got to think about if they’re washing your car, because a lot of people say oh, I am very happy if they have a Lexus or Mercedes, or Volvo, BMW, I guess I don’t know if Honda does that, I don’t know, Ford, who does it but they’re washing your car, they’re doing this, they’re giving you the – he said that they’re not giving you any of that stuff. He said they have to pay for their business.
Joyce Kasunich: That’s right, the business.
Trish Howser: So you might be paying a hundred dollars in the labor charge compared to seventy dollars on labor charge. But it’s kind of like you just said with the — if you’re going in and you’re getting the massage, you’re getting this and that.
Joyce Kasunich: They are paying for it, that’s exactly right. I’d say that’s exactly right. So –
Trish Howser: You got to pay your bills, not the government.
Joyce Kasunich: It’s not the government.
Trish Howser: We don’t have to pay our bills. So that is interesting. I like the massage and – to put that as a little –
Joyce Kasunich: I like to know how Tuesday – how the webinar goes?
Trish Howser: Well, I just wonder you know because like I said, my only measure is seeing a lot of movie stars and I’m sure there’s a lot of regular people walking around out there with it. But I just wondered because I thought Joyce knows the face and knows the muscles and I think it’s a cash crop –
Joyce Kasunich: Yeah, it could be here – yeah, plus it would be like I said it’s not covered under insurance. So if patients are willing to pay for it, then I just will learn to incorporate it into the practice. I have had patients asked. So and I know there’s an interest, it’s just how much of an interest is there in your county? So –
Trish Howser: And how much can you make? And you – you want to tell us where you are located and who all –
Joyce Kasunich: Sure. We are at — address is 1447, East Market Street, York, Pittsburgh, Crossroads of East Market, it’s a corner lot there. They have been there quite a few years. The first doctor was Dr. [Lee Park] and I believe he was on King Street, I might have that wrong, many, many years ago. And then he joined with Dr. Hess and they practiced together. I am not exactly sure when I say the wrong dates but then he moved to the East Market location. I mean now Dr. Hess and Dr. Lee Park are both retired. Dr. Bronley Walker is our senior partner and there’s Dr. Jeff Pugliese I am in with Dr. Paul Kruth and myself. So gees, Dr. Walker’s been here, oh gosh, I can’t even – yeah, I don’t want to say much here, Trish.
Trish Howser: Dr. Pugliese is about thirty years and I think Dr. Kruth is about fifteen and I’m now thirteen. Time flies. How do you look in mouths all day? I mean (inaudible)
Joyce Kasunich: I often wonder that row the teeth –
Trish Howser: Now obviously I came and I am just picture perfect.
Joyce Kasunich: Yes, you are. There is not thing wrong. Nothing wrong.
Trish Howser: You know, flossing, and that’s a thing that’s funny, I think everyone goes — the day they go to the dentist, they’re thinking oh, my gosh, I have to make sure I brush my teeth. I’m taking my toothbrush, I am taking my toothpaste, I can brush my teeth before I get in there. Better make sure I floss, it’s kind of like they want to make it look good. Then they won’t do with the rest of the 60 full days – one day I got their – insured, everything is done. And they can – like, are you doing this?
Joyce Kasunich: Yeah, yeah, some patients say that to us, oh, yeah I flossed two times a year when we see you. O my God, that’s good. So but I don’t even think of it that way is they come here for us to help them and that’s we try to do it every day to the best of our ability to help patients. Some patients are unfortunately for whatever reason have some bad teeth. And you just got to teach them, you got to educate them, you got it, nutrition is a big thing. What are the kids and adults, not kids, I mean even now with the fluoride (inaudible) and sealants that are out there, there’s still the decay that we see. A lot of it has to do with drinking with Mountain Dew or drinking pop and sugary candies and everything, they are not taking care. So just education, nutrition to try to get them back to healthy mouth as possible because there’s such a relationship with the mouth — health of the mouth throughout our system of our body. It’s – you lose teeth, you don’t eat food properly, you don’t digest properly, everything works together. Everything has to work harder. So the mouth is a very – teeth are very important for over well — overall health.
Trish Howser: Even just how you — when you speak, you think of the young child that loses their two front teeth, they are bad. And you listen to them, talking, always laughing, right to have them say things to you because it’s cuteness. But the adult that loses their front teeth, they have to talk to you, not quite a lot it — and how do you (inaudible)
Joyce Kasunich: I know, and I’ll tell you our days were so fortunate that we have – kids, we have the primary teeth and we become adults, have the – and then now there’s dental implants which is almost like a third set of teeth, if you do something does happen to have our primary teeth you can replace them with dental implants now.
Trish Howser: Dental implant, how does that work? Like what’s the difference? Why would I do dental implant instead of popping the teeth out and popping them back in?
Joyce Kasunich: Well it’s — dentures are very difficult thing to wear.
Trish Howser: Thank you. Dentures I should have let you all know dentures but –
Joyce Kasunich: Or parcels, anything that’s — are officially made is so much harder to wear in our mouth. And the dental implant is just a simple – patients that have lower dentures and upper dentures but the lower denture, it moves around a lot. It doesn’t have anything to hold onto. So patients are using that the paste in the creams and the Sea-Bond or whatever they are to try to hold them in. And if they have enough bond, there are different things for measurements we would have to take but if there’s enough bond, you put two implants in the lower jaw and it helps the denture snap on to and it gives it some stability for the lower denture. Upper dentures are a lot easier to wear. You got some suction to help hold that in.
Trish Howser: What’s suction?
Joyce Kasunich: Suction is when the denture is in and it has a grip, it has some hold to it that it doesn’t move. You don’t have the suction –
Trish Howser: So you can use like polygrip.
Joyce Kasunich: Right.
Trish Howser: Cement that baby up there.
Joyce Kasunich: Right, and patients tend to use it more in the lower because you have — you don’t have as much retention on the lower.
Trish Howser: I would think that would be harder trying to fit that in with your tongue there tough?
Joyce Kasunich: It is. It’s a hard thing to wear.
Trish Howser: That would be.
Joyce Kasunich: So dental implants, we — you complete at least two, I mean when a patient comes in I basically try — it’s the standard of care now, to treatment plan in upper and the lower denture together if I have to make them but incorporate at least try to get two lower implants to help stability for that lower denture. Because it’s not fun to wear, it just moves around.
Trish Howser: You said pop it in, so you can — when you have implants, are you saying they are not permanent?
Joyce Kasunich: You’re taking the denture in-and-out and –
Trish Howser: So I can’t –
Joyce Kasunich: You can but it was – but it snaps on to the implant to give the denture some stability when you’re talking and when you’re eating. But you’re able to take it out and clean it and then you can put it back in.
Trish Howser: See, this is only going to show my ignorance. But I’ll share, I thought when you said implants, you put each individual two things so that it was actually like having the real teeth where you stick them in.
Joyce Kasunich: You can, you could replace each tooth with an implant but that’s going to be costly. So when a patient has a little lower budget they have to work with, two is sufficient, four would be great but two is something that — for a lower denture to put in the bone to help hold that lower denture in. And it’s snapped on top of the implant.
Trish Howser: Okay. How about — on that subject, if some people get all their teeth capped?
Joyce Kasunich: Yes, that’s something different.
Trish Howser: If you have bad teeth and you still have the tooth that you can get – do you get like a root canal?
Joyce Kasunich: Every situation is different. For example if say, I try to tell patients couple of reasons why teeth die and need a root canal, the never dies and the tooth, you’re hitting the mouth trauma.
Trish Howser: I am going to give you more example. I was on swan teeth. And I was doing backstroke and a girl that was going on free got into my lane and punched me in the mouth. And I had braces at the time. But I still have like a dark spot which I have showed to you — shared with you. And I do remember, I ended up having to get my tooth capped because it got dark, brown –
Joyce Kasunich: Exactly. That’s what happens. Trauma for your teeth over time, the never will die, the tooth will darken and that’s one reason why patients sometimes need a root canal. Another one is cavity. Cavity gets – you let it go too long, it gets too deep and the nerve gets infected and then you have to have a root canal done.
Trish Howser: Is that abscess?
Joyce Kasunich: That’s abscess, yes. Some sort of infection starting, patients [commendable school] and things that way. So if you do the root canal, and with that time you take the nerve of the tooth out. The tooth stays but the nerve comes out.
Trish Howser: You can’t get out.
Joyce Kasunich: There’s a procedure that’s where the root canals go in. I try not to use the words, yank it out.
Trish Howser: I might not have shown up if you said, you will yank it out –
Joyce Kasunich: It’s so, we gently remove, how is that? No doubt, and you go in and you do the root canal but when you do that, you’re removing the nerve and nutrients in the blood vessels of the tooth. So the tooth becomes brittle. So to protect the tooth you have to put a cap parked round over that to make the tooth a lot stronger. So that’s another reason whenever a patient that has a root canal, a crown should be put over top of that. But if you for any rhyme or reason say, you break a tooth and the tooth does not have a root canal. Don’t always have to go and have a root canal, you can just put a cap on top of that. I have a crown and my tooth is not root canaled. But usually whenever you have the root canal because it’s brittle, it’s best to protect it with a crown.
Trish Howser: If you don’t, at some point it’s going to crack or like –
Joyce Kasunich: Yes.
Trish Howser: Especially front tooth.
Joyce Kasunich: Especially front tooth. Yeah.
Trish Howser: You said about – how do you think about the nutrients? What kind of nutrients — you know how they’re always saying take vitamin C for a cold, vitamin D for this, vitamin K for that, medicine for this, melatonin, I mean – sleeping. Then you go into a pharmacy, or drugstore or Walmart anywhere, I just stand there, my daughter wanted – she had a cut or something, so we need vitamin E to put on something, scar, I don’t know. She’s like pick me up. I am walking like – my good God, there are so many – what do you take –
Joyce Kasunich: And patients come in with such, a list of medications. And the side effects are unbelievable, just on the interactions and things that way but the big – one of the big things with dentistry is the dry mouth (inaudible) medications. And the patient’s saliva decreases and that’s never good because then bacteria in the mouth starts to grow, the bad bacteria and starts to cause more cavities. So that’s why when we know patients that are on radiation or chemotherapy or medications and we may give them a fluoride treatment to take home and protect their teeth that way, or there’s a fluoride toothpaste that’s a little stronger at the prescription we may recommend, at that time anything we can do to protect their teeth, especially going through certain situations like that. But really it goes back to the basic toothpaste, we hear all the time what type of toothpaste, what type of toothbrush, anything with fluoride and anything that was recommended when going through all the American Dental Association testing is good to use whitening – whitening toothpaste they’re all out there (how to whiten teeth).
Trish Howser: What is – well, let me ask you that, so all the toothpaste if it has American Dental Association, ADA correct?
Joyce Kasunich: Yes.
Trish Howser: Okay. So if that’s on it, you know that it has been tested and it’s recommended?
Joyce Kasunich: Right, correct.
Trish Howser: And I really haven’t looked because I know now and once again you go, you stand there — anymore you’re standing, you look, you could spend — sometimes one has to say, what the hell – what the heck do you do all the time? I literally will read labels. Also the [reality of toothpaste] because I had — it was Crest Kids and it sounds all – I mean you know there’s door, there’s all these people, there’s Star Wars, Spider-Man –
Joyce Kasunich: Anything to get the kids to brush and use.
Trish Howser: Exactly. And I am just like, my father said, gets you in there, brush your teeth. I don’t care what you’re using it and I can remember using peroxide and –
Joyce Kasunich: Baking soda?
Trish Howser: Yeah.
Joyce Kasunich: That used to be back when — years ago when I was just starting out in dentistry, we used to call it Keyes technique and they would use it for periodontal disease was baking soda, peroxide and salt. And they would mix that together.
Trish Howser: Wouldn’t the salt take in the enamel of your teeth?
Joyce Kasunich: Baking soda, it’s abrasive as well. So you really got to be careful and look at your health. But back then they would use it. Nowadays they — I still have some patients that will use baking soda. But I try to get them not every day. You got to back off on that.
Trish Howser: I am Irish and I’m a tea drinker. I drink tea and I know it stains my coffee cups. So I know how that stains my teeth, also probably I think you mentioned red wine –
Joyce Kasunich: Red wine would do that, Trish.
Trish Howser: And that’s I don’t do –
Joyce Kasunich: Okay, coffee, tea, red wine –
Trish Howser: Coffee, tea, red wine, what else?
Joyce Kasunich: Those are the big ones. Green tea every now and then – but smoking, chew, patients that chew.
Trish Howser: Now there is cancer, correct?
Joyce Kasunich: Yes.
Trish Howser: I actually saw some of it and they are like ground their teeth down.
Joyce Kasunich: There’s a lot of patients that can grind and they are due to their biting stress and things that way, can do a lot of damage. But yes with those, if you’re smoking and they are in coffee and the red wine, patients want to bleach or something like that.
Trish Howser: Well, and that’s where I went back to, I was reading everything and I know you had told me, I can’t use a lot of those bleaches because I have a capped tooth.
Joyce Kasunich: You got to be careful, your capped tooth is on the front that does not change.
Trish Howser: Yes, that’s what you said.
Joyce Kasunich: Everything else is enamel and your teeth, that will all come up but that crown will stay the same.
Trish Howser: So I will have all these white, white teeth.
Joyce Kasunich: You’ve got to pay attention.
Trish Howser: One that has my teeth stained?
Joyce Kasunich: Right.
Trish Howser: That’s why – see that’s why I got certain thing – if I used the peroxide and the baking soda and scrubbed that, probably then I can use all those things that just shine this mouth up. Because it is nice, you see these people that have these bright white teeth and it is distinct when you look at, you’re like wow –
Joyce Kasunich: Now bleaching will bring you up a couple of shades. It won’t bring you to a bright white. If you’re looking for something like that more cosmetically is the porcelain veneers, or crowns, caps, depending on what your situation is.
Trish Howser: You can’t like depending on where the rest of your teeth are, like have – I like to change your shoes, you color your shoes, you have one cap that you put on one day –
Joyce Kasunich: Now well you can do — there’s a thing that’s called a Snap-On Smile now.
Trish Howser: Snap-On Smile.
Joyce Kasunich: I am telling you Trish, there are so many things that are out there, it’s actually, if you’re missing some teeth or if you don’t like the color of your teeth, veneers and crowns are a little bit more on the higher end of cosmetics. It’s actually — I brought a model for you to see but it’s something here that you can replace this, it snaps right over your existing teeth.
Trish Howser: Wow, that reminds me of Halloween.
Joyce Kasunich: Halloween, yes. But that’s it. And the holes on the one side are so — if you make it on the top, you can still bite. We can chew with them in. You can – you take them out, you can brush your teeth, underneath there’s – you can see that the patient’s missing some teeth on the left side.
Trish Howser: Oh, I see that. I don’t know –
Joyce Kasunich: Of course, you know.
Trish Howser: Wow, they just — that’s really neat. So now, of course I just went straight –
Joyce Kasunich: I could make you one of those and we can put — I can make it any color.
Trish Howser: See I was thinking fashion right on –
Joyce Kasunich: Leopards, maybe hot pink for summer –
Trish Howser: Two smiley faces – so when you smile – I am telling you, I think we have a business here. I need to patent that, I hope to get like the producer to hurry up and get that patents somehow, you hop on the computer. So I could actually have two smiley faces.
Joyce Kasunich: Yeah, I have some patients that have little tattoos made on –
Trish Howser: Only one – me already.
Joyce Kasunich: Well that’s never a bad idea, Trish.
Trish Howser: Thank you, Joyce. Well, that’s interesting. That’s why we don’t see more of that. How – like a lot of people – now is this something we can have the gold teeth too?
Joyce Kasunich: It’s something like that –
Trish Howser: Or is that an individual thing?
Joyce Kasunich: It’s more like – more of an individual, you can. I have made pro dentures that the six front teeth they wanted more gold outlined, so I was able to do that. There’s a lot of things design wise that can be done. Now I am telling you, that’s my hidden talent.
Trish Howser: My gosh, and I have seen the granimals – so granimals for the mouth.
Joyce Kasunich: That’s right.
Trish Howser: I am seeing that. So we don’t have a lot of time, so we’re going to be breaking. So I will – give me just — highlight is gold more expensive than the porcelain or the enamels or when you’re doing all that, are those I guess silver, what — I have so many different things in my mouth right now. My mouth is probably as much of my life insurance but –
Joyce Kasunich: You know, that’s a hard question. Gold in our office, the goal and the porcelain crows are the same fee. There’s pros and cons to each individual material that you use. Obviously most patients don’t want the gold in the front, it will be more porcelain. But gold is a very good product, I have it in my mouth. I have gold in my mouth, I have silver in my mouth and I have composite in my mouth, just kind of like you.
Trish Howser: My husband said that, and when I pass away he’s taken everything out of my mouth and going to one of those jewelry parties where they buy gold and silver now, weigh everything and give you a little check, I don’t know, so depressed and burned out, his life will be over. So I guess it’s worth him getting everything out of my mouth and — knowing that he will buy good beer with it, shopping, I’ll take everything out of his mouth and shop, buying another pair of shoes just to irritate him just to fill the closet up.
Joyce Kasunich: That’s right.
Trish Howser: But yeah, I just off to know probably ask you more about that, then when we come back but that to me is fascinating what you do with all that stuff in your mouth and –
Joyce Kasunich: Dentistry is always changing. There is so much – you got to keep up with it. You got to keep up with it, materials and products and equipment. So yeah –
Trish Howser: Yeah, I know how it’s just changed over my short lifetime. As I live longer and longer – I don’t know, Joyce. Well, I just want to thank you for coming. Really we go ahead and take a short break and you can see what you think my mouth is worth. I will ensure that. And Trish with Illusions will be right back.