Why use a Waterpik?

Although a Waterpik is not as effective at removing interproximal plaque as dental floss used properly, it does seem to help cut down gingival inflammation. Most periodontists report that patients using a Waterpik device have less bleeding on probing than do other patients. Since bleeding on probing is considered one of the best measures of the presence of gingival inflammation, the Waterpik is a valuable tool for fighting periodontal disease.

It may accomplish this by causing fluid exchange in the sulcular fluids via the 'Venturi effect'. As its water pulses through interproximal spaces it may create a suction that removes crevicular fluid and any bacteria that have 'seeded' in it. This is a theory that I have heard proposed but I do not believe is a proven fact, but my experience has been that patients using the Waterpik as well brushing and flossing (or using inter proximal brushes do better when getting a periodontal exam, than those not using it.

Can Bad teeth run in the family?

Patients commonly explain that 'Bad teeth run in the family". The implied message is that they themselves are not to blame for the state of their mouths. While genetics obviously plays a role in determining the likelihood of developing all sorts of health problems, so do a person's habitual patterns of behavior.

My grandmother wore two full dentures by the time she was middle age and both of my parents lost about half their teeth by the time they were senior citizens. I myself, although in my 50's, have not lost a single tooth. Why?

Although I do not know for sure, I believe the choices they made and their lack of a good dental IQ are the reasons for their extensive tooth loss. All three were chain smokers for most of their adult lives and I do not believe any of them took good care of their teeth until it was too late. Poor brushing techniques, poor diet,lack of frequent tooth cleanings, and nicotine from cigarettes probably were responsible for their tooth loss. All eventually developed adult onset diabetes which compounded their tooth problems.

Although I am far from perfect , I do not smoke, I brush regularly with an electric tooth brush, floss and get regular cleanings. These habits are most likely responsible for over coming any 'genetic predisposition' that might lead to tooth loss.

Which patients sbould be taking bisphosponates?

I am sure I am not able to answer this question, but It is a valid question to ask and for medical experts to debate. Surely the decision should be made based on risk vs benefits. Taking medicines long term for preventive reasons is not without risk. Taking some medicines can place patients at higher risk for health problems than the problem they are attempting to address or prevent.

A new study published in the New England Journal of Medicineprovides useful information for both patients and their physicians. The study followed women after an initial normal bone density test to determine the likelihood of them developing osteoporosis. It found that that "osteoporosis would develop in less than 10% of older, postmenopausal women during re-screening intervals of approximately 15 years for women with normal bone density or mild osteopenia, 5 years for women with moderate osteopenia, and 1 year for women with advanced osteopenia"
I believe this finding is important since it provides some real information about a persons risk of developing Osteoporosis later in life and will help physicians decide whether they should be prescribing bisphonphonates for particular patients.

An article in the New York Times, published on January 18th, discusses the significance of the above mentioned study and provides further information and is probably worth reading. It reports that "experts also generally recommend that most people on bisphosphonates take them for just five years at a time, followed by a drug holiday of undetermined length. The idea is to reduce the risk of rare but serious side effects, including unusual thighbone fractures and loss of bone in the jaw."

How's the dental business?

This is a question asked by a patient almost every day. I answer that we are doing OK, but things are a little slower than usual. Our billings for 2011 were off by 3% when compared to the previous year. I can not complain about my billings, since I am fortunate to have a mature and busy dental practice, but I am sad that it seems that some people appear to be putting off their dental check-ups and cleanings. Also it has been more common when examining a patient coming in for a hygiene appointment, to find that they haven't scheduled appointments for previously diagnosed cavities.

I am sure that some of this procrastination is due to economic worries that patients have, but any savings that they may experience by delaying cleanings or the filling of cavities, will certainly be wiped out by a single tooth being lost or needing a root canal, post and a crown.

A simple filling is less than 10% of the cost of either of the latter alternatives(rct,post and crown or extraction and implant). Also frequent cleanings do seem to lessen the odds of a patient developing active periodontal disease.

The lesson is apparent: "A stitch in time saves nine". Avoiding or fixing dental problems early will save a patient a lot of money, especially over the course of a lifetime! I am writing this post with the hope that it will encourage people to take better care of their mouths.

What should be done about bonding that has darkened over time?

This can happen to bonded restorations over time. They can absorb some stain over time, but fortunately this stain often is superficial. The first thing a dentist can try is to take some sandpaper or a fine diamond bur and remove the superficial layer of composite. Often, directly under this surface lurks the ‘fresh’, original shade of composite. This 'freshening' of a composite restoration can often extend the esthetic lifetime of a bonded restoration.

A more vexing problem is stain at the margin of a bonded restoration. Although often it is superficial and can be dealt with by light sanding, sometimes the stain can extend deeper into the tooth and can not be addressed by simple sanding of the superficial layer. If the stain is deep but not associated with decay, then a small fine diamond can be used to remove it and a new layer of composite can be applied to 'spackle' the groove that the fine diamond made.

I should be noted that some stained restorations that a dentist suspects have recurrent decay, should be replaced in their entirety and not just sanded or 'spackled'.

What comes first, Bleaching or Bonding?

This is a question that should be commonly asked. If fillings or cosmetic bonding is to performed on teeth that are in the 'smile zone' Then bleaching should be performed prior to any visible anterior restorations. Composite shades that are used should match the teeth after whitening is completed.

It should be noted that bonded fillings will not necessarily darken with time, but the bleached teeth they are attached to will. If this happens the teeth may need to have a bleaching touch up, in order to better match their bonded restoration(s).

Can teeth Talk?

According to a recent article published in the Wall Street Journal("If Your Teeth Could Talk ...) maybe they can't, but the article points out that a number of systemic problems seem to be linked to problems in oral health. According to the Journal article "There's also growing evidence that oral health problems, particularly gum disease, can harm a patient's general health as well, raising the risk of diabetes, heart disease, stroke, pneumonia and pregnancy complications."

This idea has been posited by a large number of articles including prior Ask Dr Spindel posts.

I am glad that such a well respected and wide read News Paper is calling attention to the importance of Oral Health. This article correctly portrays the importance of dentistry to our overall health. Visits to the dentist are not just about finding tooth decay, but as the article implies, they may even help prolong our lives. Many people in the last several years have cut back on their dental visits in order to save money. Not only will delaying on fixing teeth tend to cost us more in the long run, preventive dental cleanings and treatment of periodontal disease clearly have an impact on our general health.

Great Dental New Years Resolutions?

I just finished writing and posting an article on this subject on my dental website. It features ten dental resolutions that patients could make and keep for the new year. Most of us would be lucky to keep just one New Years resolution. My dental resolution is to take care of a broken molar that I have been putting off repairing.

Does Root canal hurt?

With proper anesthesia root canals can be a pain free procedure. Most teeth respond to regular local anesthesia injections. For Maxillary (upper teeth) dentists usually employ a combination of buccal infiltration and a palatal injection. For Mandibular teeth(lower teeth)a mandibular or mental block is used.

Some teeth do seem to be hypersensitive at the time that root canal is started and patients still can report some sensitivity when a dentist attempts to access the pulp chamber. When this happens I sometimes use an additional intrapulpal injection in order to achieve complete anesthesia. Usually this injection does the trick for my patient and their endodontic procedure can be completed without further discomfort.

Is your office closed over the christmas holiday?

Our New York dentist office traditionally has been closed between Christmas and New Years. This year is no different. Our office will be closed until January 2, 2012. My staff and I are looking forward to having some good food, geting some rest and spending time with our families. We wish all our patients have a happy and healthy holiday season and we will be back in action early next year.

Can a successfully treated root canal tooth experience occasional pain/tenderness?

Sometimes root canal treated teeth, that we consider a success, do have some "low grade inlammation ". The teeth are not infected but are not entirely without tenderness.

Another possible explanation of continued symptoms it that some teeth have a small undetected crack and heavy chewing may cause some small movement of the the crack.

If symptoms are disturbing sometimes a retreatment of the root canal can cause the tooth to become less symptomatic. After all, most of our check radiographs are two dimensional and do not show the root canal system as it acutally is. Small discrepencies in the 3-D fill also may be responsible for symptoms.

Why do dentists bevel teeth when preparing them for a crown?

Bevels ave been used by dentists for many years in the belief that they help achieve a more intimate fit for the crown. When I was in dental school we were taught that a bevel on a tooth that was being crowned helped insure that the margin have a smaller gap when seated. There is a definite logic to this when compared to chamfer and shoulder finish lines, but It is hard to explain in a short blog post.

Now a days, with the advent of a number of metal free types of crowns(Emax,Lava,Procera,and Zirconium) chamfer finish lines are becoming more popular since these the manufacturers of these crowns do not advocate a bevel at the finish line.

In my practice for first molar and bicuspid teeth I continue to bevel and use Pfm crowns. I find that these work well and possibly better than some of these new crowns, especially for teeth with weakened coronal tooth structure. One possible reason for their success is that the bevel shifts some of the flexural forces to a relatively uncut an intact portion of the tooth tha is below the gingiva. Most chamfer or shoulder preps seem to depend more on the integrity of the coronal tooth structure and need to have considerable intact coronal tooth to be predictably successful.

Many teeth that require full coverage restorations have weakened coronal tooth structure and many have internal cracks that should be isolated from the forces involved with chewing. In my opinion the beveled preps (pfms) or feather edge preps(full metal crowns) do the best job of isolating the weakened portion of posterior teeth from flexing forces that can be generated during a patients chewing.

Although the newer types of metal free crowns are beautiful, the verdict is out on how well and predictably they will stand up in patients mouths over the long haul.

How long after a filling is done is it safe to eat?

This is a question that patients frequently ask. Dentists placing amalgam fillings often caution patients to wait 45 minutes after their filling to eat. This is advised because silver fillings tend to continue to harden after placement and the consensus is that after 45 minutes they are hard enough to withstand the forces that will be placed on them by eating.

Composite fillings are immediately ready to withstand the forces of mastication(eating) after placement- no waiting needed! That being said, most patients are numbed when having a filling and should not eat until the numbness goes away. This is especially true for patients having a mandibular block. Mandibular blocks are commonly used for achieving anesthesia prior to filling teeth in the lower jaw and they result in profound numbness in the tongue and lower lip (on one side).

My father who was a patient and a big fan of mine once returned after a dental visit and mentioned, almost apologetically, that he thought that possibly I had made a cut in his tongue during his last visit. I looked in his mouth and there was a fairly large gash in the side of his tongue. Knowing that I hadn't happened during treatment, I asked if he had anything to eat after leaving his last visit and he confessed he had a hot dog at the train station afterward.

My father's story points out the importance of not eating any food while still numb, since there is a definite possibility of a patient injuring a numb area. Hot foods may cause a burn and numb tongues and cheeks may be inadvertently bitten while they are numb and lacking normal sensation.

What should I do if my dentist has billed my dental insurance for work not done?

This is a question that occasionally does come up. Some patients have come to my New York dentist office with this complaint and have asked me to check whether the work in question was actually performed.

If a patient suspects that his insurer has been billed for work that has not been performed then if possible they should first contact their dentist and ask for an explanation. If not satisfied with the explanation, then it makes sense to contact the insurance carrier and let them know that some of the work submitted for was not completed or performed. Often the insurance carrier will contact the dentist and ask for an explanation or even ask him to refund the overcharged amount.

Some patients may not want to contact their dentist to ask for a clarification and in that case they may choose to contact their insurance company, especially if they are sure that the procedures in question have not been performed.

What type of composite do you use for anterior bonding?

As a cosmetic dentist in New York I use different types depending on the situation. Most often I use "hybrid composite". This is a category of composite that has been in usage for a long duration and has 'stood the test of time'. Hybrids have variable particle size for their 'fillers' and are usually considered the strongest type of composite when exposed to biting forces. They are less polished when compared to 'microfills'(smaller particle filler size) but most of the time the exact amount of polish is not the most important feature. Teeth are most often viewed in a 'wet' state and when viewed this way hybrids often are highly esthetic. If needed hybrid composites can be veneered with microfill composites, so that the restorations can appear shiny even when the restorations are viewed in a dry state.

A newer type of composite has been developed that is promising and has properties that mimic the best properties of hybrids and microfills. These composites,termed nanofils(Esthet-X is one example)are both resistant to flexing forces like hybrids and also can be highly polished like microfills. I have used these succesfully for anterior restorations but have not tried them for posterior restorations. Posterior fillings are under the greatest stress and I am currently using only hybrid composites for fillings in stress bearing areas on back teeth.

Currently Cosmetic Dentists must choose which of these types of composite to use in each situation. All work well when used in the correct situation and most cosmetic dentists have their own opinions on which composite to use for particular applications. There probably is not a universal composite that is best for every application.