What do you think of online health records?

On line health records are probably a good idea and offer a number of advantages over off line decentralized health records. In the event that there is an emergency and it ia needed,having health records in on easily located place makes it easier for health care workers to access a permanent version of your health history. No longer will you records be placed in a hospitals archives where they are not easily gotten.

When I recently went to NYU emergency room and I was passing a kidney stone, I still had to give the doctors and the triage nurse, my medical history, even though I have been using that facility exclusively for over 30 years. With online records, my history would be instantly found by anyone I gave permission to access them.

Although these online records are a good idea, to my knowledge, congress has not passed adequate laws concerning third party protection of these records from abuse, such as data mining and other invasions of privacy. This month Google has launched Google Health, their attempt at the development of centralized Internet accessible health records. I am both excited and concerned about what Google does with this new project.

How do you get your patients?

I have maintained a dental practice in N.Y.C. at 30 east 40th st. since 1984. There are a lot of dentists practicing in my building (over 40) and my office is on the sixth floor, without any street level announcements, so My office is not noticable to passers by on the street. We usually do not get 'walk in patients' and most of our patients come from 'word of mouth referrals'. Recently, we have been noticed an increase in number of new patients who are 'self referred' from the Internet and we welcome them as well.

To best answer this question, It should be pointed out that satisfied patients refer their friends, collegues and family members, so we try our best to take really good care of our patients, work to keep them happy and hope that they continue to find value in remaining patients in our dental practice!

I tripped last night and chipped my front teeth. One of them has moved. What can be done?

I was asked this question this morning from a patient who tripped the night before. After a some questioning on the phone it was determined that her lip wasn't badly cut and didn't require stitches, but was swollen. Her two front teeth were badly chipped and she wanted them repaired, even temporarily. At least one of her teeth was subluxated(moved in the socket)but she was in no real pain.

What made me concerned other than hearing about her distress over chipping her two front teeth, was the fact the her tooth had shifted in the socket, since this is a situation that I thought should be addressed right away. When teeth move forcibly due to an accident, they can remain in the new position unless they are pushed back into place.

This patient was seen the same day and after giving her local anesthesia, I moved her tooth back into position and then splinted and repaired the teeth using bonding composite. This will allow the teeth to remain in the correct position while the bone heals itself and will provide a reasonably esthetic result. It was entirely possible that part of the socket housing the tooth is cracked , so it is best that the teeth are splinted to allow healing.

The patient was informed that the two teeth might require endodontic therapy (root canals) and that she would be followed closely over the next six weeks to see if an endodontic infection develops.

If a patient has sustained a true jaw fracture, then a visit to an oral surgeon is suggested and the surgeon will most likely use an arch bar to splint the jaw(s) together by ligating the teeth to the bar.

Are There Any Good Inexpensive Eectric Toothbrushes You Recommend?

Yes, I often recommend the Oral B Vitality Precision Clean Electric Toothbrush. It's affordable(under $20), easy to find, and usually I find that patients do a better job cleaning their teeth with it than they would with a good manual brush. It is especially good for a children's brush. Children are proud to have their own electric tooth brush and this brush rotates more slowly than more expensive models and children tend to find it less 'scary'

Why do I need Full Mouth X-rays?

In my practice, I recommend patients have a full set of X-rays taken every 5-7 years. A full series of radiographs consists of 18 different views of the teeth and allows the dentist to view the teeth from multiple angles. Although some dental problems exhibit obvious symptoms, some do not. Teeth can have rather extensive decay that causes no pain and some patients have abscessed teeth that remain asymptomatic for years.

Although some dental problems exhibit obvious symptoms, some do not. Teeth can have rather extensive decay that causes no pain and some patients have abscessed teeth that remain asymptomatic for years.

The full set of X-rays allows a dentist to assess a patent's bone levels, to better visualize decay and check whether a patient has any bone lesions due to cysts or endodontic abscesses. Also, by comparing a recent full series with one taken earlier, a dentist can see whether bone loss has occurred during that period.

Other anomalies may be discovered by viewing a complete set of X-rays,including root fractures, some tumours in the bone, and retained roots.

I recently started bleaching my teeth and I have noticed white spots. How do I get rid of them?

White spots on teeth are generally caused by hyper or hypo mineralization in the enamel matrix. The enamel structure is not formed perfectly and looks white or brown. When someone starts bleaching, these defects are in the enamel layer and are close to the surface,and they are first thing to whiten. It should be mentioned that white spots also become more noticeable when teeth dry out. This phenomenon is noticeable during a long dental appointment, when a mouth is open for long periods. When teeth rehydrate, the spots become less noticeable.

When teeth with white spots are bleached, the white spots get really white, really fast. Then, As patients continue to bleach, the yellowish areas of the teeth, which are less superficial, gradually become lighter and whiter, thus making the white spot less noticeable.
When patients stop bleaching, the teeth appear to visually 'rehydrate' and the white spots tend to fade somewhat over a two week period.

Do You Perform Laser Whitening?

No, we utilize the Zoom II advanced bleaching system that has an infrared light source. The purpose of using a light, whether it is a laser or not, is to help warm up the bleach. Supposedly, manufacturers put something in the gel that helps warm the gel when the proper wavelength light hits it. Actually, I have tried a chair side whitening system made by Dentsply, called Nupro White Gold, which does not require a light and it seems to work just fine.

When I use the Zoom system, I always warm up the bleaching gel prior to using it and it is my impression that the warmed gel may work better then gel at room temperature . The gel should just be slightly warmed since, it is important not to over heat the teeth!

I just had some teeth removed and now am wearing a denture. It hurts when I eat. Do you have any suggestions on what I can eat?

It is normal for patients wearing dentures placed immediately after extractions to have some discomfort when they eat. My advice is to innitially eat soft bland foods that do not require much chewing, like pasta, soups, chicken and fish. Gradually you should be able to chew food more comfortably. If your pain on chewing doesn't improve within one week, you should return to your dentist to check for sore spots or for him to check your healing of the extraction site(s). Often, healing at an extraction site can be delayed because a tiny boney spicule( a splinter of bone) is trying to work its way out of the extraction socket. It can act like a splinter, causing pain and inflammation.

Is there anything I should not be doing or eating while bleaching my teeth?

This is a question that is almost always asked by patients who have just had their teeth bleached and by those actively bleaching their teeth. During the time when a patient is bleaching and for about two weeks afterwards, it seems that the teeth are more porous and can more easily absorb stains internally. I once had a patient who drank a gallon of some ice tea right before he came in for his third week bleaching observation and his teeth had apparently got darker. I asked him to refrain from drinking tea and he was easily able to re bleach his teeth to his desired shade, but in my mind it confirmed the idea that the teeth are more porous during the bleaching process and patients should refrain from consuming things that might stain teeth. I tell patients that if it would stain the insides of a white porcelain cup don't drink it. Try to avoid Red Wine, Black Coffee, Coca Cola, black teas, pomegranate juice, etc. Do drink things like sprite, green tea,and white wines. Fruits with srtong colors like strawberies, pomgranate, and cherries should be avoided. Patients frequently ask if they can have coffee and I answer that one or two cups a day is ok if they have it with cream. You do not have to stop smoking to bleach your teeth. Smoker's can bleach their teeth, but it may possibly take them longer to get the same results as a non smoker. Two weeks after the completion it is ok to eat what ever one wants and if your teeth slowly darken then re bleach for one to three days.

Is Oral Sex Safe?

Although one can't get pregnant from oral sex, there is plenty of evidence that you can get herpes, gonorrhea, chlamydia, human papillomaviruses(HPV),and HIV. The incidence of Oral Pharyngeal Cancer has been increasing for people in their 40s and it is thought to be correlated to HPV. A study published in the New England of Medicine in 2007 reported a strong correlation between HPV and pharyngeal cancers.
The study also found that the risk for this cancer seems to increase with the total number of sexual partners a subject had. So It would seem that "unprotected oral sex" is not completely without risk.

Will It Hurt to Have My Cavity Filled?

Not usually. If the dentist administer proper anaesthesia and waits for it to take effect, than most often no pain is experienced by the patient. Sometimes, when a patient does experience pain a second shot can be administered and do the trick. Occasionally, I use a second type of injection called and intraligamental injection to achieve anaesthesia. This type of injection works by traveling down the tooth ligament to deliver anaesthesia.

Are You a Celebrity Dentist?

I usually answer this in a tongue and cheek manner "Yes, I am a celebrity dentist specializing in missed and broken appointments!". Truthfully, the answer is mostly no. Although I have treated and continue to treat some celebrities, the bulk of my practice is made up of patients who are engaged in a broad range of activities and professions. Many are quite succesful and interesting, but I don't think I would call them celebrities (outside of their fields at least!). It is fun to treat celebrities, but many are quite busy and do indeed change their appointments quite a bit, so I consider myself fortunate to have the type of practice I have, full of interesting New Yorkers, most of whom work in professions and jobs around the city and most have interesting stories of their own to tell.

What is Vizilite Plus?

Vizilite Plus is a new technology that helps dentists and hygienests to detect oral abnormalities in a non invasive manner. It is easy and painless to use and helps us decide whether to refer early lessions for biopsy. It utilizes a tolonium choride dye and a special light to better visualize abnormalities. Its relatively affordable and my hygienest loves it.

What is the difference between Gingivitis and Periodontistis?

Gingivitis is a name for inflammation of the gums. A person who has gingivitis has inflamed gums that look red at the margins and not pink. When the gums are dried they may appear to have lost their stippling (the normal look of healthy gums is similar to the surface of an orange peel-'stippled') since the gums sometimes become edematous (swollen). Often, when inflamed, gingival papillae (the gums in between teeth) take on a 'reverse architecture' and look almost like 'footballs'. The swollen papillae no longer are knife edged at the tips and are no longer concave on the sides, but appear convex. Gingivitis is reversible and will usually go away after a patient improves their oral hygiene or has a cleaning.
Periodontitis involves irreversible changes to the supporting structures of the teeth. It is associated with bone loss, pocketing around the teeth, and in severe cases loosening of the teeth and even tooth loss. Sometimes gums with periodontis look normal because the inflammation is deep under the gums and not near the surface the way it is in gingivitis. However when the gums are gently probed with a periodontal probe they bleed easily. In fact bleeding on probing is the best indicator of the presence of inflammation of the gums, whether the condition is gingivitis or periodontits. It appears that bone loss and pocketing occur due to the presence of inflammation over time. Initial treatment for both of these conditions is to have your teeth thoroughly cleaned and to improve a patient’s home care. After treatment, the active phase of periodontal disease may end and the patient is often placed on three month recall with a dental hygienest and if the patients home care is good the disease can remain in remission. A patient in remission may not experience further deterioration of the bone and in fact when observing their subsequent radiographs, their bone can look healthier and more sound. However, bone levels will not return to the same level they were prior to the onset of the disease.

How Do You Make your Porcelain Veneers Look Natural?

Teeth that are perfectly aligned without any noticible incisal embasures, with flat and regular incisal edges, tend not to look real. The trick to doing truly aesthetic cosmetic dentistry is to introduce pleasing assymetries in the smile. The irony is that if all teeth display 'perfect symmetry' then the smile is not perfect! A perfect smile must be pleasing and beautiful to behold. One that is 'static' is not beautiful. A beautiful smile has an energy to it and edges of the teeth must not line up perfectly, but have some irregularities to look create visual excitement. All edges can't be perfecly parallel, but must have some surfaces that slope in a pleasing manner. The smile Should not be bland.
Also natural teeth tend not to be monochromatic, but instead change subtly in shade the further the tooth structure is from the incisal edge. Often times patients desire monochromatic teeth treatments, which look nice, but not natural.
Natural smiles show some wear, and a smile on an adult without any wear on the edges can tend to look unreal.
The trick to performing a natural looking smile make over is to be somewhat subtle and not to over do perfection! Too much of a good thing is not good. The made over smile must be pleasing to look at but shouldn't be over the top in all respects. Cosmetic dentistry should not be about showing off but about producing truly aestheitc and beautiful smiles.