Can pain from an upper tooth be referred to the lower jaw?

Yes, ocasionally patients complain of pain from a lower tooth and when I check, the pain is coming from a problem on an upper tooth. Just yesterday a patient presented with an ache he felt in his lower jaw for more that a week. I took several x-rays, including a bitewing and no problem showed on his bottom teeth. I tapped on them and tested them with an ice cube. The patient said he was sensitive to cold fruit, but ice didn't provoke discomfort on any of his lower teeth.

His bitewing x-ray did show a giant cavity on his maxillary wisdom tooth and when I finally placed the ice on that tooth, he responded with "Thats the pain I have been feeling!"

Does Bleaching Work For Everyone?

Teeth Whitening does not work for everyone. I have bleached over five hundred mouths and occasionally a patient's teeth have not whitened appreciably. I am not sure why, but it should be pointed out that tray bleaching requires good compliance. Patients are instructed to refrain from certain foods and drink that might stain their teeth and slow the process down. Also they are instructed to wear their trays for at least three hours and not to drink anything during this time.

Teeth that are badly stained with 'tetracycline stains' sometimes do not get a result that is satisfactory. In their case, they are better off having porcelain laminates fabricated to resurface their teeth.

Patients with lots of anterior bonding that shows are not great candidates for bleaching since their teeth may lighten but their filling will not. The same is true for patients with multiple crowns which will not change colour with bleaching. These patients will need to change their dental restorations if they desire teeth whitening.

What is the difference between screw and cement retained implant crowns? Is one design better than the other?

My personal preference are cement retained crowns. A post is fabricated with a hole in it so you can screw the post into the implant. The screw is torqued down. Since the posts can be either "stock" or custom, the abutments can be made parallel if multiple implants are involved. Crowns or Bridges can be cemented on the abutments.

I consider the screw on crowns an older design. In that technique the actual crown has a hole in it and it is screwed either directly into the implant or into second stage abutment that is screwed into the implant.

Although there is disagreement among dentists over which design is superior, There is a cosmetic disadvantage with the screw retained crowns. The opening in the crown has to be filled and often the result is slightly less cosmetic.

The screw designed crowns are better for implants whose top is very close to the gingival margin, since they do not require space for an abutment. If an abutment (post)is used, it may be visible(part of the post may be above the gums). The Screw on crowns are placed directly on top of the implant so they require less room under the gums.

Can Chipped Porcelain Veneers be Repaired?

Although it is sometimes better to just a replace broken porcelain laminates with a new one, repairs with bonding are possible. They can often be accomplished in less that one hour.

The broken edge is roughened and beveled with a diamond or sandblaster and then the tooth is isolated well, preferably with a rubberdam. 'Industrial strength' hydrofluoric acid is placed on the roughened porcelain for 10-30 minutes. When the procelain turns a grainy milky white, it is ready to be bonded. The porcelain is coated with a silane coupler for 60 seconds, then dryed,and bonding liquied applyed. After air thinning, composite can be added to replace the missing porcelain.

The final result is usually not as esthetic as a new porcelain laminate, but sometimes patients are not ready to absorb the cost of a new laminate but do want a quick and more affordable fix(In my office the fee for this repair may run from $400-$600) .

Does Your Office Accept My Dental Insurance?

My office manager must get asked this question at least five times a day. We accept most dental insurance , but patients are responsible for the difference between what the insurance pays and our fee. The only dental insurance we actually participate with is the Delta Premier Plan.

If your plan is a PPO dental insurance plan that allows you to go out of network, than you can come to us and use your insurance, but your out of pocket expenses are likely to be somewhat higher than if you went to a 'participating' dentist. If you have any doubts about your coverage it would be best if you consult you dental benefits book prior to selecting a dentist.

Are You A Green Dentist?

I am not sure what a 'Green Dentist' is. I do not drive a Prius (yet), nor do I do do dental office recycling, We still use paper charts and records and I we still take radiographs with dental films not digital x-rays.

I did recently install an amalgam separator to protect the New York Water Supply from 'mercury contaminated' fillings removed from my patients teeth. If that makes me 'Green', than I guess I am!

Where do you get the questions that you use in your dental blog?

Most of the questions that I answer in this dental blog are derived from questions patients often ask me in my New York dental practice. It seems that the same questions are asked repeatedly. I thought something might be gained by posting the answers on Ask Dr. Spindel.

If you are not one of my patients and would like a question answered, I participate in web site called allexperts.com and if you click on the link it will take you to the dentistry page for that site. Click on ask a question under my name and I will try to answer you dental question.