Is the office closed over the holidays?

My Staff and I wish all of our patients a happy holiday and hope that next year will bring better fortune to us all. May the difficulties that we all are experiencing, bring us together, so that we may better solve the problems that we are facing. Sometimes difficult circumstances can create an environment in which positive changes can and do occur.

The office is closed from December 24-December 5th. I am visiting Washington, DC with my son (the Photo is from the Air and Space Museum), but will be back in New York by December 30th and I am available to to speak with patients during the vacation. If you do need to speak with me you can call my office phone and follow the directions on my message.

What can I do about 'black holes' between my teeth?

These are spaces that are left between the teeth after gums have receded. These can be small or quite large. When they are small bonding can be added to the teeth proximally to make these holes less visible. This can be a very simple fix and does not require local anaesthetic.

When the holes are large, this problem is difficult to solve. Often, just closing the spaces with crowns makes for funny looking teeth. Forced eruption of the teeth followed by some bony re contouring followed by crowns or porcelain veneers,can create a natural appearence, but it is time consuming and involve three disciplines:Cosmetic dentistry, Orthodontics, and Periodontal re contouring.

Does sensitivity when I floss mean I have a cavity?

Not necessarily. Often times when patients complain of sensitivity when flossing they actually have proximal errosion. Buccal abfractions can extend into the mesial and distal surfaces of teeth, leaving sensitive areas of the teeth that are not decayed. Also, many patients have proximal areas that are denuded of their natural protective coating (either enamel or cementum)at the cervical (neck) of the tooth, probably exacerbated by frequent scalings(even good things have a downside)

If you are experiencing this sensitivity, you should have it evaluated at your dentist, since it can be indicative of proximal decay. It is best to have your dentist determine exactly why you are experiencing it.

Does Every Missing Tooth Need to Be Replaced?

Most people assume that all missing teeth other than wisdom teeth should be replaced. After all, when a tooth is extracted, the teeth around it may shift, and we do need our teeth for proper chewing. Most often, replacing a missing tooth is the best option.

Although this is usually the case, not every missing tooth needs to be replaced. As a dentist in New York practicing for over 28 years, I have found that for some patients tooth replacement is not their best option. If you have had an extraction of a back tooth many years ago, chances are that any shifting that will take place has taken place. Often the teeth around an extraction site shift only as much as the patient's occlusion allows. The teeth opposing the teeth adjacent to the extraction site can sometimes keep them in place.

Also when some of my elderly patients, whose health status can be fragile, lose teeth, I do not always recommend replacing a missing tooth. If they have an intact first molar and they lose their second molar, there really is no reason they have to replace it. Sometimes, not replacing it will allow the opposing second molar to extrude. In an elderly patient, this is not such a big deal.

For those with delicate health status, what is most important dentally, is that they are free of dental infections, since these infections may pose a risk to their overall health. Replacement of teeth can be of secondary importance,especially if the proposed method of replacement would require many lengthy dental visits.

If on the other hand a patient has an extraction and assumes that he will replace the tooth with an implant at a much later time, he or she may be disappointed, since after an extraction, the bone around the socket tends to narrow with time. If too much time elapses, their may not be enough bone at the extraction site to allow placement of an implant.

When one of my patients loses a single tooth, I discuss the options with them and we decide together whether it a tooth replacement would be in their best interest.

What can I use instead of floss?

Although flossing is still the number one way of cleaning the surfaces between teeth, there are a number of good alternatives available. These include a number of tiny brushes that can be inserted interdentally. Stimudents, an orange wood tooth pick is another good alternative. It seems that recently there has been an increase in the number of products coming out as floss substitutes. My hygienist, Marilyn, has written an informative article on the subject and it can be found on my dental office's web site.

Should I consider going overseas to have my bridge done?

Occasionally patients ask this question. Clearly going to some overseas location to have complicated dentistry, can save money, or at least save enough to pay for part of the vacation, but is it a good idea?

Probably not. Often with complicated dentistry, the risk for complications also increases. Some of the problems can develop after the work is completed. Patients having bridgework done run an increased risk of needing a root canal and this complication can make it self known after the bridge is cemented and complete. When work is done over seas, there is no opportunity for an adequate follow up in the event that there is an issue with the bridge. If the porcelain breaks or the gum is irritated, who is going to care of it?

If a complication happens with a bridge fabricated locally, a patient should be able to return to the local dentist and have the problem adresssed. If the problem is related to a failure of the bridge often a dentist will redo the work at no cost(or for just the lab bill). It is not easy to return for a follow up with a foreign dentist.

Another reason to have the work done locally, is that 'good work takes time'. Although I place excellent three unit bridges in my office, It usually takes me about a month to 6 weeks, to allow for try ins and good quality lab work. I am not always comfortable to treating patients from out of the country,who are visiting on vacation in NYC, especially if they expect to have the work done perfectly in one week(Having fixed time restrictions does not allow me to have work done over if it is not fitting properly).


To sum up, I would opt for having the bridge done close to your home. It is possible to have the work done adequately overseas, but I have witnessed plenty of substandard foreign dental work done for US patients traveling abroad.