When is the best time to take your kids to the dentist?

It's best to start you kids going to the dentist when they are young and before they have dental problems. My practice is a family practice and we treat all ages of patients. When asked about how old a child should be for their first dental visit, I usually suggest around two and a half years old. Pedodontists usually recommend having children go when the are even younger. Many of my patients bring their children during school vacations. This way they do not miss any school. The visit can be part of a family outing so that they associate visiting the dentist with doing fun activities. My office is located in midtown Manhattan and there are always lots of sights to see and places to go.

When are you getting digital X-rays?

This a question I am frequently asked . I have been waiting until the system I am interested in received an upgrade to its sensor. The sensor is the component that captures the information created by an X-ray beam going through hard body structures such as tooth and jaw bone.

I am happy to report that I have just placed an order for the newest Dexis system that will include a new upgraded sensor(finally!). I eagerly await the delivery of this new system and can't wait to start using it.

According to my sales representative,it is sturdier than the previous sensor and it cuts down on the radiation received by a patient, as compared to regular dental film or the previous dexis sensor as well.

What is the difference between extrinsic and intrinsic stains?

As the term implies, extrinsic stains are stains on the external surface of teeth. These can be caused by a number of sources including, coffee, tea, or tar from cigarettes. Although sometimes stubborn, these stains can usually be removed by a thorough dental prophylaxis.

Intrinsic stains are discolorations of the enamel and dentin. The can be caused by developmental problems while teeth are forming. Some possible causes are enamel hypoplasia, enamel hyperplasia, fluoride and tetracycline stain.

Intrinsic stains can also occur after teeth are formed. Plaque can cause demineralization of the enamel that can remineralize and appear as 'white spots' on the teeth. These are often seen on patients whose hygiene was lacking while they had orthodontics or s near the gum lines of people's teeth who went through a prolonged period of poor oral hygiene.

Another cause of intrinsic staining, that is non developmental, are cracks in the enamel. These cracks are usually caused by flexing of enamel. Enamel is a rather hard but brittle material and if it flexes it can develop crazes or even cracks. Over time, these cracks can become stained.

Are digital X-rays better than X-rays taken with film?

Digital X-rays actually use the same radiation source as film. The difference is that digitally taken radiographs produce an image without the use of dental film. Instead they utilize a digital sensor that conveys the image directly to a computer.

The advantages of digital sensors are that their images are more immediate since no films need be developed and they require less radiation (approximately half). The images that are produced can be easily manipulated on the computer to change both their magnification and contrast. Since they are stored on a computer, they are easy to duplicate and can be E-mailed to other dentists for second opinions.

Regular X-ray films do have some advantages. Dental film still tends to carry more information per square mm. They have more detail and I find that some incipient carious lesions are more easily detected when viewing these films on a view box. They also
can be scanned onto computers and when viewed on a computer screen can be manipulated the same way as digital X-rays .

Digitally produced X-ray images have and will continue to improve and most likely will replace dental films, but for the moment most offices , even those with digital X-ray systems, still find regular dental films useful.

When are you going away on vacation this summer?

The office is closed the first of August for two weeks. I will be available to speak with patientts on my cell phone and can refer patients for appropriate emergency care. The office staff and I will take a much needed break. I am going as usual to Cape Cod with my son . We plan on seeing old friends, swimming and sailing. The office reopens on August 17 and will remain open the rest of the summer.

What do you think of Invisalign's new "proficiency requirements"?

To my mind they are unfair. Instituted mid year, if I understand them correctly, they require that dentists must start 10 cases in 2009 to maintain their certification. This is a fairly large number of cases for a general dentist to start in one year and if it is enforced it will effectively eliminate most GPs from using Invisalign. I am inviting comment from other dentists or interested parties. I have included a link to Invisalign's Proficiency requirements. What Do you think?

How can I tell if I need a root canal?

Although many people with 'tooth aches' need root canals, not all do. The simple answer is that it is not always possible to know whether a root canal is required without an actual visit to a dentist to have a thorough diagnosis.

There a number of causes of tooth pain and many do not require the dentist to perform root canal to rectify the problem.These can include sensitivity to cold, high bite, periodontal infections, sinus infections,and herpetic infection of the gingiva. Dentists may instead adjust a bite , prescribe antibiotic, suggest a crown or just waiting, instead of initiating a root canal treatment.

Due to the complexity of diagnosing tooth problems a thorough examination is often necessary before a dentist suggests root canal as a solution. This includes the dentist asking questions about your symptoms and what causes their onset, the duration of your symptoms, a physical dental examinations and some radiographs.

Although, it is tempting to tell a patient who calls up at night, with a throbbing tooth ache, that they need a root canal therapy (and it is likely to be the case). usually, a dentist is really in a position to advise a root canal treatment only after completing a thorough dental examination

How do you go about picking an appropriate shade for someone?

I have practiced cosmetic dentistry in New York for over twenty years and I have come to the conclusion that contrary to the opinion of some, teeth do not need to be super white to look good. In fact the desired shade should be determined by holding a shade guide next to a patients lips and seeing which shade looks best. Some people's complexions can make overly whitened teeth look unaesthetic.

Shade selection can be trickier if a patient either has many different shaded teeth and I am picking a color of just one tooth. In that case I place different shade guides adjacent to the tooth being repaired to get a feeling for which shade looks best.

Some patients teeth require custom shade colors. There teeth do not match any existing shade guides or have maverick colors in them. Maverick colors exist in teeth that have non homogeneous shading . Instead the teeth have different zones of color, so a dentist or ceramicist will need to formulate a 'shade map' of a patients teeth , that details all the different colors that are present and need to be duplicated. In this case I also often take a close up photo a patients teeth that helps the ceramicist create appropriate shaded dental restorations.