Did you get the swine flu vaccine?

Yes, I did. Since I am a dentist practicing in NYC, I thought I should. I tried to get it from my physician, but his office had none, but his nurse suggested I can the New York City Department of Health. I called them and they directed me to a New York City Department of Health Clinic and I was given the vaccine free of charge at the clinic. The Department of Health can be reached by telephone and they also maintain an excellent website chockful of information at http://www.nyc.gov/html/doh/html/home/home.shtml

They have a page on the site that is particularly helpful if you want to find a local clinic where you can get a flu vaccine, either seasonal or H1N1. You can visit it at http://a816-healthpsi.nyc.gov/DispensingSiteLocator/mainView.do

I received the vaccine 24 hours ago and have suffered no ill effects. Aside from having to wait a couple of hours to get inoculated, it was a pleasant experience and would recommend it to anyone seeking the vaccine.

What should I do about a denture sore?

Many denture wearers occasionally experience a denture sore. These usually result from trauma to the tissue adjacent or under a denture. If they occur in associaltion with a newly made denture than often the problem is that the denture is over extended, has a presssure spot or has a poorly adjusted occlusion.

All of these issues can be diagnosed by a dentist and a new denture wearer experiencing a sore should return for a denture adjustment. Dentists are usaully able to adjust a denture to eliminate a sore although sometimes it may take more than one adjustment visit.

If a patient with an older denture experiences a sore they also should visit their dentist so that the cause can be diagnosed. Dentures can settle over time and new pressure spots can develop. Also tarter can accumulate inside a denture that can result in a new pressure spot. Loose dentures can move in function and result in tissure trauma as well.

If for some reason a denture wearer can not get to dentist, and they do have a sore spot, not wearing their denture will usually allow their sore to heal within a week or so. Some sores do not rapidly heal and if a patient has a sore for more than two weeks that does not heal when they refrain from wearing their denture, then they should see a dentist, who may advise a biopsy to rule out a malignancy or some other condition.

I have a little red bump on the gum next to the bottom of my tooth. What is it?

Although there are a number of possible causes of red bumps on the gums, most often when a patient asks this question, the patient usually has one of several diagnoses.

One possibility is that the patient has an abcess and it has cause the swelling. If there is a fistula present that is allowing the infection to drain the area around the fistula often looks like red bump,

Another possibilty is that a patient has herpetic ulcer(s) which can first present as multiple tiny red bumps on the gingiva adjacent to teeth, After a short period these 'blisters' burst and leave small ulcers that go away within two week.

Still another possibility is an aphthous ulcer. Aphthous ulcers usually don't look like bumps, but present as ulcers on the mucosa and not the gingiva but can look red and be described by patients as being at the bottom of a tooth. Although these can be painful, they do go away in two weeks and require no treatment.

Of course, if you do discover a red bump at the base of a tooth it is a good idea to point it out to your dentist at your next dental check up and let him or her provide an accurate diagnosis!

Is there a connection between becoming forgetful and gum disease?

Maybe yes, at least according to a study conducted at Columbia College of Physicians and Surgeons in New York. The study, as reported in the Journal of Neurology,Neurosurgery and Psychiatry, found that Periodontitis is associated with cognitive impairment in older adults.

The study found that participants with the highest serum levels of antibodies for Porphyromonas gingivalis (a pathogen causally associated with periodontitis) had significantly greater odds of impaired verbal memory and subtraction test performance.

In their study's introduction the authors pointed out that there is epidemilogical evidentce supporting an association between stroke, accelerated aortic atherogenesis and and serum antibody measures to P gingivalis.

The authors also pointed out that "Risk factors for stroke and dementia, including diabetes, obesity and smoking, have a similar systemic inflammatory profile to periodontitis and suggest that they could play similar roles in a final common pathway of atherogenesis related to systemic inflammation"

I myself have noticed that some of my more 'forgetful' senior citizen patients do seem to have more plaque and periodontal disease symptoms , but I always assumed it was because they were being more neglectful of their home care at home. I assumed that it was their cognitive impairment that was causing their gum problems and not the other way around.

What causes sensitivity in crowned teeth?

Traditionally dentists have believed that this sensitivity stemmed from cracks in the teeth, previously injured pulps, and dying pulps. Some 'traditional cements' have been known to occasionally cause a pulpitis when they were used for cementation ( Zinc phosphate and glass inomer cements). This type of cement induced sensitivity occurs immediately after a crown has been cemented and the symptoms are predominately sensitivity to cold liquids. This sensitivity often goes away with time. In my experience it can take up to a year to resolve, but occasionally a tooth may require a root canal in order to resolve the problem of this cement induced sensitivity.


Recently new resin based cements have become popular with many dentists and they may be to be causing a whole new category of sensitivity. Although they can cause traditional type of cement sensitivity, most times they do not. They have the advantage of actually 'bonding' to the tooth. Supposedly, this is an advantage, but the problem in my mind is that under chewing pressure and function this bond may fail. If that happens, the crowns often do stay in place, but probably become leaky. This leakage can cause sensitivity and can cause sensitivity to biting as well, since under pressure the crowns may flex very slightly against the tooth.

I do use some of the newer resin based cements and I have experienced some patients who have complained of this newer form of 'delayed sensitivity'. Recently I tried an experiment. I had a patient who was complaining of sensitivity every time she drank cold. Her crown was cemented with a resin based glass ionomer cement and seemed well fitted and well cemented.

I removed the crown and fabricated a traditional acrylic temporary cemented with a eugonal based temporary cement and her symptoms immediately disappeared. Although this a sample size of only one, I wonder how many other patients are experiencing the same problem?

What is the difference between an onlay and a filling?

An onlay is an restoration that is made in a dental laboratory that is designed to protect a tooth that whoose tooth structure has been compromised by decay or by the preparation made for prior fillings. Usually onlays cover the chewing surface of the tooth including the cusps . The design of an onlay can protect a tooth and make it less likely to suffer a future fracture. When designing an onlay, a dentist must create enough clearance between the tooth being restored and the opposing arch. The ideal amount of reduction of the occlusal reduction is approximately 1.5 -2mm,; enough thickness to allow for a durable restoration. When designing the onlay preparation a dentist should remove any prior tooth structure as well and often onlays can become partial coverage crowns. They differ from crowns in that more tooth structure is left intact on a tooths buccal and lingual surfaces.

It used to be that onlays were a two sitting procedure, but now with the advent of cad cam technology, it is possible for a 'high tech' dentist to prepare and place an onlay in one sitting. This technology is expensive and most dentists have not yet invested in purchasing an on site cad cam milling machine.

Onlays can be cemented in with a number of different types of dental cements. At present most ceramic or composite onlays are 'bonded in' with a composite resin cement. When cementing in gold onlays dentist have a wide variety of possible cements to choose from. I personally use old fashioned, but tried and true dental cements that are resin free.

Fillings, on the other hand, are usually inserted directly in the tooth during one sitting. They are not made on a bench or in a cad cam milling machine, but placed in the mouth by the dentist. They can be made from a variety of materials, including amalgam, composite, glass ionomer, and even gold. With care, they can also be used to onlay and protect cusps, but because of the difficulty in placing well made large multi surface fillings, usually laboratory onlays or crowns are a better choice for a dentist to use when restoring a tooth with compromised tooth structure.