Should I cut down on dental cleanings to save money?

Prevention is the best medicine and in the case of frequent recall, whether it is reimbursed by dental insurance or not, it will most likely save patients money in the long run, by preventing problems and allowing dentists to discover any problems that develop at an early stage.

Obviously if someones can not afford dental treatment due to a financial setback, cutting back on cleanings, to lets say once per year, may make short term sense,
but on a long term basis it will likely result in dental and health problems that may be harder to fix and more costly as well.

In difficult times each of us has to make hard decisions on how to tighten our belts in order to conserve money, but some choices like putting off the payment of taxes, fixing the brakes on our cars or taking care of dental problems can lead to greater hardships later.

How is your dental practice doing in the recession?

Lets face it 2009 was a tough year even for dentists!

This has been the most severe recession I have ever experienced. Somewhere around ten percent of my patients have lost jobs in the last 18 months. Not surprisingly,
patients have been procrastinating about scheduling appointments and have been coming in for cleanings less frequently.

Their reticence about scheduling appointments is understandable, since people have become increasingly concerned with conserving money. When I ask in passing about what they have done during their vacations, many comment that they 'stayed close to home'.

My practice has been holding its own. In 2009 our billings were only off about 2% from the previous year, which is positive news, considering the economic slump
New York and the rest of the country has suffered.

This steadiness in my practice is particularly surprising since it is my impression that patients have been putting off committing to expensive treatment plans(understandably) and most of the procedures I have been doing for patients have been based on patients immediate dental needs(repairing broken and decayed teeth) and not elective cosmetic dentistry.

If I was asked to account for how well my practice is doing under the circumstances, I would have to answer that it is probably due in part to the loyalty of my patients and their perceived value of the dental services that our office provides them. Also my website and my blog continue to attract new patients and these help in part to offset some of effects of our economic downturn.

I was told I have a large cavity and would need an Inlay or a Crown. Which is better?

When a patient requires a large restoration on a tooth, often the remaining tooth structure may be compromised and best protected by a crown or an onlay/inlay. That being said, not all multiple surface restorations require this protection. If the filling is not too broad your tooth may only require a filling.

Onlays and Crowns both offer significant protection from the forces involved with chewing. Probably crowns are the more predictable restoration and may be more long lasting, but they require more tooth preparation, Onlays are a more conservative restoration when one considers the amount of tooth preparation involved.

Old fashioned gold onlay restorations have traditionally been a favorite choice of dentists, but now they have been replaced by more cosmetic white bonded inlay and onlay restorations. No one really knows how many actual years of service these will provide as compared with more traditional crowns.

Are Implants a predictable way to replace teeth that have been lost?

Implant tooth replacements are becoming the standard of care in dentistry. Assuming that a patient is a good candidate for one then they are the best tooth replacement option.

Their major drawback is an initial high cost, but over the long run this initial investment can be offset by their length of service. When implants and implant crowns are well done, they last predictably for many years.

Implants often do require more pre-operative planning and if an implant is desired, extractions are often accompanied by bone grafting procedures. Bone grafting helps insure that the future implant site will have sufficient thickness for an ideal sized implant fixture.

How soon after a tooth is extracted should it be replaced with an implant?

Obviously,if its front tooth, some sort of replacement has to be made right away. The first replacement is usually temporary in nature, either a temporary bridge or a temporary one tooth denture(nesbit or flipper). If it is a back tooth that is extracted often initially no replacement is required immediately post extraction.

These days many extractions receive bone grafting at the time of the the procedure. This grafting material is intended to stimulate bone re-growth and will tend to preserve the bone in the socket afterwards.

Implant replacement teeth are the most ideal type of replacement assuming a patient is a good candidate for one. Although some extraction sites receive immediate implants on the day of an extraction, most do not. Most of the specialists that I refer to seem to feel that the ideal time for placement after an extraction with bone grafting is three to four months. They feel that after three months the bone grafting material is being actively replaced with new bone and this 'active new bone' is ideal to receive an implant.

Of course implants can and do successfully get placed after more time has elapsed, but after an extraction, the bone tends to continue resorbing for the first year or two. The result of waiting too long can be a site that becomes too narrow to place an ideal sized implant.

What do you do on Fridays?

Friday is an administrative day for my office. Many people think that dentists play golf on their day off, but most dentists use part of a week day in which patients are not booked to catch up on things they were not able to do while treating patients.

Reading and responding to mail,Case planning,attending continuing education courses, ditching dies, returning calls, cleaning my desk and dealing with clerical matters, are all things that I do on Fridays. Occasionally have to treat a dental emergency and I sometimes work on my website or this blog on 'my day off'.

Although I confess, I sometimes take care of personal errands during this time , I never play golf on Fridays!

What did you do over your holiday?

I spent part of my vacation staying at a friends house in Delray, Florida. While there my son ans I did an informal tour of the beaches on the florida's gold coast in search of the best beaches for body surfing. It turns out that the beach in Delray was our favorite!

We also spent New Years Eve visiting with one of my favorite former dental students, Dr Jay Schuster. Jay was one of my best dental students, but It turns out that he has become a fine dentist in his own right and was named a Top Dentist in New Jersey, by New Jersey Monthly in 2009!
He showed us around Jupiter( The town where many golf celebrities live including Tiger Woods) and then we spent New Years Eve celebrating at one of his favorite haunts.



We spent New Years day at Orlando's Sea World and caught some of the marine shows that they have there. As one of my friends pointed out, it was a very touristy thing to do, but both my son and I enjoyed our time at Sea World.