Are some dental pains more difficult to diagnose than others?

Sometimes diagnosing the cause of a dental pain can be easy. This is especially true if an x-ray shows a problem and my clinical exam provides supporting evidence. If, for example, the dental radiograph shows a dark radioluscency at the end of a tooth that is bothering the patient then it is almost always means that the patient has a necrotic pulp and will require a root canal.

Unfortunately it is not always so easy. Often patients complaints are vague ,radiographic and clinical findings are not clear, and not all pain is easy to replicate while a patient is in the chair. Sometimes a number of tests and challenges need to be performed and a series of questions need to be asked, in order to come up with an accurate diagnosis.

Complicating the matter is that pain can originate from a number of non tooth related conditions, including heart problems, neuralgia, sinus problems, and muscular pain(associated with TMD). Often if I am not sure which tooth is causing a patent's discomfort I suggest 'watchful waiting' . I am operating under the assumption that either the pain will go away or if not, then a symptom will develop that will make my diagnosis more certain. A tooth that wasn't sensitive to percussion may become so, or the patient may develop a swelling(often the case with dental infections) or new radiographs will better suggest the nature of the problem.

There are times when after I have thoroughly checked out a patient I am not certain of which tooth is causing the pain or even if I have pinpointed the particular tooth, I am not certain as to why it is hurting. Clearly if I am not certain of my diagnosis (if any ) is the problem, then waiting can sometimes be the best option, since treating a particular tooth can be very discouraging to both the patient and their dentist , if their symptoms turn out to be caused by a different tooth.

Is it a good time to do a spring cleaning of your mouth?

People can get the winter 'blahs' during the winter season in the northeast. Once the nicer weather comes many people seem to have more energy and more of an inclination to take care of their homes as well as well as themselves.

While airing out your house or apartment is often involved with our home spring cleaning efforts, It turns out that airing out your mouth is important as well. When people forgo having their teeth cleaned the number of anaerobic bacteria in plaque tends to increase and these potentially harmful bacteria are thought to be instrumental in the development of periodontal disease.

If you or someone you care about has put off going to the dentist for a cleaning, now might be a good time to go. Do not be embarrassed if it's overdue, JUST DO IT! Most dentists or hygienists are used to seeing patients after extended absences and if they are smart will not deal out a heavy dose of guilt (maybe just a little , but that is part of our job).

Some patients put off seeing the dentist after a long absence because they are afraid of what the dentist may find. Often they are pleasantly surprised. Even if some problems do turn up, it is better to know about them before they start hurting and are often harder to fix!

Is it possible to over whiten your teeth?

Yes it is. The degree of whitening desirable probably depends on a persons complexion. Often patients with pale skin color look great with super white teeth, but when they have too much red pigment in their skin, very white teeth can look strange and unnatural.

Before whitening begins, I often hold a shade guide up to my patients skin and see what shades look good. For some a B-1 shade is too white. Some patients look better with a slightly darker shade such as a A-1 or A-2 or even a D-2 shade.

When patients do bleach their teeth , the dentist does not have complete control of the degree of whitening, but it is advisable to check what shades look good against their skin, prior to beginning the whitening.

Why is dentistry so expensive?

Although dentistry can be treated like a commodity just like any other, it is an art and not a science. Many dentists do things differently and invariably some offer better results than others. Often in dentistry as in life, it not what you do that’s important, it’s how you do it! An excellent filling is better than a poorly fitted crown.

Fees are of intense interest to many people shopping for a dentist and often patients seem to be seeking affordable dentistry. This is all well and good, but usually it is wise when seeking ‘bids’ to stay away from the lowest bidder (unless you’re our government?)

As one of my wise dental assistants once pointed out ‘You can’t get to heaven without dying”. Similarly where dentistry is concerned good work takes time and usually has a fee that properly reimburses a dentist.

How do you stay current in dentistry?

Having been a practicing dentist for thirty years, I can attest that dentistry is constantly changing and often improving in its techniques. If I practiced dentistry the way I was taught in 1980 and had not evolved in my techniques, I would not be a very good dentist!

Continuing Education courses play a large part in helping a dentist stay current. At the moment, New York State requires that every three years a dentist complete 60 hours in dental continuing education. Some courses such as CPR, and Infection Control are required but other courses are probably equally important for a dentist's skills to remain sharp and upto date.

Currently I am taking a 'dry' online course named "Differential Diagnosis of Soft Tissue Lesions". It is hard slogging but it is a worth while course and is sponsored by dentalcare.com (Crest/Oral B). Last Friday I attended an interesting course entitled"Surgical and Non Surgical Periodontic, An Interpretation of the State of the Art 2010. The Lecturer, Dr James B. Fine , a periodontist and an associate dean at Columbia, gave an informative and thought provoking presentation.

The Invisalign Study Club

Last night Metro Dentist New York sponsored the first meeting of the New York Invisalign Club. Ongoing and completed cases were discussed and our next meeting was scheduled for the last Thursday in March. These meetings will be open to all dentists with an interest in Invisalign. Although they are not sponsored by or officially connected with Align Technology, they are intended to help interested New York Dentists develop a better understanding of this emerging method of tooth movement.

Attendance will be limited to the first ten dentists who RSVP each month and if you are interested in either attending or finding out more information please email Metro Dentist New York at nymetrodentist@gmail.com

Which do you prefer, an electric or an air turbine drill?

Actually I use both. I started using an electric drill about 5 years ago and found that it is great for preparing teeth for crowns. It cuts faster, with less noise, more torque and less vibrations. My patients seem to prefer it to noisier air turbine drills and they say they fell less vibration. The vibration from an air turbine is produced by what dentist's refer to as "chatter". Most air turbines are floating inside a drill and actually move microscopically back and force while spinning. This translate to some vibration when these drill are cutting.

I believe the electric drill,due to their lack of chatter, cut not only faster but also more precisely than air turbine hand pieces. On the down side, they are heavier, and can be especially tiring for dentists used to the lighter air turbine hand pieces. Also they require patients to open their mouths slightly wider to accommodate the the larger head of the hand piece. This can sometimes be a problem when working on a back tooth.

I tend to use air turbines for work requiring a more delicate touch. I find that When using my air turbine, I can use my finger muscles to better guide the fine motions of this drill.

Consequently, I make use of both of these types of drills on a regular basis. Thier combined use tends to allow me maximaum flexibility and I think produces a better over all result.