What should I do if my front teeth are chipping?

This can be problem for patients who have worn off the enamel covering the edges of the anterior teeth. Once the dentin is exposed, small pieces of enamel seem more likely to peel off from the tooth. Chipped edges can often be easily fixed, using bonded tooth colored composite, and when properly done the repair provides a natural looking result. Afterwards, I often recommend a night guard to prevent extra wear and chipping that can happen at night. Once a night guard is worn, often patients notice less of a tendency to develop chips on their front teeth and repairs tend to last longer as well.

Porcelain veneers are another technique commonly used to fixed chipped and worn edges of anterior teeth, but they usually require some tooth preparation and are a far more costly alternative. Porcelain Veneers have another drawback. They are usually placed over the edges of anterior teeth and contact with the porcelain tends to accelerate wear on opposing teeth. Composite placed tends to wear and not wear out the opposing dentition.

Do you place implants?

This is a question that I am often asked. The answer is that no implants are placed in my practice. Instead I work closely with implant surgeons to achieve consistently excellent results. My surgeon will do any needed surgical treatments, including any needed extractions, bone grafting and the placement of the implant(s). My part is to fabricate needed provisional restorations, take records needed to fabricate custom implant abutments and final implant crown(s).

Although it has become popular for general dentists to incorporate the placement of implants into their practices, I feel its best for my patients if I choose a fine implant surgeon for their implant placement. My surgeons tend to place many implants each year and their experience tends to allow them to achieve a high success rate and also makes it possible for me to achieve excellent esthetic results.

Why don't you have a video on your dental website?

This is a very topical question since I just made a video last week and the rough cut is featured on my videographers website. I must say that it is hard for a neophyte to talk into a camera extemporaneously, but it came out pretty good. I think the secret is in the editing.

My friend Steve Cooney brought his equipment to my office and took some video shots and somehow made a coherent video out of his clips. My hat is definitely off to him! He did the filming during one of the busier days at my office and I think he got some good footage. To see a copy of his video please visit his website One Man Band

He still may make some minor changes and once we get the video finalized it will be posted on my dental office website: http://www.lspindeldds.com . The video seems to do a good job of capturing the "flavor" of my dental office and should give potential new patients a realistic preview of my dental practice.

What does it mean if one of my teeth has turned dark?

This is a question that is asked rather frequently. The answer is simple. If a tooth looks darker than the adjacent teeth it may mean that there is a problem with the pulp. Although sometimes it means that the pulp has receded, other times it is can mean that the pulp inside has become necrotic and the tooth will require an endodontic procedure.

Two quick tests will help a dentist decide why the tooth has become darker. The first thing for a dentist to do is to take a periapical radiograph and look for a dark area in the bone adjacent to the apex of the tooth. If it is present, and a tooth is noticeably darker than its neighbors, it almost always means that the pulp has become non vital.

The second test is an ice cube challenge. Although this test is not infallible, it can confirm that a tooth remains vital or not. If a patient can 'feel' the sensation of cold when the ice is placed on the tooth, than it usually indicates a vital pulp.

Of course some patients can respond to the cold felt solely on their gingiva. They can give a false positive, but after repeated testing of a tooth and its neighbors, patients tend to give a dependable response.

Some teeth with extremely receded pulps can give a false negative, since the pulp has relocated so far down the root that it can't feel the ice probe when placed on a tooth's clinical crown. In that case the periapical X-ray takes precedence in making a judgement.

Are there times when composite should not be used for a filling ?

For patients with high rates of decay along the gum line, composite fillings are often not the best choice. Some patients have a greater tendency to develop decay on teeth near the gum lines than normal. Some of these patients suffer from dry mouth,poor oral hygiene, poor diet,acid reflux, bulimia or even a combination of these conditions.

For these patients I usually choose a restorative material that release a relatively high rate of fluoride over time and can cause a zone of "caries inhibition". This term implies that the tooth immediately adjacent to the filling is offered some additional protection from developing recurrent decay. Composite restorations, even when they contain fluoride do not offer this additional protection.

If I am treating a senior citizen and I working on a tooth in a non aesthetic zone I often choose a material by GC, termed Miracle Mix. It is an interesting material that combines glass ionomer cement with the metal fillings from amalgam(sans mercury of course) and can work well in restoring moderate size cavities adjacent to gingival areas. Apparently this material does offer protection for these patients and I have witnessed a decrease in recurrent decay on the teeth that have been restored with it.

Another material that I often use for teeth at high risk for recurrent decay is Vitremer restorative material by 3M. This material is tooth colored, offers high fluoride release and can be used in aesthetic areas and also offers the patient some caries protection.

A disadvantage of both of these materials is that the are not as tough as composite or amalgam materials. Since they tend to be on the brittle side, they can be accidentally gouged out by a hygienist who is unaware of their presence or are more likely to crack when they are placed in an area of the tooth that is in occlusion.

Do you treat children?

Although most of our patients are adults, children are welcome! This cute little guy was at my office this week. At first he was suspicious, but by the time his visit was over he didn't want to leave. He kept patting the chair and asking his mom to stay!

I often recommend patients bring a young child for their first visit while their mom is getting her teeth cleaned. Ida my office manager and Larisa, my assitant, love children and often watch the kids, while I clean mom's teeth. Sooner or later the child can not resist and comes into the room to see mom.

Most often they choose to take their own ride in the "Magic chair" and are delighted to meet 'Mr thirsty'(he's always thirsty!}, and his big brother 'super thirsty'. I ask them to roar like a lion and sometimes I even get to count their teeth. The point is to make their first visit fun and to insure that they develop a positive relationship with dentistry at an early age.